8/4/2023 Update

[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 and 8/4/23 now 1.46 at my PCP physical. Have MO appt 8/16 which includes another PSA check but looks to me like another PET scan and/or Xtandi. I would appreciate any thoughts from all of you to better prepare me for my 8/16 appt.

[Ahk1]

I am NOT expert on any of this but my observation about MDT from so many patients on here indicates that once you radiate, in the beginning, the psa goes down then new Mets appear someplace else and psa starts to rise. I have no explanation for this nor I have trials but I noticed that. I am not sure why is that. It’s just an observation and hope the experienced folks can elaborate on this. Obviously I could be be very wrong.

[RyderLake2]

Hello,

There have been many posts over the years that have indicated switching from Zytiga to Xtandi or vice versa only works for a short time. The two drugs have different mechanisms of action and, from what I have read, Xtandi (enzalutamide) is considered slightly better than Zytiga (abiraterone) at treating metastatic-castration-resistant prostate cancer. After five years on Xtandi, I was switched to Zytiga as part of a clinical trial. I never expected Zytiga plus Prednisone to last very long but I am approaching a year on Zytiga and touch wood it is keeping my PSA reasonably low. It was 1.2 in July. My experience goes to show everyone is different and nothing is for sure. Good luck!

[TEXAS_dan2022 in reply to RyderLake2]

My MO suggested that I try Xtandi a few years back but when I saw the cost of it, I had to decline and stayed on Zytiga. My copay on the Xtandi would have been over $1500 per month, my Zytiga costs me only $ 163 a month. Just wondering how much you were paying for the Xtandi if you don't mind sharing. Glad your PSA is stabilized!

[RyderLake2 in reply to TEXAS_dan2022]

Hello,

I live in Canada and the Cancer Agency and our provincial medical plan pays for drugs like Xtandi and Zytiga.

[TEXAS_dan2022 in reply to RyderLake2]

WOW! That is a great benefit. Have you had to have any surgeries? I have heard that it takes a long time to get scheduled to get any cancer or cardio surgery in Canada

[RyderLake2 in reply to TEXAS_dan2022]

Hello,

I had back surgery where I had to wait a month. Our medical system is not the best in the world but it is far from being the worst, and far better than not having a medical plan at all. Nobody in Canada has lost their house because of exorbitant medical costs.

[alperk in reply to TEXAS_dan2022]

I get drug coverage thru The Assistant Fund (TAF). Zero cost. Did your MO want the switch because Zytiga failed. Hopefully it is still working. I have MO appt next week and may face that choice.

[TEXAS_dan2022 in reply to alperk]

The reasoning was that my PSA had started to slowly creep up with the Zytiga and a Clinical Study was starting up using Xtandi and the doctors wanted me to join the group. The problem was that I would have to pay for the medication. Not sure why but that is how I found out about the cost of Xtandi. I am still on Zytiga and it is working still.

[Tall_Allen]

It sounds like it's time to bring out the bigger guns- and fortunately, there are several to choose from and possibly combine: Taxotere, Xtandi, Xofigo, and Provenge.

prostatecancer.news/2021/02...

[alperk in reply to Tall_Allen]

What about another scan and radiation (whack a mole)

[Tall_Allen in reply to alperk]

The efficacy of that is unknown. The efficacy of those medicines is well known.

[CocoTheAlphaCat in reply to Tall_Allen]

Another option might be keeping the Zytiga but replacing the prednisone with dexamethazone. That's a switch that's been mentioned to me in a low-but-slowrising PSA situation.

[Nowhereman9]

Sorry to hear that. I just started on Lipton and abiraterone and steroid. Good luck. Pluvical?

[Ramp7]

Two years ago, I was in the same boat. I enrolled in a trial study at Dana Farber, LuPSMA177. I responded but it was not durable. Met with Sam Denmeade at Johns Hopkins regarding BAT. He thought I would be a good responder. I am. Presently on a BAT protocol, improved QOL and cancer is stable. urotoday.com/video-lectures...

[Magnus1964]

Switching to xtandi or Casodex might be a good move.

[NecessarilySo]

My belief is that tumors can grow arms like an octopus and so a precise radiation treatment might eliminate the body of the tumor but then the arms grow. Your PSA then grows in proportion to the size of the new tumors.

[j-o-h-n in reply to NecessarilySo]

youtube.com/watch?v=LCRZZC-...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 08/05/2023 1:38 PM DST

[chips1942 in reply to NecessarilySo]

After many treatments & scans etc, my belief is scans are virtually no risk and inform us of the location of our PCa. Multiple locations indicate systemic treatment few locations suggest local treatment (radiation, surgery etc.). A top GU oncologist can help you pick a successful path.

[ishitasen]

I would agree with your medical oncologist, since there is increasing PSA levels, a PET scan will help in detecting the new site of disease if any and if it found to be positive then treatment can be planned accordingly.