how does one decide if to go with zytiga or xtandi ?
I read xtandi can cause falls and that sounds scary !
Are both equally effective ?
Are there any comparitive studies
zytiga or xtandi ? Which to choose - Advanced Prostate...
zytiga or xtandi ? Which to choose
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Tinkudi
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Hello,
Pepsi or Coke? Each one has its adherents and detractors. With Xtandi (enzalutamide) you don’t have to take Prednisone.
I'm 2 weeks away from 4 years on Xtandi (Enzalutamide). No falls yet.
There is some research that doing Zytiga (Abiraterone) first, you can then switch to Xtandi later.
Everyone responds differently. You can Google for comparisons. There is very little difference. If I was starting now I would ask for Darolutamide (Erleada) the newest 2nd generation hormone treatment.
Did you take the full 160 mg xtandi dose from the start
There are no comparative studies. But abiraterone->enzalutamide works (in terms of preventing PSA progression) longer than enzalutamide->abiraterone.
thelancet.com/journals/lano...
Thanks a lot Allen 😊
Allen , this article says for castrate resistant men ?
Allen. , Would this study apply to castrate sensitive men too ??
It's the best evidence we have.
Here are some articles that might be of interest:
urotoday.com/conference-hig...
jamanetwork.com/journals/ja...
onclive.com/view/real-world...
ascopubs.org/doi/abs/10.120...
Thanks a lot
I read the same thing that TA posted which is why I was pissed when my dad was put on Xtandi first due to Zytiga requiring a steroid. My dad has glaucoma and is blind in one eye and steroids are not good for it, but it beats dying from cancer. I was furious with my dad as his MO ordered Zytiga first and the oncologist pharmacist switched it.
Sorry to hear this. What’s a oncologist pharmacist ? How did he change what the doctor wrote
She talks to him monthly by phone..she is a pharmacist that specializes in oncology. She orders blood work and other tests too. I have never met her.
My understanding is that this healthcare situation is with the American "VA" - this is the "Veterans Administration", for US military veterans. It's a huge government institution and runs by its own rules. And there are always issues. And of course "he who pays the piper calls the tune".
I was on Xtandi for 6 years u til it stopped being effective. No falls.. but fatigue ( really noticed it after I stopped) and pain in lower back. But it was worth the ride.
thanks. Did you have any other side effects. Have you been on zytiga too ?
No other SE's . And no Zytiga either. I started with the recommended dosage of 160 mgr. But after a few months it was determined by study that 120 mgr is just as effective , so that's what I used till the end. Costwise it made no difference to me as all was covered by our healthcare insurance here in the Netherlands. Actually for teh past 9 years besides my premium of about 1400 euro per year, no extras ! Scans, chemo's , radiation etc : all covered. It sucks having cancer but it’s great not having to worry about the cost of all the treatments .
Thanks. Do you have a link to study saying 120 was as effective ?
No , I don’t. A doctor in the University Hospital of Nijmegen told me while I was there for a consult . She was definitely right because after lowering the dosage it kept my psa down for about 5 more years.
What was your initial diagnosis
Psa > 2000 , Gleason 5+4 , bone mets all over.
That was 9 years ago …started with Firmagon ( Degarelix) and chemo ( Docetaxel) at the same time. That worked. Over the past 9 months , psa started rising again to 12 , right now chemo again , this time Cabizetaxel. Psa down to 5 now, next monday a PET psma scan to see what’s happening with the mets.
Wow you are having a battle. I pray that PSA goes back down and your scan is clean. Please let us all know the results.
Peace
Scan results were rather positive. No new mets and two shrunk. Worth the SE’s of the chemo.
Xtandi has a lot of down side stuff that goes with it, that being said. I’ve been on it now since Dec. of 2016. Worst part of Xtandi is it doesn’t play well with a LOT of drugs. But in all I give it credit for me still being alive today. My dad was on Ztiga and I didn’t see anything that was positive about it especially when you add the prednisone to the mix.
Just a layman’s observation. Keep up the war there warriors 🙏🙏🙏
Thanks Larry. What downside did you experience with it
Well 2 trips to the ER due to wrong opiods ! Some neuropathy due to wrong pain meds. I had to switch to morphine based pain meds for the bone pain. Missed the fentanyl but that’s just one. My doctor is overjoyed every time I see him ( every 28 days ). Cost is the major down side but both meds are way overpriced in America compared to any other nation
Thanks. No falls etc right. I Read xtandi can cause falls and that’s scary.
I am in India and all these medicines here are way way cheaper
Falls are just part of both drugs as I see it, great care is needed with both, my dad was on the zytiga and fell broke a hip. I’ve had a few tip overs myself on the Xtandi, you just have to know your limits, use a cane or walker especially until you get used to either med. just saying. Keep up the fight Warrior 🙏🙏👍👍
I was on Zytiga for 2+ years, main SE was fatigue but I think ADT also contributed. As it began to fail I asked about Xtandi but MO said cross resistance was an issue, so that did not happen.
Hi Ian. Thanks. Did you start adt and zytiga together or added zytiga later ?
Started ADT (ZOLADEX) Aug 2021, Zytiga Jan 2022. PSA hovered around 10 then gradually began to rise a few points every 3 months. Stopped Zytiga May 2024, was meant to start Docetaxel, meanwhile tested positive brca2 so now on Lynparza instead.
I did Zytiga and failed after 8 months. Also you have to take steroids which hurts sleep.
Moved to Xtandi 89 months ago. No falls.
For some reason Mayo likes to start with Zytiga.
As far as I’m concerned Xtandi is a miracle drug.
89 months? Good run.
What was your initial diagnosis and Gleason. Did you do chemo too ?
My husband agrees with you on Xtandi being a miracle drug. Switched after Zytiga stopped working after 3+ years. Lots of fatigue and muscle pain, but it’s keeping his PSA in the teens now for over 6 months.
Great to hear. Are they nervous about that PSA in the teens?
What was your initial diagnosis and Gleason. Did you do chemo too ?
Initial Gleason 9 4+5
Did 6 chemos and failed after 9 months.
6 more chemo and another 6 month fail.
6 more bags with an additional bag of Jevtana added on the last 3, so 21 bags total.
Did 2 rounds of cryotherapy
Hard to believe now that PSA is undetectable when I consider I started this in 2012
May I ask your age please
58. DX at 46
They’re watching it but don’t want to change anything as long as it’s stable.
Do you take the full 160 mg dose of Xtandi
Ya full dose
Usually they say after one stops working the others don’t work much too but you are saying xtandi worked for you for 89 months after zytiga failed ?
I’ve been taking Xtandi for nearly 10 years now and have never had a fall issue.
Ed
Hi Ed.
Apart from B12 and vitamin E did Dr Sartor say not to take any other vitamins or supplements ??
No those were the two he strongly said to avoid. He is not a fan of multi vitamins either. For the most part IMO supplements are very limited in their benefits, I currently only take a couple of them - Vitamin D for bone health and iron for anemia (gotta check iron levels in your blood regularly, too much is no good) and I’ve been taking Fisetin for cognitive health. I don’t know if the fisetin really helps but I seem to notice a difference although it could be a placebo effect. For the most part most supplements you take are poorly absorbed and end up in the toilet, and there is a possibility of them doing more harm than good. Be sure to check with your doctor.
Hi Ed, are you still PSA undetectable?
Currently 0.06
I selected Xtandi to avoid the prednisone that one must take with Zytiga. Regular exercise helps a great deal with fall avoidance, especially leg presses.
I started Zytiga in March 2022 and was taken off in October 2022 because of rising blood pressure and irregular heartbeat. I then went on to develop Atrial fibrillation soon afterwards. Nobody has yet told me the A/F was as a direct result of taking Zytiga. I have been off and on it ever since as it interacts with my A/F medication and causes breathlessness. I cannot go on to Xtandi because NICE will not fund it as they say it would make little or no difference to my longevity.
Before you started zytiga there were no rhythm issues ?
I previously had atrial ectopics for a number of years without any real problems. BP and BPM were all good during that time.
No one can tell you what your side effects will be; however, if you take the ADT medications your chances of dying from aggressive metastatic cancer decrease. I have had no falls in 4+ years of Lupron and Erleada.
Been on Zytiga since 2017 while it has significant side effects it's very tolerable at least with me. All the normal side effects belly fat loss of muscle mass hot flash libido is non existent. I live with beast and Zytiga keeps it at bay with six month Eligard shots. My PSA has been 0.1 since the start of my journey in 2017 with Zytiga and Eligard I also had Provenge infusions back in 2019 . It's a battle for sure stay active and positive God Bless. Never give up never surrender. Leo
Thanks 😊. What is provenge
Provenge is immune therapy given like blood transfusion they extract your blood through a machine extract some of your cells then you return in a few days and it's given back to intrevinous containing Provenge cocktail of your cells to increase longevity. My Doctor said it works best when PSA is at a low level.
Everyone can react differently. So far, I think I am doing better on Xtandi than on Zytiga but that might be because Zytiga is given in combination with Prednisone and it is likely the Prednisone that was slowly destroying my body (constant cortisol, insulin resistance, high blood pressure, bloated feet that were really painful in the evening after a year on Zytiga/prednisone).
All that went away in my 13 months long vacation from ADT.
Right now I am on Orgovyx plus Xtandi and I do not have any of the above. Orgovyx gives me insomnia but its fatigue and sporadic brain fog are not as bad what I experienced with Lupron. And even when adding Xtandi to Orgovyx, my blood pressure is still normal for now and I hope it remains that way.
Best of luck!
when we started, zytega was a lot cheaper cost than xtandi. So we went on that first, used for 15 months. Then had to switch to xtandi (had already done chemo). Much more out of pocket cost but we managed. But each month PSA doubled. Stayed on it 5 months, then went back to chemo. Xtandi was not a good fit for him - he slept all the time; no energy
yes. Took it for about 15 months before it stopped working
This is a great thread, with lots of good information.
Here is one article that seems to cover the trade offs between them ascopost.com/issues/august-...
Good luck and keep us posted.
Using Xtandi you can try BAT like in the STEP-UP trial when you will be castration resistant. Controls my pCA.
Tinkudi• in reply to
Can you say more about it pls
• in reply toTinkudi
Please study this research carefully: Figure 7 f, SPA - Enza explains everything in a nutshell. ncbi.nlm.nih.gov/pmc/articl...
JohnInTheMiddle• in reply to
This is an in vitro research article. Worth recalling Tall_Allen's comments about the value of such research for members of the advanced prostate cancer forum.
As for BAT, it's a great theory - "let's confuse the PCa by doing one thing, and then stopping doing that thing and doing something else, sequentially" - with the objective of preventing the development of resistance.
Because resistance develops due to evolution and the massive selection pressure on prostate cancer cells. With possibly millions or billions of cells eventually some cells figure out a way of thriving despite the absence of testosterone.
It's a great theory. Even an elegant and beautiful theory which provides hope. I have not seen any reports that it works systematically.
If one has a team of top specialists, who do regular examination of cell populations at the gene level, and hyper-individualized care, then sure, it might work!
But we are not at the level of CHAARTED, ARASENS, STAMPEDE, LATITUDE or PEACE-1 data and predictability.
It would be nice. But I'm hopeful about the stats that imply my own probabilities that resistance is some years away still.
• in reply toJohnInTheMiddle
I have been following the STEP-UP protocole for 15 months, it works. PSA after two months of BAT was 4.1, using Daro for 17 days down to 0.7. Expect around 0.2 in a month. Had 15% AR-V7, now 0. But maybe I should leave this site, there is a FB group for those who are interested.
Tinkudi• in reply to
What is that fb froup called
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