Should I be concerned about rising T while on Xtandi?

Hey there Xtandi Vets or knowledgeable members. I am reaching out to get Xtandi/Testosterone level experience.

I'm seven years into the PC game; have been on Firmagon since 6/16 and added Xtandi back in 2/2017.

My PSA went to <.01 within 3 months of adding the Xtandi and is still there. However, my "Testosterone Total, Serum", which was 14 just before I began Xtandi, has now risen to 63.

My MO said he's more concerned with the PSA at the moment, but, we'll keep an eye on it. I am ok with that, he hasn't steered me wrong yet. However, I thought I'd reach out to the HW Peloton to see if you've have similar experiences with this situation.

Thank you in advance for any help or input you might provide.

Tony

It sounds like your adrenals are kicking in. There are two drugs that suppress adrenal production of testosterone - Zytiga and Ketoconazole. I doubt you'd be able to get approval for Zytiga on top of Xtandi outside of a clinical trial. So that leaves Keto. The other thing worth discussing is an estrogen patch (with tamoxifen to prevent breast issues). Let me know what your MO says about them.

Tall Allen said...
There are two drugs that suppress adrenal production of testosterone - Zytiga and Ketoconazole.

This caught my eye... I used topical Ketoconazole and Nizoral oral suspension in the past, but have never heard of it being used in treatment of PCa. How does that work?

RobLee said...

Tall Allen said...
There are two drugs that suppress adrenal production of testosterone - Zytiga and Ketoconazole.

This caught my eye... I used topical Ketoconazole and Nizoral oral suspension in the past, but have never heard of it being used in treatment of PCa. How does that work?

Keto was developed in the 1970's and introduced for fungal treatments and male patients noted an effect on their sex response. This led to further investigations that showed the patients were correct that T was reduced, including from the adrenal glands which are a source of ~5% of T production. It was a more commonly used before zytiga when psa was rising while on LHRH drugs. It seems to have a similar effect on CYP17 which is a main enzyme target of zytiga. Because Keto reduces adrenal production including cortisol then cortisol replacement with steroid substitutes such as prednisone are usually added with the keto.
Keto has been overtaken in the anti fungal field by other drugs which have a -conazole ending to their name.

Thanks, tarhoosier and TA.

Hello Tony In Virginia,

My oncologist started tracking my testosterone ... many doctors fail to check testosterone levels for fellows who are on ADT shots ...

I started with LUPRON ... we started to see the testosterone showing "spikes and flares" ...

My oncologist said, "I think maybe we could try another form of ADT shot, to see if we can get the testosterone level worked down, to help suppress the PSA levels."

We tried FIRMAGON next ... after a couple of months, we didn't see the testosterone levels falling ...

So ... from there, we tried ZOLADEX injections ... that's when my testosterone level went down below 10 ... and that's where it has stayed.

Third time's the charm, as they say!

You can always switch back to your original form of ADT shot ...

My original urologist was unwilling to use anything but LUPRON ... it was my oncologist who was willing to try the other forms, and I feel it was worth it, in my particular case --- because we finally got the testosterone worked down to a lower level.

I know it's helpful to hear from a range of respondents, so I thought my experience might be helpful for your case ...

Handshake, from across the miles,
I.S.U. "Cyclone"