Hi all! I'll begin by thanking everyone on this site for the invaluable information I've found here. I'm Gleason 9, very high risk, localized pca. In Jan/Feb I rec'd 5 treatments of SBRT and have been on Lupron and Abiraterone/prednisone for the past 7 months. Just had labs done, and psa is at 0.1. The concern that I have is that my ALT and AST levels were elevated from what they were before I began ADT. After checking online, it appears that a "mild elevation" is considered to be 2-3 times higher than normal. Mine aren't that high...yet. I'm also taking a statin and flowmax. Is it typical for these liver enzyme levels to go up while on adt, and is this something that I should talk to my mo about? I realize that it's possible that the statin could be causing this rise too. Just wanted to check to see if others have experiences this while on adt. Thanks again!
ALT and AST levels: Hi all! I'll begin... - Advanced Prostate...
ALT and AST levels
Quarky -- please if you can put case details in your bio. As for your blood #'s, your MO should be putting them into context. As an apparent newb to APCa, exercise is virtually mandatory. Lots of exercise, multiple types. Aerobics, resistance, and cardio. Done several days a week (if not daily), is said to reduce the odds of PCa morbidity a lot (up to 70%.) If you have limitations many say to find a cancer-aware trainer. Your oncology department may help with that.
If you are on ADT for any length of time (the first year is the worst) sarcopenia and BMD loss are potentially very big concerns. There are no tests for sarcopenia but exercise is almost sure to help. Both issues should be brought to your MO's attention. Especially if bone loss runs in your family or you are osteopenic already.
Thanks Derf. You've prompted me to fill in my bio which I kept putting off. Appreciate it. I do resistance exercise and eat well, and am generally healthy. Hot flashes are the worst ADT side effect I've experienced, but want to stay on top of potential liver problems. I can probably do better with the exercise. I like the trainer idea, but don't think Kaiser will cover that.
Here is an article from 2023 on hot flashes from ADT plus other quality of life side effects and possible solutions. I just copied the part about hot flashes but there is much more to the article.
ncbi.nlm.nih.gov/pmc/articl...
How to Improve the Quality of Life of Patients with Prostate Cancer Treated with Hormone Therapy?
Hot flashes are defined as an intense heat sensation, flushing and diaphoresis that usually involve the face and trunk, sometimes associated with anxiety and palpitations.24 They are one of the most frequent adverse events of ADT occurring in up to 80% of patients and it is reported as the most bothering from 27% of them.84
Hot flashes can be associated with sleep disturbance and may lead to a deterioration in quality of life.85 Moreover they may decrease compliance to ADT and are a major contributor to its discontinuation.24
Literature suggests that estrogen and androgen withdrawal disrupt the equilibrium of the neurotransmitters, norepinephrine and serotonin. This consequently affects the omeostatic mechanism in the thermoregulatory zone in the pre-optic zone of the hypothalamus.86 Antiandrogens have a significantly lower risk of hot flashes than LHRH agonists (<1% vs 45%) and intermittent ADT is associated with significantly better scores for hot flashes compared to continuous ADT (p<0.001).24,87
First in patients who report frequent hot flashes lifestyle modifications may be recommended, including avoidance of potential patient-identified triggers, commonly heat or spicy food88 (Table 1). In addition, several pharmacological hormonal and non-hormonal agents have been assessed in the treatment of hot flashes, however few evidences exist for their management.
In several small prospective studies, the use of diethylstilbestrol resulted in complete resolution of hot flashes in more than 70% of patients.86 A double-blind, randomized study showed a 75–80% reduction of hot flashes in patients treated with megestrol acetate versus placebo, but it is associated with an increase PC growth.89 Cyproterone acetate showed similar results without the risk of tumour progression.90
Gabapentin, used as an anticonvulsant and for treatment of neuropathic pain, was evaluated for the treatment of hot-flashes. In a randomized trial, 214 patients with PC treated with ADT were randomized to placebo, or gabapentin at the dosage of 300, 600 or 900 mg.91 There were reductions in hot flash scores by 22%, 23%, 32%, and 46%, respectively, without increased toxicity with gabapentin compared with placebo.91 Based on these data, gabapentin is a reasonable therapy to treat ADT-induced hot flashes with a starting dose at 300 mg daily augmentable up to 900 mg.
Venlafaxine, a serotonin-norepinephrine reuptake inhibitor used as antidepressant drug, was also tested in patients with PC with the aim of reducing hot flashes. In a randomized clinical trial in PC patients treated with ADT venlafaxine was compared to medroxyprogesterone acetate and cyproterone acetate and showed to reduce hot flashes of 47.2% although cyproterone and medroxyprogesterone obtained better results (−94.5% and −83.7% respectively).90
To mitigate the hot flashes in patients with PC treated with ADT, it has also been investigated the role of complementary medicine, such as the acupuncture. It leads to a decrease of hot flash symptoms by 89–95%, however, these results are not based on randomized clinical trials data.92 Finally, the use of intermittent ADT showed a reduction in hot flashes compared to continuous ADT (p<0.01).93
In the pivotal trials, the addition of ARPI to ADT appears to result in an increased incidence of hot flashes compared to ADT alone. In the AFFIRM16 and PREVAIL17 studies, 18–20% of patients treated with ADT + enzalutamide experienced hot flushes versus 8–10% of patients treated with ADT alone. In COU-AA-302 trial,15 patients experiencing hot flushes were 22% in the ADT + abiraterone group and 18% in the ADT alone group, respectively. Similar findings in the TITAN11 study where adding apalutamide to ADT resulted in an approximately 6% increase in hot flashes. On the other hand, darolutamide does not seem to increase the incidence of hot flushes: in the ARAMIS study,13 5.2% of patients in the darolutamide arm developed hot flushes versus 4.2% in the placebo group.
Thanks! That’s very helpful. I’ve started taking Gabapentin recently for hot flashes and found it to be quite helpful at first, reducing both the frequency and intensity. After several weeks it was less beneficial so I’ll try increasing the dosage from 300 to 600 mg. The article provides some other option's I can consider if Gabapentin eventually isn’t effective. Appreciate it!
Best to ‘do better with the exercise’ asap. It will be harder the longer you put this off. Also, although I can provide no data to prove it, I am convinced carrying less fat and regular cardiovascular and weight bearing exercise kept hot flashes to a minimum during my ADT course. I believe it can do that for anyone. It is also directly beneficial for everything else imaginable.
I tend to support this idea of exercise also. Getting up and moving also takes your mind off this cancer issue. If you have the option of getting out in nature it can also have a calming effect which can help.
The YMCA has a free 12 week exercise/educational program called Livestrong. Anyone in your household can also attend for free! If you have a YMCA nearby you might want to give them a call and see if they offer it. It’s for any type of cancer and it’s a coed program. My husband and I signed up and we’re enjoying it. Google Livestrong at ymca for more info.
No problem if not very elevated.
Thanks Allen. Will keep tracking it for additional increases.
I also take a statine and my ALT (11-18) , AST (18-23) levels have been within normal ranges for longer than 5 years now. I got some improvement in numbers when started taking Milk Thiesle 4 years ago. Note that I wrote "some" so don't expect miracles.
One thing that lowered my ALT, AST back to normal was scaling down my supplements.
I’m currently just taking Calcium with d3 and k2 to reduce bone density loss. What did you stop taking?
Oh boy!! Lol! Let see, off the top of my head. You gonna love this. Pure Fenbendazole via dmso, honokiol, nano encapsulation sulated curcumin, ginger, andrographis, EGCG, quercitan, frankincense, berberine, silimarin,; serapeptase, I also did, and will do again is most of those nano particles orally with DMSO. I have also done the COC protocol with metformin, doxycycline, membendazole, forgot the third one.
All i take now is Orgovyx, darolutamide, cardarine, Osterine with senolytics every three days during my low T cycle of pBAT, and high T cycle I inject testosterone propianate 50mg every other day for two weeks and 150mg bid of Olaparib during high T cycle . I also do the vit D wK2 a few times a week during winter.
So basically i scaled down everything that causes high alt and ast. Right now every single cmp, and CBC w diff is right down the middle.
Sorry i got long winded and i know i missed a bunch of supplements lol
Hi, Gleason 9 localized PC. 25 EBRT then one round of brachytherapy in Sept. AUgust had 25 EBRT visits prior to brachytherapy. Was taking Casodex at the beginning before EBRT/Brachytherapy but then it was screwing around with my liver values and stopped. Have been taking pamorelin shots every 6 months with 2 more to go one more december then a year from now. Last product PSA not measurable .01 and testerone gone. Sucks to lose libido but life goes on. Diligent with training. Weight training daily with cardio training as well. intervals 2 times a week other days cross training or jogging. run about 50k per week....had this behavior before i was diagnosed as well..
Quarky, It may be anecdotal to me but ADT treatment did nothing to elevate my AST and ALT numbers when I was on Flomax. However, second time on ADT treatment, I had been placed on a Statin by my GP as a preventive measure. I did not have high cholesterol numbers. Statins with ADT raised by numbers and when I stopped Statin, they went back to normal. I eventually had cardiac tests to prove my arteries are clear and GP agreed to drop Statin.
You probably know those numbers max at 5 times normal. That's where I went. I paused abiraterone for about 7 weeks to let numbers return to normal. Restarted at 500mg dose and then went to 750mg. Never had another issue.
I have very similar Pca characteristics and received identical treatment from March-August in 2022. My AST & ALT remained normal throughout. I would suspect the statin. Perhaps a change in statin would help normalize. On a good note, I stopped my ADT at the 6 month mark - nearly 2 years later PSA remains between 0.06 and 0.08.
Great to hear about your low psa numbers! Will check with my pcp about the statin since I started taking it just before beginning ADT.
My husband was on Lupron and his alt and ast did not go up. He had an orchiectomy last August so no longer needs the Lupron. He is also taking abiraterone and prednisone. Once he started the abiraterone (approximately June 2023) his alt and ast went up. They have since come back down somewhat, but are still above the normal range.
Your doctor should be checking them every 2 or 3 months. My husband's doctor does labs every 2 months and isn't concerned with the elevated liver enzymes at this point.
Thanks. Will be talking with my mo next week about this but I suspect she'll say the same thing.
Abiraterone is known in some cases to have issues with the liver in some people. Your MO should be monitoring your blood #s but I would make it a point to ask him about them. It's always good to ask, and learn.
Had prostatectomy in Jan 2019...Gleason 10
I started ADT(abiratirone +prednisone+lupron) in July.
In Nov 2019 my ALT & AST got high and Doc cut abiratirone from 1000mg to 500mg.
Since then AST & ALT have been normal and PSA has remained <.01 plus the big T has been in the 20's most of the time. Check with your doc about Abiratirone dosage?
Thanks! Will do.
My ALT and AST went up when I started Abiraterone. It leveled then went down, never enough to make any changes.
Thanks!
One side effect of abiraterone is elevated ALT and AST, hence the drug mfg recommendation for frequent blood monitoring initially when treatment is begun. Abi elevated my ALT from the 20s to 650 and AST from the 20s to 250 within 6 weeks. Upon stopping the drug my levels returned to normal within approximately 2 months, and a rechallenge with the drug at one half dose immediately caused those levels to begin to elevate. Continued use would have damaged my liver, the drug was stopped permanently.
It would be wise to monitor your blood levels frequently going forward if you continue to take that drug.
Not a big problem if slightly elevated and most likely not related to ADT, would be something else.
Zytiga/Abiraterone made my AST/ALT skyrocket after a few months...over 5x recommended high ALT. When I stopped for a couple of months, ALT/AST went back to normal (eventually), when I re-started Abiraterone at 1/2 dose, the ALT/AST skyrocketed again...had to say no more. Interestingly, I saw no symptoms from high ALT/AST...felt perfectly normal.
Curious about what you moved to after stopping Abiraterone and how that's going?
Abiraterone was very effective in keeping my PSA and Testosterone low...so effective that my doctor said I could stop with injections (Firmagon/Lupron)...so when I stopped Abiraterone, I was on nothing for a few weeks and my PSA climbed slightly to .021. About 5 weeks ago I started back on Firmagon injections and Bicalutamide (aka Casodex). After 4 weeks the PSA stayed at .021...I have another blood test next week. I am also Gleason 9, spread to lymph nodes and a pelvic and rib bones...diagnosed in summer 2023. After 9 months since diagnosis, my recent PSMA scan showed no significant growth from last year. Still working my business full-time (I'm 63 and love what I do), but spending more time with my extended family than before. Life is pretty good under the circumstances. One note...my doctor wanted to prescribe Xtandi to replace the abiraterone, but he was okay with combining Firmagon and Casodex instead. Casodex is similar to Xtandi, but much less potent and fewer side effects. May the Lord bless you as you continue down this road of uncertainty.
Glad to hear that you're on a good path. All the best to you too.
Check out the protocols for the PATCH trial. If/when I am detectable again I think I might want to use estradiol patches as my treatment.
Not familiar with PATCH trial...do you have a link?
Exercise is a huge advantage in many ways; the link below might be helpful.
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ymca.org/what-we-do/healthy...
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all the best
Thanks chips! Unfortunately there isn't a Y near me, so I've had to rely on my own resources but always feel better after excercising.
I am also a member of the 'Abiretarone spiking AST and ALT' club......These counts went way up, and my platelets went way down......We tried stopping Abi for a few weeks, then restarting at a lower dose, and once the lower dose began, counts went wacky again....So we threw in the towel on Abiretarone on May 7...AST and ALT are at normal levels now....Next on the hit parade for me will be Apalutamide/Erleada, which supposedly does not have these side effects (it has many other side effects, though)...Best of luck to you !!!
Thanks Jazzman. I'm definitely going to be keeping an eye on my ast and alt levels over the next 3-6 months and see where they go. Good health to you!
AST / ALT ratio
Is there seasonality to testosterone levels?
After BCR and PSA Return: An Update on My Treatment Path
Zytiga + Statins + CRPC
Help.. confused and concerned daughter.. Sepsis.. PSA Levels fluctuating
