Is it Time now?

What is your age and other health issues.

Once PSA goes over 4.9 - 5.9 it is time to start ADP in my view. Time to get that PSA back down before it can spread to bones or organs. I wouldn't wait for it to get to the bones, if one can prevent that by starting ADP now.

Ron, you are at a crossroads.....ADT comes with a big side-effect load that is going to change your life, so postponing that event as long as possible should be your goal..Have you had a recent bone scan and PET/CT scan? There is a chance your cancer is still localized and can still be treated locally..But first you must find where it is located and if it's treatable by means other than ADT..There are trials that combine chemo with Zytiga that are having excellent results..Prostate cancer treatment protocols are changing rapidly. Yes, at some point, ADT is in your future. But I would make sure nothing has been overlooked before I shouldered that load....I don't think there is any difference in patients mortality whether they start ADT early or late....What is at stake is a big quality of life issue...

Lupron is one of a class of drugs called GnRH agonists - they act on the brain to stimulate the production of testosterone by the testicles. The surge of testosterone causes a negative feedback loop whereby the brain then shuts down the testicular production of testosterone completely. Another drug, called Firmagon is a GnRH antagonist - it directly shuts down testosterone production, without a negative feedback. They both accomplish the same thing, and get rid of the bulk of the testosterone your body produces.

But there are much smaller amounts of testosterone that may be produced within the adrenal glands and in the tumor itself. Zytiga inhibits enzymes that are responsible for those sources of testosterone. So Zytiga is never used instead of a GnRH agonist or antagonist, but is only used complementary to their use.

A third kind of drug, anti-androgens, like bicalutamide (Casodex) or enzalutamide (Xtandi), work in a different way. They block the androgen receptor on cancer cells so that testosterone can no longer activate it. Without activation, the cancer cell cannot multiply.

I am 100% service disabled and would like to know if the VA covers Zytiga?
Thanks!

Ron,
Not sure about Zytiga and VA. I obtain prescriptions through employer's retirement drug plan. I am 10% VA disability (too much time around the jet engines at NAS Oceana), and they covered some pretty heavy duty hearing aids.

As far as PSA, I have been going to Cleveland Clinic since onset in 2010. After surgery the Onc. made it perfectly clear that IF, and he emphasized if, PSA does rise then he would suggest waiting until it reaches 10.0, taking into consideration QOL issues. Well about six years later it hit then 10.0. He did not seem alarmed, only that past experience, studies, etc., have shown same results starting at 1.0 as 10.0, and the treatment definitely affects QOL. He waited until mine reached 19.0. Then advised some Lupron (later changed to Zytiga), Prednisone, and 6 rounds of Chemo. I am really glad he suggested waiting. He is one of the best in the U.S., and very well respected in the PCa community.

Maybe, he just felt sorry for an old man. I dunno.
Mr. Bill

you may want to check with onc. with regards to the magic number.

No scans that showed anything. All for other health issues. But had a Pet scan before starting Chemo. Found some mets in ribs, spine, and hip. Due for a PSA, Prolia and Lupron December 1. Onc. may want another Pet scan then.