Two questions for the group concerning PCa spread to lungs and also about high liver enzymes.

[wpeebles]

1. PCa spread to lungs. Not 100% sure whether PC spread or lung cancer according to scans and biopsy. Started Zytiga, prednisone and eligard 3 month shot on 7/8/24. Just got my CT/chest with contrast back this morning and it states "largest metastatic nodule in right lung has decreased in size when compared to 3/2024 report and the smaller nodules are stable and no new nodules". So before I meet with my MO does this report suggest that since the nodules have decreased in size that the tumors in the lung are Prostate cancer and not lung cancer since they appear to be responding to the Z/P/E treatment. Thank you.

2. My liver enzymes have now gone very high while doing the treatment mentioned above. AST lab value from 16 before treatment to 51 last week and ALT value from 45 to 141. The range for both should be 35-40. Probably related to these drugs I would guess as I have never had liver problems. I meet with MO next week. Should I ask to possibly reduce dosage. Zytiga is 1000 MG a day and Prednisone is two 5MG a day. Any suggestions is appreciated.

Thank you all.

[Tall_Allen]

"does this report suggest that since the nodules have decreased in size that the tumors in the lung are Prostate cancer and not lung cancer since they appear to be responding to the Z/P/E treatment." Yes

"Should I ask to possibly reduce dosage?" Yes. Back off to 750 mg. If that normalizes your liver enzymes, you can try 1000 mg. Sometimes the liver just needs time to acclimate.

[wpeebles in reply to Tall_Allen]

Thank you. Very much appreciated and sounds like good advice.

[petabyte]

Also make sure you are not taking the Zytiga with food. (But Prednisone is with food)

Two hours after eating or 1 hour before eating. With food, especially fats the absorption is much higher. There is even a protocol with 250mg taken with a low fat snack.

I take mine first thing in the morning 06:00 and snack two hours later with the prednisolone (and Orgovyx). I read it is better to take prednisone/prednisolone in the morning.

Are you taking prednisone or prednisolone? The later does not need to be processed by the liver.

Here is a link to the information for one brand of Abiraterone (same as Zytiga). See the hepatotoxicity section.

ema.europa.eu/en/documents/...

There is also a micronized version of abiraterone (Yonsa) that can be taken with food. No idea if it would change anything, it is not available here so haven't researched it.

[wpeebles in reply to petabyte]

Thank you for the info. I take my Zytiga around 11PM about 2 hours after any late-night snacking is done. Pharmacist stated that since Zytiga can make you tired right after you take it that it is best to take before you go to bed. Made sense to me.

[petabyte in reply to wpeebles]

Some information on micronized abi.

urologytimes.com/view/prost...

[Dlanghorne]

FYI: I was gleason 10 and had prostatectomy Jan 2019. Started Zytiga 1000mg in Jul 2019. Then AST and ALT went high in Nov 2019. Doc dropped Zytiga to 500mg. I have remainded on 500mg, 5mg Prednisone, and Lupron since. PSA is <.01. Did have PSMA scan 2 years ago with spot on T11 which was radiated. Continue to hang in there until ????

[wpeebles in reply to Dlanghorne]

Thank you. I will be asking MO to reduce dosage.

[RoseDoc]

The fact that the lesions seem to have responded to treatment suggests that they are metastatic PCa. They can do genetic testing on biopsy specimens to clarify the issue.

Your liver enzymes are most likely elevated due to the drugs that you are taking. Talk to your MO about adjusting the dose. They should also check to see if you are on any other meds that could contribute to the elevated enzymes.

[wpeebles in reply to RoseDoc]

Thank you.

[7OaksTom]

My MO started me on Ogorvyx, but stopped it when my liver enzymes went up and then started me on Eligard. Then my RO wanted to start me on Zytiga+Prednisone after IMRT (SOC), but the MO refused because of the history of elevated liver enzymes. She started me on Xtandi instead which sent my PSA to less than .1 within weeks with no effect on liver enzymes.

[wpeebles in reply to 7OaksTom]

Thank you. Interesting.