Update: 1 month post Zytiga and question on zometa

Hi everyone,

Just wanted to post an update on my dad:

1 month since starting Abiraterone acetate (Zytiga generic) and 10 mg prednisone PSA went down from 4.46 on August 03 to 0.837 on September 06 and from initial PSA of 114 on diagnosis on June 24, 2019. Hoping to have a long run on Abiraterone.

On the not so positive, but expected front - he is having side effects from the hormone therapy - hot flushes, fatigue and frequent bouts of constant itching (this one is not what is frequently witnessed - not sure if it is because of zytiga, pred. or the B12/D3 medication (He had low B12 and D3 levels in August, for which the doctor had recommended supplements - anyone else experienced itching?. As long as the beast is under control, i am not complaining about the SE.

The liver numbers (SGPT/SGOT), B12, D3 were within the normal limits, T. Bilirubin was marginally high at 1.03 (normal range is 0.2-1.0). The postprandial blood sugar levels were however elevated at 218 (70-140 is the normal range).

The MO said the results were good, not to worry about the T. bilirubin, the elevated sugar levels are due to the 10 mg prednisone and asked us to lower the dose to 5 mg pred. once a day. Now to visit him after 2 months. Routing for undetectable PSA for him then and hoping the lower pred. will control the sugar and limit the side effects to some extent. Have read about Dr. Myers advocating use of Metformin for advanced Pca. If the sugar levels are not in range during the next blood work - will ask the MO about adding metformin.

Also, the MO asked dad to take a 4mg Zoledronate IV. (zometa) for his bone strength. I asked if we should do a bone density check and whether he needs the zometa as his alk. phosphate is at 64 (normal 46-116) and he just has one pelvic bone met. The MO said that for his age of 75 and since he is on hormone therapy he should be taking it once every 3 months. So he had the Zoledronate 4 mg. IV. 24 hours post the infusion, he had an onset of nausea and fever, which kept him on his bed sleeping for most of the day. The next day he felt better with the effects subsiding. Anyone with stage 4 distant mets to lymph nodes/one or two bone mets on zometa and whether this has to be taken on an ongoing basis or intermittently will do - the side effects with its long term use are scary.Also, the MO did not recommend Celebrex with it and i have read Tall Allen post about increased OS with addition of Celebrex to zometa but the reports were in 2016, anyone on the forum on celebrex and zometa?

Post Edited (givemesomesunshine) : 9/9/2019 7:08:36 AM (GMT-6)

Sunshine,
Overall, pretty darned good report. Of course, no guarantee, but I sense he is headed towards an undetectable PSA. Encourage your Dad to be active - maybe go for walks, which can help mitigate ADT side-effects and improve mental outlook.

Good on you for looking out for your Dad.

My MO said there was not a need to taper the prednisone when I stopped using it in conjunction with Zytiga. The dosage is small enough that it shouldn't pose a problem. Indeed, I had no issues then when I stopped it cold turkey.

Single blood sugar numbers are difficult to draw much inference from. You need to have a good baseline set of data and understand what is a normal range and what isn't. I find mine will bounce (sometimes as much as doubling) with several different drugs I am taking for pain, for chemotherapy side effect control, etc. If you aren't meticulous about holding things constant, time when taking, time since food/drink consumption, medications, etc., you can get misled pretty easily. And I would hate to give up some of life's great eating pleasures too quickly on unreliable numbers.