Can I discontinue Abbie and Prednisone

[wpeebles]

7/1/24 prostate cancer and spread to lungs. No bones or lymph nodes. Started with Eligard 3 months shots and Abbie (1000 mg) and prednisone. PSA is <.04. Everything good until January 2025 when ALT and AST again were over 5X normal. Stopped Abbie and Pred. 3 weeks ago and as of today liver enzymes are even slightly higher. Going for liver MRI next week but had a liver scan done two months ago and nothing. I do have a fatty liver, but I think most people do. Previous CT scan of chest showed that lung nodules have reduced in size since July. My question is this: If the Eligard shots are working and keeping PSA low and lung nodules are decreasing why do I even need to take Abbie even at a reduced dosage. I will discuss with my MO after the MRI next week but would like some other thoughts if you can. Can I just go with HT treatment until PSA starts to rise?

[Derf4223]

I'm not a doctor, but am ~8 months off abi/pred/lupron myself. I took them for 21 months, at which point my MO asked me if I wanted to stop. Her reasoning was that I was very responsive with undetectable PSA from the get-go, and there was the issue of accruing long term side effects. From reading elsewhere, such SE's include dementia, CV issues, sarcopenia, and BMD loss, and last but hardly least, increasing odds of developing castration-resistance. I continue with a better diet, daily aerobic/resistance/cardio, etc.

[Cyclingrealtor in reply to Derf4223]

I was at 24 months and stopped at the end of June 2024. I.use uPSA testing and so far I have been stable < .006. But as we know , it's a long game , so time will tell.

[speranza10]

It would be better to continue with zytiga, if you stop it now and start again when the psa goes up it will work for a shorter time. Several people have solved the problem of high liver enzymes by taking 500mg of zytiga for a few weeks and then the normal dose of 1000mg. Another solution could be to switch to another new generation hormone drug for example erleada or xtandi. Now I don't know your gleason score but if it is high I would think very carefully before continuing simply only with adt.

[wpeebles in reply to speranza10]

Gleason was 4+3. You and TA both suggest the same thing and know more about this than I do so Thank you.

[Tall_Allen]

Men live longer with ADT+abi than with ADT alone. Perhaps you can switch to one of the other ARPi drugs (Xtandi, Erleada, or Nubeqa).

[wpeebles in reply to Tall_Allen]

Good point. I forgot about that study. Thank you.

[Wolfee53]

My MO recommended Eligard in combination with Zytiga and Prednisone for 2 years minimum. PSA was undetectable during this time period. I suffered a brain bleed at the two year anniversary. MO and I decided to take a vacation from Eligard Zytiga and Prednisone and I've been off of them for 2 years.

My PSA has been .04 and Testosterone has returned to normal levels. So I would recommend staying on ZYTIGA and Prednisone unless there is some complication.