5/25 update on Zytiga failed

[alperk]

To review, after 19 months on Lupron, Zytiga, prednisone, PSA increased on 1/23 to 0.253, then 0.309 on 2/21. Plarify scan showed only one active site in hip which was radiated. 4/4 PSA dropped to 0.24 which indicated the lesion was knocked out and I would be hormone sensitive and stay on Zytiga. Yea ! HOWEVER, 5/23 PSA went UP to 0.343. Now what? Am I now hormone resistant? Is Xtandi the next step ? Am I overreacting and should wait a couple of months for the next blood test. I would appreciate any thoughts from all of you.

[Tall_Allen]

Try switching to dexamethasone:

bjui-journals.onlinelibrary...

[SeosamhM in reply to Tall_Allen]

Since it worked for me, I obviously agree. This study came out in 2018... so, oh-informed-one, do you have any insight why this simple option seems to be routinely missed - or dismissed - by treatment specialists?

[Tall_Allen in reply to SeosamhM]

A friend just had it suggested by his oncologist last week. I don't know how prevalent it is. Some oncologists stay informed more than others.

[rsgdmd in reply to Tall_Allen]

My MO had me try that, but my PSA continued to rise. Next step is one of the ...lutemides.

[Tall_Allen in reply to rsgdmd]

I hope you mean enzalutamide and not bicalutamide.

[rsgdmd in reply to Tall_Allen]

Yea, enzalutemide, apalutemide or daralutemide.

[Tall_Allen in reply to rsgdmd]

Only enzalutamide is approved for mCRPC, although I've seen patients get the others from agreeable insurance companies.

[rsgdmd in reply to Tall_Allen]

I've heard that....will see. Nubequa seems to have less SE than the other two.

[Tall_Allen in reply to rsgdmd]

I'm not sure of that, also don't know which is most effective of those 3. NRG Oncology seems to prefer apalutamide. Enzalutamide has the longest history of use. Docetaxel seems to help it work longer.

[Iloveyoudad in reply to Tall_Allen]

Hi Sir, any thoughts on Abiraterone? My dad is currently taking Bicalutamide together with Leuprorelin. If Bicalutamide isn’t working anymore, dad needs to shift to either Xtandi or Zytiga according to urologist. Both are very expensive in my country and at the moment, dad couldn’t decide what options to take as sustainability of either is our optimum concern. Thank you

[Tall_Allen in reply to Iloveyoudad]

abiraterone is available as a generic.

[TEBozo in reply to rsgdmd]

Nubeqa is where I'm heading, I'm afraid.

[TEBozo]

Mono therapy with Xtandi or Nubeqa?

[Tall_Allen in reply to TEBozo]

Always with ADT, except in clinical trials.