My husband was diagnosed with PCa in December 2015 and had an RP in February 2016. After getting a second opinion he started taking ADT plus Abiraterone & Prednisilone in March 22 for mHSPC and since then his PSA has been undetectable. He tolerates the medication pretty well; takes Veoza, that has effectively eliminated hot flushes, works out regularly at the gym and is very active.
However about six months ago he noticed that he was bruising easily. Initially a mark which he realised was from the pressure of a watch strap on his wrist. However the bruising (Purpura) is becoming more regular and the slightest knock causes his skin to tear and bleed on his forearms and hands.
Is there a problem changing from Abi to Enzalutimide - where it’s not necessary to take the steroid? Or can the steroid dose be reduced without compromising the efficacy of the treatment. Often medications are based on the average person’s weight, reflecting the fact that clinical trials don’t allow for different body weights.
Any insight, greatly appreciated.
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Cortisone is not taken to make Zytiga more effective but to alleviate side effects. If I really had to change drugs, I would think about switching to Erleada (apalutamide) rather than Enzalutamide
They are both very effective drugs, however hearing the experiences of some patients I got the idea that apalutamide has fewer side effects. And then being a more recent drug it inspires more confidence in me. This is my idea, maybe you hearing other people will get another one. Then you also have to see the presence of other health problems, for some it could be better enzalutamide, for others erleada because in the end it is the doctor who knows the patient well who decides.
My father in law switched from Zytiga to Xtandi. He was not responding to the Zytiga but is responding to the Xtandi. He stopped the prednizone cold turkey and suffered for it. So, if he does switch then taper off the prednizone and not stop all of a sudden.
yes exactly you don't have to stop it immediately but you have to reduce it little by little, especially when it has been taken for a long time this is very important
Thank you for the link. He’s actually been taking 4mg Methylprednisolone with Yonsa (abi). We’ve found nothing online about the minimum dose. I gather that people taking 10mg Prednisolone and may reduce it to 5mg, but we can find nothing about lowering it even further. I believe the 4mg Methylprednisolone is equivalent to 5mg Prednisolone.
The effect of the steroid causing purpura is also not highlighted as a side effect of taking the combination of Abi + Methylprednisolone - or at least none that we can find. Only when we research the side effects of steroids.
Yes, it’s good to remember that he should taper off the steroid if he stops taking abi. However, apart from the purpura, he is tolerating the abi well physically, and his blood tests are good, and because of this he’s hesitant to change to meds that might have different side effects - especially cognitive impairment.
It would also be good to know how well the skin will improve if he needs to change his medication. Or has anyone found a way of reducing their paper thin skin from tearing and bleeding. He obviously always wears long sleeves, and when cycling or hiking ensures he wears gloves. But even that doesn’t always help.
I have been on Abi/Prednisone for 18 months and initially had exactly the same problem. To such an extent that I would carry bandaids in my pockets and car. I spoke to my MO and she reduced my Prednisone from 10mg per day to 5mg. Problem solved.
Thank you. I'm happy that reducing the dose has solved the problem for you. As 4mg Methylprednisolone is the equivalent of 5mg Prednisolone I guess we'll have to find out from his Medical Oncologist if it's possible to reduce the dose even further.
Consider taking a med vacation. Those who have responded well qualified for a clinical trial stopping meds. I've been off meds since June '22. Still <0.01. If he doesn't want to stop meds, consider reducing meds. I was on a 3/4 dose for years.
In month 7 of Zytiga my liver numbers went haywire. I stopped completely for several weeks. Then restarted at half dose. Then went to 3/4 and stayed there. I always took 5 mg of Prednisone.
I have the same problem of skin bruises and tearing , if I use a hammer or any impact to my arms I get bruising. I don't think It's from my adt - Orgovyx/ Nubeqa. I'm 69 spent my working life outside no skin protection. Now maybe dealing with damaged aging skin ? I bought some kevlar arm guards on Temu , use them when working. Think they were around12 bucks. Cheaper than band-aids in the long run, lol
I've been on Dexa for about 5 years. I have been suffering from thin skin and bruising and saw my PCP. She did a A1c check and I was type 2 at 6.1 I changed my diet, reduced some weight and 3 months later my A1c is normal at 5.6 I do not have skin or bruising issues. For what it's worth.
Hello I have been on venlaxafine for hot flashes but considering Veozah which it sounds like it has worked well, just wondering if you tried anything prior to Veozah and are now satisfied with the solution?
This was the first and only med he's tried. His MO suggested it as the hot flashes were waking him during the night and he said it worked very successfully for many of his patients. It's a small tablet (Veoza 45mg) taken an hour before bed.
My hubby has been taking Abiraterone and low dose Prednisone for two years but the doctors say that his bruising is caused by the Eliquis he is taking.
I had the same problem with Zytiga (abiraterone) and Prednisone. The slightest bump on my hand resulted in a blood blister. These often took forever to go away. I suspect the culprit was Prednisone. When I stopped taking Zytiga the problem went away.
Would you please be kind enough to update your Dear Husbands bio. All info is voluntary but it helps him/you and helps us too. You may wish to glean some of your posts and use that as information in his bio. Thank you!!!
Always consult with your medical expert , Urologist , before changing medications . Or get a 2nd Urologists opinion . Members on this forum are well meaning but "DO NOT -- I REPEAT . DO NOT FOLLOW THEIR PERSONAL EXPERIENCES .
You do not know their personal medical history -- Nor they your husbands .
You are aware that " NO MEDICAL PROFESSIONAL WILL RECOMMEND A MEDICATION OR TREATMENT -- " WITHOUT FIRST SEEING THE PATIENT IN PERSON AND REVIEWING THEIR MEDICAL AND FAMILY HISTORY " ---- period .
Don't worry Conlig1940, we have no intention of do anything without his MO's approval. This forum is good to gather opinions and real life experiences. But at the end of the day he will make his own considered decision together with his medical consultants.
"... can the steroid dose be reduced without compromising the efficacy of the treatment?"
I think so. Because of the side effects, and some research, in September I told my Uro I was reducing the Prednisone from 10 mg. I went to 7.5 mg and then 5 mg. When I saw him in October the labs were OK so he said 5 mg was OK. Today I saw my MO and he agreed 5 mg was OK.
10 mg caused red and bleeding arms, a big belly and higher blood pressure. 5 mg has cured the arms, caused a little ankle swelling, and not reduced the BP much, for which the MO has adjusted its medication. I like the 5 mg.
I would do everything I can to stay on abiraterone, as they say, never change a winning team. Xtandi will certainly work too, but I would prefer to leave it for later. If abiraterone fails (I hope not), if I start Xtandi now, Zytiga will hardly be effective in the future, because Zytiga rarely works after Xtandi, while Xtandi after Zytiga might work. It's an important decision, these are the most effective therapies with the fewest side effects available and you need to use them as much as possible. When they fail, people usually start talking about chemotherapy and, ironically, cortisone.
There are a lot of people here smarter than me but reducing testosterone by itself will cause your skin to get thinner and easier to bruise and tear. I have never had Abi and just started taking Enza this week. I was on Lupron from 2020 until 2021 and then had castration as part of a surgery to repair what a prostate surgeon did to me in 2018. In other words. my skin has been just like you describe for several years without taking any kind of medicine for the cancer.
The great part about oral medication is that if something start to feel off you just stop taking it. It's worked for me beyond 10 years with natural ADT.
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