Abiraterone Honeymoon is over, what next?

[IKNY]

My liver has not been terribly happy with Abiraterone… first month elevated enzymes with a return to above normal after 40days, then a spike and progressively higher ALT/AST enzyme levels. So this happened in the spring and I was taken off for 4 months until recently.

same pattern even in half dose, MO told me to stop. He stated the next medication considered may be Darolutimide.

I do have epilepsy, off of medications though for a year as I haven’t had an issue for 24 years, previously on Dilantin for 46 years.

It keen on Darolutimide warnings of clotting and low white cells… of course the obligatory liver toxicity as well.

Anyhow, very upset that my body may not handle these second generation androgen receptor inhibitors.

Gleason 9 (4+5) Stage 4, localized lymph involvement, one para-arortic lymph involved outside the pelvis.

RALP

ADT (Lupron)

RT (38 sessions)

No measurable cancer via PSA

Thanks!

[Yokohama2023]

So sorry this has impacted you as it has me. I just want to say I hope the input of others helps you like your posting does us for us all . I read a lot of these post wondering what’s in store for me .. and wish you the best wish I could help more but expect some solid advice here from everyone. Take care.

[IKNY in reply to Yokohama2023]

Thank you, I wish you and all members the best in this journey.

[Still_in_shock]

Good thing for us the liver is the only organ that rebuilds itself!!!

I had to stop Abi due to heart issues. Was on it 2 years.

Now Im solely on Lupron (2 1/2 years), been 6 months, and my PSA is <0.02 every month.

Going to UCLA in January to get advice from Dr Rettig on how to proceed.

In the past ad RALP, then 2 years later radiation full pelvis and lymph node for 1 hot node.

[Jewelrylady in reply to Still_in_shock]

What heart issues were you having. My husband is being evaluated for Afib. He’s on abiraterone.

[Still_in_shock in reply to Jewelrylady]

Yes, Afib. First time.

It was bad. 187 BPS Hospitalized for 2 days. Took 42 hours on meds to revert to sinus.

[ELOfan]

I too was shocked by my high LIVER function blood-tests since going on Abiraterone-Zytiga 1000 mg daily. The nurses kept hinting that I must have drank a lot of alcohol in the past - however that is UNTRUE for me. And I haven't had a drink since May either.

SINCE DO said Zytiga can sometimes have that side effecton liver, I tried DECREASING from 4 Zytiga pills (250mg ea) down to 3 pills = 750mg and within just ONE week retested and good news - Both (AST and ALT) liver-enzymes were back in the NORMAL range!! The other Alkaline phosphatase decreased 100 points down in the direction toward normal.

Trying to learn what the LIVER does beside act as a filter and found Dr. Mike on YouTube giving a Very detailed explanation that might interest you too. I had to SLOW down the speed and pause it a few times to take in what he is teaching medical students.

LIVER FUNCTIONS VIDEO by Dr. Mike:

youtube.com/watch?v=2GlWMvF...(Not working as expected?)

[IKNY in reply to ELOfan]

I’m not a drinker or recreational drug user, gummies do impact your liver.

However, 46 yrs on Dilantin is hard on the organ, even though I always tested within normal for that medication.

I’m on only 500mg of Abiraterone and my AST recently tested at 268, when it get past 165 I notice nausea… when it became constant I tested ASP and Dr told me to stop.

Being on Dilantin and Phenobarbital most my life, drinking is out of the question.

Though my Dr once accused me of smoking when my blood oxygen was 93, fun side effect of Dilantin is how it screw with your red blood cells.

Anyhow, I digress and look forward to an alternative I can live/survive with

All the best

IK

[TomsD1]

My understanding is liver also removes testosterone and thus good function in liver very important.

[Brad70]

I also had to stop Abi due to liver issues. No problems with darolutamide.

[IKNY in reply to Brad70]

Thanks!

Greatly appreciated!

[binati]

I have a somewhat similar history. Gleason 4/5 with seminal vesicle involvement but no nodes visibly impacted as seen on PSMA Pet CT scan. RT and ADT for 24 months. After 24 months apparent BCR, assessed from rising PSA velocity with no visible lesions, on PSMA Pet CT scan. I got an Orchidectomy and then was started on Darolutamide. So far 20 months and things seem ok. No SEs from Nubeqa. Blood parameters and Kidney/Liver parameters are alright.

Keeping my fingers crossed.

Nubeqa might work for you too.

[IKNY in reply to binati]

May I ask, what was the deciding factor in going with an Orchiectomy instead of an ADT like Lupron?

Much appreciated.

Best wishes for your continued success.

IK

[binati in reply to IKNY]

Depending on age you will probably not recover T at all. Additional headache of Lupron shots is avoided. SEs are less with Orchidectomy.

[MedicaMahnJahm]

TY for your post.

Same age, same metastasis, same Gleason, liver enzymes spiking 2 months in.

Radiation starts Monday.

Hope you next med is a fit and does the job.

Jim

[IKNY in reply to MedicaMahnJahm]

Best of luck, my RT went well, didn’t get side effects until 6 weeks into an 8 week treatment.

Intestinal upset and then sporadic, heavy fatigue.

All went exceedingly well (so far).

IK

[7OaksTom]

I started Orgovyx as my first ADT, but my liver enzymes headed up so my MO switched me to Lupron. After completing 28 sessions of IMRT. RO wanted me to start Zytiga + Pred, but mey MO was concerned about my liver. When my PSA zoomed up from .8 to 5.2 90 days after IMRT she added Xtandi. My PSA dropped to .2 in 3 weeks and <0.1 30 days later. Side effects are typical: fatigue, hot flashes, belly roll. Liver enzymes remain within normal range.

[Zzzgott]

Stage 4++ After liver issues with Abe switched to half dose of Xtandi 3 years ago. All is well with PSA,