ADT, HDR Brachy, EBRT, Zytiga

[WaterRat14]

Looking for input from this great community. I’m a high risk PC 72 yo. I’ve been on ADT since April 1. Getting HDR BT this Tuesday from Dr. Wong at UCSF. Expect to start EBRT two weeks after. Told by Dr. Wong that Zytiga for two years is likely warranted. He will refer me to MO for that. I’d be very grateful for thoughts on this journey, particularly about Zytiga.

[Tall_Allen]

Excellent choice! Since this is at UCSF, I assume you got a PSMA PET/CT to rule out distant metastases.

[WaterRat14 in reply to Tall_Allen]

Thanks. Yes. Clear with exception of several small nodules with mild to moderate tracer uptake in a pattern suggestive of a normal variant, although early lymphonodular metastasis cannot be excluded at this time. Hence, the consideration of Zytiga. Any thoughts on Zytiga from folks who have been on it?

[Tall_Allen in reply to WaterRat14]

Most guys I know on it, tolerate it well. Most of the side effects are from ADT - abiraterone adds a bit.

[bean1008]

I've been on the Lupron 3 month-Zytiga-prednisone regime for about 18 months now. Some days the fatigue is bad enough to keep me on the sofa and there are hot flashes that are completely unpredictable. Other than that, my PSA has been undetectable since Feb 2021 and I'm staying the course for as long as I can. I do look forward to having more energy as I retired in late 2020 and still wanting to get out and work on that travel bucket list!

[ADTMan]

If you don't mind me asking, what was your psa? I had HDR with IMRT and am on ADT w/o abiraterone but I had Gleason 8. Perhaps abiraterone was added because of the Gleason 9?

[WaterRat14 in reply to ADTMan]

2/21 - 5.9; 8/21 - 7.6; 3/22 - 14.4. Had biopsy 10/21 with Gleason couple 7’s and couple 9’s. RO said Zytiga indicated by suspicious lymph nodes in upper pelvis showing in PSMA Scan.

[ADTMan]

Interesting. Besides the GL9, it looks like they are using psma not traditional scans to determine treatment. Shows how psma is changing treatment. A psma scan was not available to me when I was diagnosed in May 2020. I knew about it and tried to get it but it was only available in a trial that required a prostatectomy. Had I had a positive psma scan perhaps they would have included the abiraterone.

[WaterRat14 in reply to ADTMan]

I guess we all just have to go with the flow. Take care.

[timotur]

Been there, done that (see bio). Zytiga did well in all the trials, but I had arrhythmia and high BP issues with it, so I dropped it after 6 months and continued on Lupron, which kept me at castration level. Good drug, just be mindful of possible cardiac SE’s.

[WaterRat14 in reply to timotur]

Good to know. I’ll be discussing all these SE’s with RO and MO. My BP has elevated in last year. Currently trying to keep it 135/80 with 8 mg of doxazosin.