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PSA lower but elevated liver enzymes on zytiga

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Posted 11/6/2019 11:44 AM (GMT 0)
Hi everyone,

Wanted to post an update and ask your help for my dad's latest numbers. While the lower PSA has brought us some relief from the pre-test anxiety, the elevated liver enzymes has caused concern.

My dad had a orchiectomy and is on 1000 mg Abiraterone acetate (Zytiga generic) and 5 mg prednisone (lowered from 10 mg since September due to high sugar levels). He is stage 4 with multiple lymph node mets and one pubic bone met.

PSA:
June 24, 2019 - 114
August 03, 2019 - 4.46
September 06, 2019 - 0.837
November 06, 2019 - 0.103

SGPT/ALT (normal range: 16-63 U/L)
August 03, 2019 - 32
September 06, 2019 - 34
November 06, 2019 - 140

Bilirubin Total (normal range: 0.2-1 mg/DL)
August 03, 2019 - 0.49
September 06, 2019 - 1.03
November 06, 2019 - 1.7

Bilirubin Conjugated (normal range: 0-0.20 mg/DL)
August 03, 2019 - 0.18
September 06, 2019 - 0.41
November 06, 2019 - 0.7

Bilirubin Unconjugated (normal range: 0-0.8 mg/DL)
August 03, 2019 - 0.31
September 06, 2019 - 0.62
November 06, 2019 - 1

I have read few reports which state that the numbers can go up to 5 times the normal range before we have to stop the Zytiga and/or shift to a lower dose of 750 mg. Some people have shifted to Xtandi due to elevated liver enzymes. People who have experienced the same or know about it, could you please throw some light as to the path forward as my dad's ALT/SGPT is two times the normal range now.

Since the zytiga seems to be working in lowering the PSA i was hoping for a long run on it. Now i am concerned whether these enzymes indicate liver mets? My dad tends to have a glass or two of whiskey almost every night. Could that have contributed to the elevated enzymes?

My mom dad have planned a trip in Dec End- Jan and i am worried if switching medicines or altering the dose would impact their travel plans.
Posted 11/6/2019 1:12 PM (GMT 0)
You may want to see if he is on any other medicines that can cause elevated liver enzymes. There may be alternatives that will work better with Zytiga.

For example, when my husband was going through chemo treatments his ALP started to rise - I looked at the meds he was taking and looked at their side effects. I mentioned to the MO that he was taking a statin and he agreed that he could temporarily go off of that and my husband's ALP returned to normal for the duration of chemo.
Posted 11/6/2019 4:30 PM (GMT 0)
My liver numbers went way out of wack in summer of 2018. I actually stopped Zytiga for about 7 weeks until my numbers went back to normal. My Dr waited until I was just under the 5 X threshold. I restarted Zytiga at 1/2 regular dose( 500mg). After several weeks of normal liver numbers I went up to 750mg and have stayed there. You can see by my signature I am still at <0.01. Since Zytiga was working for me I certainly wanted to stay on it. The little break and reduced dose have worked for me. Hope it can work for your Dad.
Posted 11/7/2019 5:29 AM (GMT 0)
Thanks Union98 i checked for his medication - he does not take any statins or any other medications except for these and one for his marginally high BP. Will remind the MO about the BP medicine he takes.

GoBucks - When you say your doctor waited until you were just under the 5 X threshold, does it mean your MO continued the 1000 mg abiraterone with 5mg pred. even though your liver enzymes were above the normal limit but not as high as 5 times? Then he continued regular monitoring and continued the medication till they were slightly below 5 times and then stopped the medication for 7 weeks and then restarted at a lower dose?

or

does it mean as soon as the liver enzymes were found to be elevated he asked you to stop medication for 7 weeks and then you restarted at a lower dose?

Also, when you were off it for 7 weeks did the PSA remain at the same level or did it elevate?

I know elevated liver enzymes is listed as one of the side effects of zytiga but could lower prednisone also cause elevated liver enzymes? Maybe he just needs higher dose of prednisone to compensate - i m thinking the same because earlier when he was at 10 mg - the liver enzymes were in control...

Also, did you take any other measures to lower the liver enzymes? such as milk thistle, dandelion tea, ursodiol, limit your alcohol consumption, increase your water intake etc...

I so hope and pray we can find a way for Zytiga to work for him without impacting his liver. In case it does not, do we have the option to move to Xtandi? (I know 142 did from his earlier post) or owing to contraindications with Zytiga, once zytiga has been used and worked for him Xtandi wont work?

Now i am also worried the reduction in PSA from 0.837 to 0.103 in 2 months time is not good enough, it should have moved to undetectable by now...I am sorry for a lot of questions but the elevated liver enzymes have scared me. Also, there is one more problem that he is currently facing- he took one 4 mg 3 monthly infusion of zometa on September 07 and was due for another in December, but four of his teeth were troubling him and the dentist said two of them have decayed and will have to be extracted for which he needs consent from the MO due to the use of zometa. For the other two teeth he could do the root canal. He has had just one infusion of zometa yet the thought of ONJ is scary. The only respite we have is everywhere it states the risk increases with the increased usage of bio-phosphates and we take solace that he has had just one infusion, so hopefully things should work out for him.
Posted 11/7/2019 4:35 PM (GMT 0)

givemesomesunshine said...


GoBucks - When you say your doctor waited until you were just under the 5 X threshold, does it mean your MO continued the 1000 mg abiraterone with 5mg pred. even though your liver enzymes were above the normal limit but not as high as 5 times? Then he continued regular monitoring and continued the medication till they were slightly below 5 times and then stopped the medication for 7 weeks and then restarted at a lower dose?

Yes.

givemesomesunshine said...



Also, when you were off it for 7 weeks did the PSA remain at the same level or did it elevate?

My PSA has remained the same <0.01 for 22 months now. This from my signature re: the dates you ask about:
7/3=<0.01
stop Zytiga 7/16 bad liver #'s
9/11/18 restart Zytiga 1/2 dose
10/5=<0.01
I did not take any extra measures to "help" my liver. I did cut down alcohol limiting myself to 1 wine or beer on the weekend.
Posted 11/8/2019 4:03 AM (GMT 0)
Thanks a lot Gobucks, we visited our MO yesterday. He advised us to stop the Abiraterone for 2 weeks, and take udiliv 300 mg tablets twice a day (ursodeoxycholic acid) for the liver for 2 weeks and to visit a gastroenterologist for a check up of the liver. He did manually check my dad for liver inflammation (below the ribcage) and said there should not be any problem but owing to the alcohol intake it is advised to get it checked once to be on a safer side. Also, regarding the tooth extraction he advised us to wait for 12 weeks after the zometa shot and then get any invasive procedures done. The teeth are painful and troubling my dad - problems with chewing - to get respite from his pain he had increased his alcohol consumption, which he denies but mom and I can vouch for it. He is averse to taking pain killers and instead prefers respite from alcohol. He does not say so but we know. He is from a school of thought that one should not unnecessarily take medicines. Regarding the PSA response from 0.837 to 0.103 in 2 months time the MO said it is not great and could have been better- then said what i mean is its good but not the best. I think just like me he was also hoping for an undetectable. Anyways the disease itself brings us things which we cant control. I just pray that the liver has no issues and the high enzymes are only due to abiraterone usage and they come down soon and we can continue the abiraterone at a lower dose and that the PSA does not rise in these two weeks without the medicine. Hope and prayers are all we have.
Posted 11/8/2019 4:12 AM (GMT 0)
I had liver inflammation from Zytiga. In my case we cut it back to 500mg and later tried to increase it to 750mg, but it showed trouble again at that level. But I was always fine at 500 mg. That said, I did not have advanced PCa and we were using it as an adjunct to ADT and at the time it was just a guess if it would be helpful. I recall my MO saying that the liver numbers were increased but not at all dangerous (I don't recall anymore what they were) so in my case it was easy to cut it back since its use wasn't required.
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