Lupron+Zytiga vs Lupron+Chemo

When Zytiga was added to my Lupron about two months into my HT, there were no "apparent" additional side effects in the sense I didn't feel any different. (HT sucked before and it sucked equally bad with Zytiga.)

However, in monitoring my blood it turned out tat the Zytiga was causing liver inflammation so my doc cut the dose in half. Later on we tried to increase it again and had the same result so the dose was cut in half for the duration of my HT.

What confuses me about what your MO said was that I understand that chemo is optimal for high volume mets. It doesn't seem that you've had imaging to know about mets.

Here is a brief summary but the ultimate sources are the CHAARTED and STAMPEDE trials.
https://www.urotoday.com/conference-highlights/cua-2017/96656-cua-2017-chemotherapy-and-novel-hormones-in-low-volume-hormone-sensitive-metastatic-prostate-cancer.html

My husband is on ADT + Zytiga (hormone sensitive) and tolerates it pretty well. (At least he never complains)

Annie and TA,

I guess I wasn’t clear on the OP. I’m not starting treatment now. My MO’s proposals are for when mets show up on the scans. I’m just trying to determine the best course for when that time comes.

My MO’s criteria for starting treatment is for any of three things:
1) physical symptoms
2)Mets visible on a scan
3)High PSA velocity

No mets on my July scans. Will rescan in January.

I would like to get the chemo done while I feel healthy, but it would be very disruptive for my life, plus difficult to keep the cancer private with the bald head. I have a few months to sort out which path to take but at this point I have no idea which would be best. I don’t like the idea of taking prednisone and the hassle of taking the Zytiga in the specific manner required

Post Edited (mattamx) : 10/19/2017 7:00:37 PM (GMT-6)

Thanks Fairwind.

I need to update my signature. My PSA is actually 7.4 now. My MO said he has had no problems with getting approval for early use of Zytiga as long as mets are evident.

This is just my opinion, but I would not let your recurrent cancer get that big a head start....I would get it under control now and keep it there for as long as you can....But there is another viewpoint...ADT is no fun at all...It changes your life in several unpleasant ways..So if you choose to postpone starting it until your PSA reaches higher levels, that's probably okay too, gives you more quality time and in the end, it probably makes little difference when you start the ADT..

mattamx said...
My MO said he has had no problems with getting approval for early use of Zytiga as long as mets are evident.

I'm confused. Your signature doesn't mention mets. If you have detected mets, ignore what I wrote.

Fairwind said...
The sad thing is, none of these drugs and treatments will result in a cure..They will just hold the Grim Reaper at bay for a few years longer, if you are lucky..With a PSA of 5.3, you are not moving closer to ADT, you are there...

mattamx said...
Fairwind, I hear your concerns. I’m not bothered by waiting to start treatment. QOL is very important to me. My current MO, and my previous MO, were both of the opinion that starting treatment early doesn’t gain much, if anything, on survival. I would have preferred the traditional treatment strategy, which I have understood to be first line ADT, then second line ADT such as Zytiga, then chemo when nothing else works.

Matt, I've always felt a sort of kinship with you as we have followed similar paths... same T3b, G8, 20+ PSA. So I'm wondering why your Uro or RO never put you on ADT earlier? Was it never brought up or did you decline HT because of the SE's ? You have stated a preference for QOL, but personally I most fear BR and being faced with decisions such as you are now pondering.

In this battle we are confronted by uncomfortable decisions at every turn, often unexpectedly. And I certainly understand your desire to plan ahead and consider the what-if's, but as with Fairwind, find myself wondering why you are not on HT already... or did I miss something?

So I'm guessing that means that neither your Uro nor your RO suggested starting ADT during the time between your RP and RT (?) That was all I was asking.

When my RO put me on Lupron I had never even heard of ANY of this stuff. I just did what he said. But my RO did say that there were only a couple of studies that showed that neoadjuvant ADT was a benefit. If you went right from an RO to a MO I'm wondering just where the ball was dropped... or if it would have even made any difference.

Early on I even asked my RO if I should get a MO involved and he said no. Were you referred to the MO's right after RT? Just curious. I've been told I won't even know if the RT worked for another year from now.

Rob Lee,

I'm sorry if any of my comments to you and TA came across as snarky. That wasn't in my mind when I wrote them. I may have been feeling a little frustrated because I'm starting to question my ability to communicate clearly. lol.

But Rob Lee, I'm not sure anyone dropped the ball. In retrospect it's pretty clear that I was micro metastatic prior to my RP/RT. Eight weeks post surgery my PSA was 0.2, so I went right into Adjuvent RT at that time, without ADT. At the end of ART my PSA was 0.1, and that's as low as it went. So, again whether or not I had ADT prior to ART is probably a moot point because the mets were likely already elsewhere. Interestingly, my RO never brought up the subject of ADT. I mentioned it but she thought it was not necessary. My RO referred me to the first MO.

At the first meeting with my MO his plan was to let my PSA go to 20 (twenty), zap any bone mets, and start me on ADT at that time. The idea of letting the PSA go to 10 or 20 before initiating palliative care may not be as uncommon as you might think. I too found his plan to be very surprising and I posted it as a topic on HW about 18 months ago for comment. I tried to find the thread so I could paste our esteemed Tall Allen's response, but I was unable to locate the topic. By memory, TA basically acknowledged that the practice of delaying palliative care for PCa was becoming more common.

For me, quality of life carries as much weight as survival. I will not necessarily do everything and anything to increase survival, regardless of the QOL costs. I like to think that I make my decisions somewhere along the spectrum of what it reasonable. With a doctor's supervision, I am comfortable allowing my PSA to increase. Psychologically, not everybody may not be comfortable with doing that. I think our instinct tells us to “do something!” when it really may not be necessary at that particular time.

The more I think about it the more I’m leaning towards doing Lupron/chemo on the front end and then do Xtandi on the back end. Seems like I want to avoid Zytiga/prednisone if possible.The fear of chemo is etched into everyone’s minds, but I worked with a guy who was diagnosed stage IV PCa a month after my diagnosis. He did chemo and only missed a few days of work. The guy has balls and inspires me.

Thanks for your replies.

Thanks Annie. I will probably change my mind several times over the next few months. lol. Thanks for posting ur DH’s experiences with ADT + Zytiga, which was the original intent of my topic. Things got a little off track.

Hi carattop, I'm sorry to hear about your husband's diagnosis. I don't have a good answer for your question, but I'd like to suggest that you start a fresh thread for it...I think it will attract more responses that way and since you're new here it will help people get to know you.