adding Zytiga, yes or no?

[Vman1]

74 year old with Gleason 4+3 pca and spread to presacral lymph nodes only. Had 45 radiation treatments and currently on first 6 month Eligard injection. Original PSA of 16 now down to 0.16.

Urologist wants 24 months of Eligard and now wants to add Zytiga. PSMA showed no mets other than the presacral nodes.

I’m wondering if adding Zytiga is an overkill at this point and if anyone else has a similar situation.

[Tall_Allen]

3 years of ADT and 2 years of Zytiga:

pmc.ncbi.nlm.nih.gov/articl...

[Vman1 in reply to Tall_Allen]

Thank you

[depotdoug]

yes adding Zytiga 250mg daily w/breakfast is what I’m on since 2020. My 68Ga-PSMA-11 did show show minor lymph node infiltration. Abiraterone 250mg is working so far no SE’s but a little fatigue.

[Vman1 in reply to depotdoug]

Thank you for your reply. I’m so glad you are currently doing well and fighting the good fight against this enemy. Did any doc tell you that the original ADT was responsible for your cardiac problems? That is one of the potential side effects I fear the most.

[dhccpa in reply to depotdoug]

With pricing for generic Zytiga so low these days, what's your main reason for doing low-dose? Do you believe it's less side effects? I'm not faulting you, I believe the effectiveness has been shown, and it does save some money, just nothing compared to taking less of the brand names like Xtandi.

[depotdoug in reply to dhccpa]

Reason I’m sticking with abiraterone 250mg w/breakfast is: higher doses 500 or 1000mg can cause my cardiac rhythm to go AFIB and increase my PVC’s. Mainly 250 generic to keep my heart calmed down. Why? Because the prednisone 5mg also contributes to irregular heart rhythm and higher BP.

I get my Abiraterone 250mg monthly from my Oncology hospital spdcialty pharmacy through a grant @ $0.0.

Hope this helps…

[dhccpa in reply to depotdoug]

Thanks.

[Vman1 in reply to depotdoug]

If you don’t mind me asking , do you have a history of afib or are you just worried about the possibility. I had a singular bout of afib in 1974. No other episodes. Recently had a Holter monitor that showed some PAC’s and PVC’s but cardiologist said the test was essentially normal. I’m currently on Eligard first 6 month injection (4 months in) and Dr. recommends I start Zytiga. Diagnosed in June with Gleason 4+3 with mets to presacral lymph nodes only. Just finished 45 radiation treatments on December 2nd. Keep the good fight my friend.

[petabyte in reply to Vman1]

Before I started Abiraterone I had an ECG (normal) then a consultation with an oncology cardiologist and an echocardiogram. Mostly normal with v mild mitral valve reflux.

My lifestyle is very cardiac friendly but based on some family history I will get a Coronary CT Angiogram on Friday. Not sure if they are being over cautious or if this is standard but I'm glad they are doing it.

[depotdoug in reply to Vman1]

Yes i developed AFIB big time about a yr after my SCA. My cardiac arrest was May 12 2011. Spent 12 days in CICU.

My paraxysmal AFIB started in 2012 then got worse in 2013, more episodes. First try to control AFIB was meds Amiodarone. Didn’t work. 1st cryo ablation was in 205. 4th rf and last extensive ablation was June 2022. I’ve AFIB free since June ‘22. Yes I stll have PVC’s on all my EKG’s but don’t worry about those much. NSR and no Aflutter are great! No blood thinner either since Watchman LAA device implant.

[Vman1 in reply to depotdoug]

So sorry to hear that but glad you’re better now.

[Professorgary in reply to depotdoug]

I had this issue before Abi. It was caused by nsaids. I started taking magnesium and curcumin and heartbeat great as well as bp. Then when I started Abi I also started 250 with low-fat breakfast and T level went to undetectable. I recently switched to 1000 a day without food. I have absolutely no arrithmia and bp still good. There is a hidden benefit that few discuss. That is 1000 without food is processed in the gut and enriches gut bacteria and 250 with food is processed mostly in the stomach and produces less benefit for the gut balance. You may want to Google “gut prostate axis”. God bless.

[depotdoug]

Thanks, Still doing ok I was going to say fine on my Abiraterone 250mg + PRed but am still addressing my Protitis caused by IMRT 19 yrs ago. Just saw a new Rad Oncologist last Friday. On some new meds and Vitamin E.

[Vman1 in reply to depotdoug]

Sorry my bad, what is SCA?

[depotdoug]

Sudden Cardiac Arrest. Before that happened I drove 3 min to our right close to our home ER and 5 hrs in ER my heart stopped. It was like the worst time of my life. I survived. Thank GOD i was in that ER room.

[Vman1 in reply to depotdoug]

Thank God indeed. But I’m still confused. Was your sudden cardiac arrest due to ADT therapy or something totally unrelated?

[depotdoug]

Sorry I should explain.

No nothing to due with ADT or IMRT radiation. My Cardiac Arrest Diagnosis determination was NSVT (non sustained ventricular tachycardia.) Due to my long term 35yrs of alcohol drinking. ETOH ethanol alcohol effect I think. Vman1 I stopped drinking 3 months exactly before my SCA, not soon enough. Been in sobriety 13yrs, 10months, 21days. Feels great my heart thanks me!!

[Vman1]

Thank you depotdoug for the explanation. You are to be commended for your strength and resolve. God bless you.

For some reason (can you say chronic worry wart) I have been inordinately concerned about ADT and potential cardiac side effects even though I have no history of heart problems (except that one paroxysmal afib in 1974). Almost didn’t start Eligard because of my worry. Now facing addition of Zytiga and more worrying. After I explained my concern and worry, my urologist said I’d die from prostate cancer before I would die of a heart attack. So far, I have tolerated the Eligard pretty well. The plan is 2 years of Eligard and Zytiga then stopping at that point. My original PSA was 16 and after 9 weeks of radiation and 3 months on Eligard, my PSA fell to 0.16.

[j-o-h-n]

Greetings Vman1,

Quoting you: "After I explained my concern and worry, my urologist said I’d die from prostate cancer before I would die of a heart attack."

I think I saw your urologist in the worse movie ever made "Plan 9 from Outer Space", dump that asshole urologist asap and get yourself a real one (and/or a M.O.).

FYI-HINT: We never use the expression "If you don’t mind me asking" here on H.U. we just ask.

BTW: Good Idea to update your bio,. All info is voluntary but it will help you and it will help us too. Thank You!!!

You've come to the right place for Help, Information and Camaraderie. So stick around and keep posting. Enjoy 2025.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Vman1 in reply to j-o-h-n]

Thank you j-o-h-n. I’m not committed to any one provider and will definitely look for another. Your opinion and advice means an awful lot. I will definitely update my bio and ask as many questions as I can 😀

This is a great and reassuring forum.

[j-o-h-n]

Way to go regarding your Providers....Members here are a solid bunch. I can see you'll fit in very nicely and you don't even have to pick up the tab.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Vman1 in reply to j-o-h-n]

Love your sense of humor. Besides being refreshing, it’s healing. Laughter is the best medicine esp when dealing with this monster.

[j-o-h-n]

Thank you kind Sir..... Humor is my hobby and my life....In fact it was my wife's suggestion when I said to her "Honey why don't we fool around a bit tonight" she responded "Get a life".

Good Luck, Good Health and Good Humor.

j-o-h-n

[Vman1 in reply to j-o-h-n]

😂

[RalphKramden]

Gleason 9: Orgovyx ( initially Firmagon then Eligard and then Lupron) and Abiraterone plus Prednisone for 24 months. ( 7 months to go) PSA <0.02. Prolia for bones.