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PSA drop with Xtandi????

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Posted 5/2/2015 2:18 PM (GMT 0)
Question for all you guys who are so awesome at answering them!!!! Husband was started on Xtandi on 4/9/15, as the Lupron only brought his PSA down for 4 months and then started on the rise again. Who would figure castrate resistant after only 4 months. PSA was at 2.1 before starting Xtandi. He is due for blood draw on Monday and just wondering what others have seen when starting Xtandi.
He's doing well on the med so far with only very minor side effects. Is still working about 10 hours a day now that farming season is in full swing. Mind you this is down drastically from the 14-16 hours he used to work when in the field. Thank god for a son who has really stepped up and taken the reins. But none the less still working and says he is "feeling better" than before starting the new med.
Feeling anxious again as testing day approaches. Ugh.
Thanks in advance for your answers and everyone's support.
Dawn.
Posted 5/2/2015 3:50 PM (GMT 0)
Hi

My Dad started Xtandi at the end of Feb - PSA was 126. Within ten days it halved to 63, another 20 days and it was down to 27 (end March). However, since then, it has has only dropped 4 to 23, which is still great, but obviously slowing down. My Dad was on Casodex and Zolodex (still on the latter). SE are horrendous for him, having said that, it's difficult to know whether the SE is from the Xtandi or from the progressing cancer.

Everyone is different and resonds differently. From what I have read, there aren't an abundance of people who have got on well with it, whether in terms of SE or PSA rising again shortly after starting, but your husband may well have great success with it - I really hope he does!

Good luck and take care

Di
Posted 5/2/2015 7:27 PM (GMT 0)
Hi Dawn,
I am in an NIH trial where I recieve Xtandi. I entered with a PSA of 15 on 2/14. I am also taking lupron and the PSA had started to rise on lupron thus the trial entry. My first PSA after 28 days on Xtandi was 2.7 and the second PSA after 56 days on Xtandi was 1.22. I am scheduled for a follow up on 5/4 along with another round of scans.

By the way I have lung mets and had persistent cough and would spit up blood with the sputum when I went into this. Within two weeks of starting the Xtandi the cough went away and remains quiet. I do get blood with the sputum if I clear my throat deeply.

I have not had the fatigue with Xtandi/lupron combo that I has on the lupron alone. Not a ball of fire mind you but I can work steady all day. I am retired but do a lot of gardening.

Good luck to you and your Dad. Hope his numbers are good.

Don
Posted 5/2/2015 8:08 PM (GMT 0)
Has docetaxel been precluded for some reason?
Posted 5/6/2015 4:41 PM (GMT 0)
Tall Allen, it had only been precluded by husband himself.. Lots of fear about it due to his also being a very brittle Type 1 diabetic. He had it in his mind that he would not survive the Taxotere. However now for the update since yesterday.
PSA was down to 0.7 after the first 4 weeks of Xtandi. Pretty happy with that however not too happy with the fact that T is now 36, when it was 25 last month and ALK Phos is 136 when it was 125 last month. Obviously some bone issues still going on. After a well deserved melt down last night, lots of tears and talking he has now decided that maybe it is time to talk to MO about the Taxotere. He says he is ready to give it his best try and I think that with his PSA down and physically feeling well that ,aye it is the best time to start. Tried to convince him the he would do better and have fewer SE if he goes into chemo physically strong as he is now. Now just waiting for a call back from the MO office to set up the appointment, then on to this new part of the journey. Any words of wisdom going into this would be greatly appreciated.
Am really very anxious about it as I know it will be a real challenge for him.
Thanks
Dawn.
Posted 5/6/2015 5:10 PM (GMT 0)
How wonderful that you two were able to have that talk, and cry over it. Just last night in my support group, we talked about partners who were non-supportive for some reason, or patients who refused to open up to their wives and include them in the decision. It affects both, and I think that both have to decide it together. You are a model for us all.

I think that Taxotere gives him the best chance for extending survival and quality of life for the longest time. I don't know how Type 1 diabetes affects things, but I'm sure he'll be watched closely. There have been some great clues on this site for minimizing SEs if you use the search bar.

T can fluctuate due to adrenal-generated androgens. Zytiga can handle that and I think that Zytiga and Xtandi together is a good pairing (the second one doesn't work well after the first fails). As you know, Zytiga prevents androgen production, while Xtandi blocks androgens from activating the cancer cells. The two drugs combined with Taxotere might knock the cancer back for a good long time. The alk phosphatase will be a key indicator that the Taxotere is working, I think.

After the Taxotere treatment, perhaps he can also try an immunotherapy, either Provenge or one of the combinations in clinical trials.

- Allen
Posted 5/6/2015 8:01 PM (GMT 0)
I think I learn something on this forum every time I come here. Zytiga + Xtandi together? Is there benefit to doing this combo with Taxotere after Zytiga fails? My MO only said that Xtandi would not work once Zytiga fails and chemo is next for me.

Dawn- y'all stay strong and know that your husband is not alone. I'm also a G9 and will do whatever we have to do in this fight. Zytiga has my PSA down to 3.88 now.
Posted 5/6/2015 8:08 PM (GMT 0)

Faustmann said...
Is there benefit to doing this combo with Taxotere after Zytiga fails? My MO only said that Xtandi would not work once Zytiga fails and chemo is next for me.

No, not after Zytiga fails. There is quite a bit of cross-resistance with the sequential use of Zytiga and Xtandi, and it doesn't seem to matter which is used first. The use of them both together is in clinical trials now. It makes sense to me to attack the cancer from as many sides as possible all at once - a "cocktail" approach. The cancer, if attacked sequentially, will always evolve to find a way around each medicine.

- Allen
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