Is abiraterone failing? What's next

[Rafithussain]

I started abiraterone acetate 1000mg along with prednisolone from 25/2/22 that time psa level was 9.40 highest since 2018, psa decreased to 0.02 in feb,2023 now on 5 aug it has risen to 4.32, does it mean abiraterone did it's job and i need to stop this....

[Magnus1964]

That is a good sized jump. If it's up again next time, you may want to switch to Casodex or xtandi.

[Magnus1964]

I do not think you are castrate resistant.

[Nowhereman9]

Sorry to see that. That seems to be the average time to failure. 16-17 months.

[Tall_Allen]

Try switching from prednisone to dexamethasone before you give up on abiraterone. Discuss this with your oncologist:

pubmed.ncbi.nlm.nih.gov/300...

[SeosamhM]

"..does it mean abiraterone did it's job...." - A strong "maybe." Nowhereman9 is correct in his statistic cite. But remember that, while we chase PSA, it is only to keep ahead of our disease if we can - it does not confirm progression (and castrate resistance). You do need to talk with your MO, of course.

Three recommendations to make, Rafi:

1. Follow up on Tall Allen's suggestion, i.e., try switching from prednisone to dexamethasone. This extends abiraterone efficacy in about 50% of cases. It worked for me and gave me an additional 12+ months.

2. Time for a scan, in my opinion. Confirm or rule out castrate resistance.

3. Look into Provenge - a first generation immunotherapy.

What's next? It depends on your specific circumstances, but we are in an era of increasing choice of treatment and changing standard of care. Now is the time to educate yourself and ask questions of your MO!

Good luck. - Joe M.

[Rafithussain]

My mo is suggesting of taking xtandi 40mg 4 times a day... I used to take abiraterone acetate 1000mg along with 5 mg prednisolone.. If now I replace it with dexamethasone and continue abiraterone then what's is the dose of dexamethasone

[rsgdmd in reply to Rafithussain]

Dexamethasone is about 10X as potent as prednisone, so dose would be 0.5 mg. FWIW, I tried the switch to dex and didn't help.

[kaptank in reply to Rafithussain]

Taking enza after abi has failed is not a good sequence. The enza will not fulfil its potential because abi resistance is partly also enza resistance. Better to have something in between them that cuts down the resistance. Such as docetaxel. Then enza often works better and/or abi may even be good again.

I agree with others: the switch to dexa is the obvious next step.

[Islandboy2021]

I tried Abiraterone and it only worked a few months for me. I switched to dexamethasone but it didn’t work either. You should try switching it could work for you.