PSA up to 3.8 and scans show progression (in bones only). Currently continuing with Abi/pred and decapeptyl. Reading the systematic review of switch to dexamethasone suggests to me it's worth a try. MO is resisting, quoting possible side effects of edema, fatigue, hypertension etc (husband is frail). Few studies of this but they suggest these are relatively low percentage effects and the review found no grade 3/4 events. I am wondering how hard to push for this, as we would probably need to change consultant and it's not that easy in the NHS. Question: If he gets problem side effects is it easy to just swap back and would this return us to status quo ante? Basically, Any risks in giving this a try? He has cognitive impairment and we don't want to rock the boat in that he has been managing Abi/pred without SEs, but it's obviously beginning to lose its effectivity. Thanks.
Question on switch to abi/dexa please - Advanced Prostate...
Question on switch to abi/dexa please
I asked my MO about this when PSA was beginning to rise while on Zytiga. He was against it. Dexamethasone is far more potent and so the dosage needs careful setting and monitoring to minimise SEs. I did not pursue it.
I had similar response from my MO. I’ve now switched to Xtandi.
thanks for replying. tried xtandi before abi but had to discontinue due to SEs.
Thanks for replying. Hope you're doing ok. He would have 2 monthly blood work to monitor - I wonder if this is sufficient.
Actual recommendation is every 2-4 weeks initially to check on liver function and possible immune suppression, then every 4-6 weeks after things stabilise. It’s likely that additional cost plays a role in the decision making process.
That's really helpful, thanks. One does wonder if the need for increased monitoring has played a role in MOs response! I am leaning towards another request to switch. Do you have a reference for the recommendation on monitoring - I might need to quote it....... ?
I started Abi + Pred in 2019. Pred at 5 mg/day (Zytiga dose recommendation for my mCSPCa) resulted in BP increase and mild calf edema. Pred at 2x 5 mg/day seemed to reduce BP and edema, but was concerned with this dose for long term. Stopped Pred and started Dex at 0.5 mg/day in 2023 and have continued this to date. BP is OK and not much edema. PSA was 111 when diagnosed, and has been <0.1 since a few months after starting Lupron + Abi in 2019 (i.e., 6+ years). Hope this helps, but of course everyone is different.
Thanks for your reply. You've had a great run on abi. Good luck. Good to know your SEs were minimal.
Actually, SEs are not minimal. While BP and edema are under control, for 6 years I've experienced all the other typical ADT SEs. Too many to list here. Fatigue (in spite of gym workouts every other day) is probably my most problematic. But, given my situation (met and initial PSA=111), I think the fact that I'm still castration sensitive is worth all the SEs.
I was switched from pred to dexa and my PSA came down. I got about 10 mths from it before a PSA rise. No side effect.
prednisone is to mitigate side effects of Abi. Dexamethasone does the same but at a much lower dose and has a longer half life which is why you don’t need a dose later in the day. Prednisone has been shown to fuel the cancer after continued use. The pic shows the opinion of Dr. Sam Denmeade at JHUH. It was taken from the very extensive notes he left after my visit with him recently. Hope this helps. God bless.
Many thanks
You are quite welcome. I have not had any test since I started but will post. First test is April 1.
Docetaxal - The Honeymoon is Over
When ADT fails, we continue it anyway... why not Zytiga?
Shortness of breath on Lupron; switch back to firmagon?
Any long remissions on ADT , Abi , pred ?
Hungry!!
