The steroid with zytiga can be a deal

[TomsD1]

My Dads new oncologist switched his steroid from prednisolone to dexamethasone - she was distressed at first appointment to see he was on zytiga and prednisolone. She said research pretty clear that dexamethasone is better. On today's PSA results she is clearly correct. We thought that he had become castrate resistant but this now doesn't seem to be the case, he was on the wrong steroid. (He's also on flutamide? I think). I have since found quite a bit of supporting research so just wanted to share.

[God_Loves_Me]

thank you

[6357axbz]

I switched to dexamethasone a few years ago.

[Cenerus]

Why isn't dexamethasone the SOC given that it has the ability to extend Abiraterone's PFS numbers. I see that it's unpredictable as to how much it may extend PFS, but it still seems to be better than prednisone. Anyone know why this is the case?

[Seasid in reply to Cenerus]

ChatGPT (please check the answers for accuracy.) :

"Replacing Prednisone with Dexamethasone in the treatment of metastatic prostate cancer, particularly when using Abiraterone, can have several potential downsides:

1. **Increased Risk of Side Effects:**

- **Immunosuppression:** Dexamethasone is more potent than Prednisone, so even at lower doses, it can lead to greater immunosuppression. This increases the risk of infections.

- **Metabolic Effects:** Dexamethasone can cause more significant alterations in glucose metabolism, potentially leading to hyperglycemia or worsening existing diabetes.

- **Osteoporosis:** Prolonged use of Dexamethasone can increase the risk of osteoporosis and fractures due to its stronger effects on bone resorption compared to Prednisone.

2. **Adrenal Insufficiency:**

- Dexamethasone suppresses the hypothalamic-pituitary-adrenal (HPA) axis more strongly than Prednisone, which can lead to adrenal insufficiency if Dexamethasone is stopped abruptly or if the body's demand for corticosteroids suddenly increases (e.g., during stress or illness).

3. **Mood and Cognitive Changes:**

- Higher potency glucocorticoids like Dexamethasone are more likely to cause mood swings, anxiety, depression, or even steroid-induced psychosis, especially with long-term use.

4. **Fluid Retention and Hypertension:**

- Although Dexamethasone has lower mineralocorticoid activity than Prednisone, it can still cause significant fluid retention and hypertension, particularly when used long-term.

5. **Myopathy:**

- Glucocorticoids can cause muscle wasting or myopathy, and this effect may be more pronounced with Dexamethasone due to its greater potency.

6. **Long-term Toxicity:**

- The long-term use of Dexamethasone, even at low doses, can lead to cumulative toxicity, potentially affecting various systems in the body, including the cardiovascular system, skin (e.g., thinning), and eyes (e.g., cataracts, glaucoma).

Because of these potential downsides, the decision to switch from Prednisone to Dexamethasone should be carefully considered, weighing the benefits of possibly enhanced cancer control against the risks of increased side effects. Close monitoring and appropriate supportive care are essential to manage any adverse effects that arise."

[billyboy3]

what is the dosage he is on and once or twice daily ??

[TomsD1 in reply to billyboy3]

Can't remember dose but once daily.

[billyboy3 in reply to TomsD1]

Please check if you can thanks.

[TomsD1 in reply to billyboy3]

Not at home rn - but I think it's a smaller dose than the pred (10 mg) because it's more potent.

[billyboy3 in reply to TomsD1]

Thought .4 mg x 2

[Balylone]

interesting. I thought dexa was a second line when prednisone fails. Didn’t know it could be used as first line. Will ask my MO on next appointment.

[JohnInTheMiddle]

I'm on the prednisone steroid for the corticosteroid add-back required when is taking Abiraterone/Zytiga ARPI therapy. I was briefly for a couple of days on dexamethasone, around each of my six Docetaxel chemo infusions.

Never felt so great as when I was on the dexamethasone! It was explained to me that on the long run that dexamethasone was dangerous. Anyone can explain this?

Also I have been of the understanding that a steroid is only to mitigate downside side effects of an ARPI therapy - not that it also contributed directly to success against metastatic prostate cancer. Can anyone clarify this?

[billyboy3 in reply to JohnInTheMiddle]

There is NO long run now at this stage where we are at!!!!

[JohnInTheMiddle in reply to billyboy3]

You are correct Billy Boy, sort of. Metastatic prostate cancer is not yet a chronic disease. It's a terminal diagnosis, sadly. (Although the public and relatives usually don't distinguish between non-metastatic prostate cancer - which can be considered chronic - and metastatic prostate cancer which is terminal. This ignorance shows up in lazy journalism and comments such as "my uncle lived for 30 years with prostate cancer".)

But things are getting better, even quite a bit better. Maybe 5 years ago before triplet therapy, if you had a stage 4B diagnosis i.e. with bone metastases etc., your life expectancy might be a year and a half, give or take. There are exceptions of course.

However with the adoption of new generation ARPI and AR antagonist drugs, and the big clinical trials that examined different sequencing of therapies (how about "all at once up front?"), median survival has been reported as 5 years.

This is if you look at patients treated with the new therapies. If you're looking at whole population of "people with metastatic prostate cancer", that population includes people with the older therapies. So this skews the numbers negatively.

Even more interesting, some of the big trials have patient participants where "endpoints" have not been reached yet!

So there is some reasonable expectation that things are getting better. Which is not to deny of course that a median has a distribution around it and some people do worse than the median.

I accept your point that there is no long run yet. But maybe we can say "a longer run"? 🙄🙂

[billyboy3 in reply to JohnInTheMiddle]

Yup. It keeping in mind none of the new drugs have been around long enough yet so a shitshow at best for us guys !

[JohnInTheMiddle in reply to billyboy3]

By the way Billy, I always like the song. Here's a version I'd rather like:

youtu.be/scfNc4haFGA?si=M7c...(Not working as expected?)

[j-o-h-n]

Thanks.

Good Luck, Good Health and Good Humor.

j-o-h-n

[God_Loves_Me]

jeetu_g27 here you go

[God_Loves_Me]

Who is your oncologist ? Please PM or leave comment with name and locations. Thank you

[TomsD1 in reply to God_Loves_Me]

In western Australia

[Bspouse]

hello TomsD1, My husband just had his third raised PSA, .51. .61. .75. , so I guess that means he is officially castration resistant. I plan to ask his MO to switch from prednisone to dexamethasone, at least while we look into next steps. How is your dad doing on the dexamethasone?

[TomsD1 in reply to Bspouse]

Better

[Bspouse in reply to TomsD1]

Good to hear. Thank you. He is lucky to have you watching out for him.