Zytiga stopped working? PSA increase

While using Zytiga my PSA dropped from 43 to .00 and last month it went up to .21. I began Zytiga in April of last year. My Onco also said when the time comes he will switch me to Xtandi, I will have to ask him about Provenge as well, as one of my friends had that and he had only positive things to say about Provenge. Maybe some of our board experts will chime in Faustman, but wishing you the best results possible.
Michael

Dear Faustmann,

Our paths have crossed over time on previous threads. Your post struck a chord with me, since I am also on ZYTIGA, starting over six months ago in the summer of 2015. I know when posting on a specific topic, it's good to get a range of responses. I think it's wonderful that you are also in contact with an oncologist from M.D. Anderson in Texas --- that's a top-notch facility, in my estimation --- great that you have their expertise overlooking your case !

I've been on continuous ADT shots since being diagnosed in 2013, then I pursued a series of TAXOTERE chemotherapy treatments at the end of 2014. After my PSA began to creep up after my chemo treatments, then my oncologist and I decided to try ZYTIGA, beginning in the summer of 2015.

Thankfully, I saw immediate results from ZYTIGA --- my PSA started to fall within 20 days, based on lab work results. That was very encouraging ! A couple of months later, it seemed like a day filled with miracles when my PSA went even lower than it had while I had been undergoing chemo treatments --- my PSA reaching an all-time low while on ADT shots plus ZYTIGA. I have also seen ZYTIGA help some friends of mine who are in my same boat, but I know that ZYTIGA does not work in every case. Each case has its own characteristics, safe to say !

Just recently, my PSA has crept up just a bit while on ZYTIGA. My lab work is monitored every four weeks, without fail, and my oncologist is watching my case with great care and diligence. Realizing that the slight rise in PSA might be the beginning signs of resistance to ZYTIGA, my oncologist and I had an in-depth consultation this last time. Together, we "mapped out" my treatment plan, looking ahead to the future. That seems to be exactly where you are at in your story right now, Faustmann.

The plan is for me to stay on ZYTIGA, as long as we continue to see positive results. When true signs of resistance emerge, then the plan for me is to then switch over to XTANDI, hoping to see some positive results from that medication, although I realize that there is commonly cross-resistance between ZYTIGA and XTANDI.
From there, the plan would be that I would then undergo a SECOND series of chemotherapy treatments, this time an even longer series of chemotherapy treatments than before. There's no way of knowing today when I might need the next series of chemo treatments --- time will tell me the story as it unfolds.

For right now, I'm holding onto ZYTIGA with all my might, because I know it has helped me in my case. My oncologist refers to another patient of his who has experienced success on ZYTIGA for three solid years, so that's a testament to the impact of some of these newer breakthrough medications that have emerged in more recent years. Doctors are still finding ways to maximize the effectiveness of newer breakthrough medications like XTANDI, ZYTIGA, XOFIGO, and so forth.

Faustmann, you mentioned the strong possibility of PROVENGE in your future. I wonder if chemotherapy has also been presented as an option for your case? Each case has its own unique complexities and characteristics, yet I feel it's important for everyone to keep sharing their experiences so that we have a collective knowledge of different treatment sequences, especially with these newer breakthrough medications. The medical landscape of treatments has evolved so quickly in the past five years for prostate cancer patients, with the emergence of new medications and treatment sequences ... we all need to keep sharing, to help each other ...

Please keep us posted as you switch over from ZYTIGA to XTANDI, as that is likely my "next step" in the game. I hope that you experience a positive impact from XTANDI. It would be wonderful to start seeing cases where a patient can be on either XTANDI or ZYTIGA, and then switch over to the other one and NOT experience cross-resistance --- experiencing a good run with BOTH medications for a period of time, taken in succession after one of them fails.

I also know from other threads here that undergoing chemotherapy can result in somewhat of a "second chance" with ZYTIGA or XTANDI --- as "Celebrate Life" has attested to lately on this forum ! It's as if chemo treatments can sometimes give patients a "clean slate" and then doctors can re-introduce XTANDI or ZYTIGA and have it work again for their patients, in some instances. There's a beacon of HOPE shining right there ! That's a candle I want to light up and see blazing brightly in the future for all of us !

Keep us posted on your switch-over from ZYTIGA to XTANDI ... hope that you see a positive impact in your lab work --- I'll probably be following in your footsteps in due coarse, so draw me a good map, leave behind a compass to point me in the right direction, and help blaze the trail ahead of me --- meanwhile, I'll be sending positive vibes your way, Faustmann !

Thanks for traveling on "Treatment Road" with me, Faustmann !

Iowa State "Cyclone"

Faustmann,

We have asked our oncologist about PSA and Zytiga. He said that occasional upward movement is not necessarily a sign that Zytiga has failed. What matters is the general pattern of the increase and what the scans show. 2 or 3 successive upward movements, after a year of steady PSA might indicate progression, but 1 PSA increase by itself, may or may not. It might be worth it to take it for another month (especially if you'll be taking a scan to show what's happening), and you had such a good run with it?

Are you taking statins? There was a recent study showing that statin intake boosts Zytiga effectiveness: advancedprostatecancer.net/review-statins-boost-abiraterone-zytiga-activity-in-prostate-cancer/

Arthur

Faustman and Michael,
So sorry to hear that you may have come to the end of your current tx on zytiga. As Cyclone said, I think our experience, coupled with some current clinical trial study results supports the evidence of chemotherapy resensitizing the cancer to xtandi. Gary went straight from zytiga to xtandi with no chemo in between and failed results. He has also had a lot of other tx, as you can see in his signature. After liver mets were discovered this time last year, he participated in an immunotherapy clinical trial. Then after several PSA doublings, he quit that and had 8 or 9 rounds of taxotere, which he had also had before, early on in this battle. Then he was put on Xtandi again and has had remarkable drops in PSA. He gets another test tomorrow, and results on Thurs. While he has been very fatigued, he feels good overall, and his liver markers are excellent thus far.
Be mindful that you won't qualify for Provenge unless you are asymptomatic and not on opiates, so consider it early on. However, your PSA is likely to continue to rise, while doing Provenge, so you need nerves of steel IMHO!
If you would like to email me, I am happy to share our experiences, including how Gary's medonc overcame his vascular reaction to chemo.
There's not much he hasn't tried as a tx. He and his medonc are both amazing warriors!
Best wishes to you both. I hope your next tx is the last you'll need for a very long while.
Beth

Thanks Gunner! I will post results on Feb PSA thread.

We were told that the xofigo was palliative and no drop in PSA expected, but even though Gary had only one tx, his bone Mets cleared up significantly. I do believe there is supposed to be a documented level of pain associated to get it outside of clinical trial.
But to get Provenge you are supposed to be asymptomatic. WTH??
Gary's medonc thinks the bone met disappearance was attributed to the xofigo, but who knows for sure.
It sounds like you have an excellent team, but it can't hurt to ask about recent findings.
We were scared to death of starting down the chemo road, but it wasn't as bad for Gary as he thought it would be.
Hope it was a glitch, Faustman, and this is much ado about nothing for now.

Hi, new to discussion. Just wanted to quickly say my hubby was diagnosed at age 44 in June 2013. Started zytiga in December 2013 and is still taking zytiga.. he did provenge immunotherapy in combination with zytiga in May 2014. They tried to tell him he couldn't take Prednisone but he stopped zytiga/Prednisone and within 2 weeks his PSA trippled so they did the provenge in combination with and he has had GREAT results. Any questions, please ask. I'm not sure though how this forum works.