Zytiga not working

Started Zytiga September of 2019. Helped some but never got a big drop in PSA. I’ve been on ADT for < 2 years so, this is a little soon I would think. Anyway, my MO and I agreed Xtandi is the next step. Those of you that have also made this change, what was your experience? What were your side effects? How long before you had to make the change? Little anxious right now....


Here’s the progression of my PSA since August of last year. See below for the “Paul Harvey”...

03/12/2020 - 8.75
02/13/2020 - 7.6
01/17/20 - 7.35
12/19/19 - 8.59
11/21/19 - 6.10
11/7/19 - 6.93
10/24/19 - 7.43
10/9/19 - 11.5
09/26/19 - 9.16
08/29/19 - 8.60
08/20/19 - 8.12

I’m currently 63 dx with PC at age 60. Here’s a timeline of events.

June 2016:Had routine physical. PSA was 14.4 Biopsy revealed 8 out of 10 cores positive for PC. Gleason score 9

July 2016: Had RALP. Dr found PC in 1 out of 8 lymph nodes removed. Started Eligard. PSA went to 0.2

Aug 2016: Had a blood clot that stopped up my catheter. Went to the ER where they managed to rupture my bladder replacing my catheter. Next day I was having hallucinations and I went back to the ER. They discovered the ruptured bladder and drained around 2 liters of urine from my body cavity. Week in the hospital with drain. (Really long story here, I won’t bore you with all of it)

December 2016: stopped Eligard. PSA stable through radiation.

Jan 2017: Radiation 32 treatments

Aug 2018 PSA up to 4.2. Started Casodex due to reduced side effects. Worth a try I figured.

Feb 2019 PSA back up to 4.2. Bone Mets found in ribs and spine Started Eligard

Aug 2019MO started Zytiga, Xgeva, Prednisone to augment the Eligard. Started having mild pain I attributed to sciatica.

Oct 2019 Dr. started Casodex to augment the Zytiga for 1 month as PSA wasn’t going down fast enough.

Dec 2019Pain was a bit worse from Casodex flare. MO prescribed opioids for pain

Biker,
Sorry to hear that your response to zytiga hasn't been what you expected. I do not have any experience with switching but have heard that there has been success by doing so. You still have many options available to you including the switch to Xtandi. For some reason Zytiga does not work for all and the switch to Ztandi can often help with bringing your PSA back down. As for the bone mets, Have you talked with your oncologist about Xofigo, or perhaps Clinical Trials. It may be too early for trials but that is something to think about. You can find a link for them here https://clinicaltrials.gov/. Best wishes to you and please keep us informed. Take care.

Biker,
I was on Zytiga for about two years before changing to Xtandi. After changing to Xtandi, I remained on that for a little over a year. The main reason I had to discontinue Xtandi was sever headaches and fatigue. I have been off of Xtandi for almost a year, and my last PSA was .02. So the ongoing effect of having taken Xtandi, and now taking Lupron and Zometa has given my about two years of ongoing low PSA readings on .02. And I think Lupron also gives me headaches, but adding Xtandi made them much worse.

Wishing you the best on your next part of your journey.
Michael

I had a brief stint on Zytiga but experienced some kidney issues and stopped, restarted a couple of weeks later and had to stop again. Switched to Xtandi and have had several side effects but nothing so bad as to make my MO suggest I stop taking it or that I would voluntarily do so. Headaches, high blood pressure, some nausea/loss of appetite, a strange metallic taste in my mouth, and probably a couple of other things including insomnia. I am hormone sensitive and also take Eligard and Xgeva so hard to know what side effects might be from the ADT. I like the fact that it’s easier since it doesn’t matter whether taken with food or without and no prednisone so those are conveniences. My PSA is <0.1 and my MO doesn’t do uPSA testing. That said, since I had bone Mets with a PSA of 0.1 I’m one of those guys whose PCa doesn’t produce much PSA so that’s not real helpful in determining how effective my treatment is. I’ve been having a lot of back pain and just had a bone scan today to see if more Mets have materialized. Hope not! Good luck and hoping you get good results on Xtandi.

When I copy the link and paste it into my signature file it gives me an extra https:// at the end. I’m on an iPad.

A review of 10 studies:

Sequential therapy of abiraterone and enzalutamide in castration-resistant prostate cancer: a systematic review and meta-analysis (2020)

"Conclusions
ABI-to-ENZ sequential therapy in patients with CRPC was associated with better PFS, PSA–PFS, and PSA response rates. Regardless of sequencing, response to drug therapy was transient for both ABI and ENZ when either agent was used as a secondary therapy. Despite this, treatment sequencing is important to achieve the maximum possible benefit from available drugs in CRPC."

Unfortunately, it appears this doesn't translate to improved OS.

Doing ok for now. Got a big drop in PSA the first month of being on Xtandi (Over 3 points!). The next test a month later PSA was up a point but I had radiation on my bone mets to reduce pain a couple of weeks prior to bloodwork. The doc says this probably caused the flare in PSA and it should go down again. From what I read, the radiation kills some of the cancer cells causing dead cancer cells to get dumped into my bloodstream and raising PSA. I’m going to keep my fingers crossed.