Hi ,
Just got my father's latest blood work report . His PSA shoot from 2.96 to 14 in two months . He was on 3 month lupron shot + Abiraterone . Does this means that Abiraterone failed .
what are the next steps ahead ?
Thank you all for your kind suggestions and reply .
what’s the testosterone level ? Try dexmethone and stop prednisone
Unfortunately T levels were not checked and recommended by doctor . will discuss with doctor to Try dexmethone and stop prednisone .
will it work if we change prednisone to dexmethone?
Thank you 🙏
May be .. do TRT immediately
yes will do it tomorrow only
Hi Jeetu. My heart goes out to you for your Father. And diagnosed so recently this past March!
In response to the earlier suggestion, I was going to be grouchy and ask "why not take watermelon?" Because the idea that you would just try something because someone says such and such in a forum doesn't seem like the best plan.
But I found this:
pubmed.ncbi.nlm.nih.gov/343...
So there does seem to be some value to switching steroids to dexamethasone. (I noticed that it doesn't seem to last as long as one would like.) I'm also on the prednisone. It's interesting to note that your Father's primary meds are the Lupron and the Abiraterone. The steroid is sort of just like a sideshow - Abiraterone has serious steroid related side effects which however are easily fixed with as steroid add-back such as prednisone. I never thought of prednisone as a primary therapy, but everything is so complicated.
Then I also read your father's medical bio. Apparently he was recommended to add chemo but didn't do it or something? Maybe the bio isn't up to date? Because also bicalutamide was mentioned at the same time. It wasn't clear to me what major protocol is being followed. And maybe there are cost issues?
I'm just an interested lay person that has a not-dissimilar situation compared to your Father. And I do a bit of reading. And I'm interested to learn about what happens after the development of ADT + Abiraterone therapy resistance.
What does the oncologist that you seem to have talked to at one point, and who suggested chemo, think? By the way, the combination of ADT plus Abiraterone plus chemo adds up to "triplet therapy". Maybe there is a reason why you didn't want to pursue chemo.
I just did my own periodic blood panel and I'm now waiting for the results. It always takes about three or four business days to be able to see the results (the results are available but not reviewed yet by the staff - I don't understand the situation - there's a lot of anxiety). And of course the PSA. Always the PSA. Another 2 days from now. Not everybody knows that PSA is an acronym for "Permanent State of Anxiety".
Looks like you have reacted quickly and that's good!
Hi John , Thank you for your kind reply . You are such a nice person 🙏.
Regarding my father initial treatment plan : He was suggested for chemo by some private clinics who are only after money , that time he was very very weak and it was very difficult to see him in that situation . Many private clinics in India are only after money and patient health is secondary for them , so i was afraid and this was first cancer case in my entire family lineage . Seeing my father health at that time i went to AIIMS(All India Institute of Medical Sciences), the doctors there told me that they will try to control the cancer with Hormone medicine and injections . That gave me some positive hopes , So i opted for AIIMS treatment protocol to start with .
Bicalutamide was started 15 days prior to Lupron and Abiraterone , once Abiraterone started Bicalutamide was discontinued.
So , in short he started with Bicalutamide for first 15 days and then shifted to Abi+Lupron after that .
Now tomorrow, i will visit AIIMS again and may be they will suggest to add chemo , I remember during one of my sitting with MO there , i asked ,"Why are you not adding chemo?"
They told , "we will consider once ADT stops working ".
Money is not issue ,but my father health is priority. sadly, I am yet to find best oncologist for my father . Here in AIIMS doctors are good but they are overloaded and sometimes are irritated by questions.
You rightly said PSA is "Permanent State of Anxiety " . Its very tough for whole family . Hope your number comes undetectable and you keep living a great and Happy life
Jeetu - Here is my personal opnion and also coordinate with your doctor. It is important for you, your family and dad to understand the situations.
if you are planing to go for chemo (docetaxel) than ask for 25mg zofran and benadryl iv that will reduce side effects.
Also find good radiations oncologist. I hope there are chance to get him spot radiations and reduce the mets.
Also remember, triplet therapy like (ADT + XTANDI + CHEMO ) that's best triplet and also get you best results. I think private doctor were right and also I agree with them.
prostatecancer.news/2022/10...
GLM - you are very sure about specific therapy recommendations, stated in the imperative. In this case the recommendations concern tolerating chemo, and concern a specific recipe for triplet therapy. With no references or support. And my comment would not change if you did provide references or support.
On this forum specific therapy directives based on personal opinion only are not appropriate. Whether you are a doctor or not doesn't matter. There are exceptions to this rule, but this discussion isn't such an exception.
Agree with you
Thanks a lot GLM , Chemo may be added after one month . will discuss the suggestions given by you.
Thanks Jeetu, your information is very helpful and you seem to be navigating things very deliberately. And it seems that in fact you are following a good plan.
Based on the giant RCT trials the received opinion is that, in the right circumstances such as a brand new diagnosis and metastases, that adding chemo to make it triplet therapy could be a very good idea. However if your father is not strong enough then they probably won't offer it.
All this is complicated both in terms of sequence of therapies and in terms of what therapies are used!
Thanks John, Chemo may be added after one moth as per my yesterday visit to MO
Bravo Jeetu and your Father!
Docetaxel.
Don’t they normally go on another arsi like xtandi when one fails ?
No. If he hasn't yet had docetaxel, he would go on it. Second ARSis typically don't work for long.
Thanks TA , they have suggested the same to start after one month , now my MO have some doubt regarding the brand of Abiraterone i was using , i switched different brand(which as per MO is not trusted one) two months back and he is of opinion that ADT generally don't fails so early , he changed the brand and asked to wait for one more month before adding Docetaxel .
Jeetu, you have raised a very important question. Which is the quality of a particular brand of Abiraterone.
I'm on the Natco product. And they got another FDA notice just this past April. But I can't tell if this product is made in the specific plant.
You don't care to mention whether or not this company was mentioned in your discussions? Over 2 years with me, so far so good. Big thanks for bringing this up.
i switched to Abiraterone manufactured by Curemart Pharma in India in june 2024 , but now shifted to Abirapro by Glenmark pharma . Hope it works well .
Counterfeiting of medicine and efficacy of some pharma company medicines is a big issue we face in here
praying that you find right answers dear Jeetu 🤗
yes , there are wonderful people out there in this forum who are very helpful
Duration of ADT
2 or 3 yrs ADT
Abiraterone failing...Xtandi next best step? 
LATITUDE - Zytiga & ADT - NEJM Paper
