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PSA trending up on Xtandi

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Posted 5/10/2016 10:05 PM (GMT -5)
Hello everyone, I have a question to ask. How is it determined if Xtandi is still working or not? I know they go off of PSA levels rising but does it depend on how fast or how many times it goes up? My husband just started Xtandi in March with his PSA at 3.74 and it went all the way down to 0.09! We were so encouraged to have it back down so low but now it is up to 1.03 since last month. That is not a high number but he had progression of disease in March with several new lesions with a PSA of only 3.74.
He has done well on Xtandi (with very little side effects) and we will be devastated if it is already failing.
Thank you for your time.
Posted 5/10/2016 10:16 PM (GMT -5)
Sometimes when Xtandi fails, Zytiga will work better..Also, for extensive bone mets, Radium 223 has had good success...

http://www.xofigo-us.com/patient/index.php

Also, be sure they check his testosterone level..Sometimes Firmagon (Lupron) does not work as desired and the "T" level does not fall to castrate levels...

Best Of Luck To You...
Posted 5/10/2016 10:32 PM (GMT -5)
Dear Teamchris,

I always read your posts and updates --- you have my loyal support, every step of the way as you pursue your treatment strategy.

Yes --- as mentioned above, leave no stone unturned --- make certain that you have worked the testosterone level down to the lowest point possible --- my oncologist tried three different forms of ADT hormone shots to finally work my testosterone down to very LOW levels --- below 10, in fact.

So -- we started with LUPRON, as most folks do --- then tried FIRMAGON --- and finally went to ZOLADEX injections, which brought my testosterone down below 10, at long last.

Before that, my testosterone was experiencing some "spikes and flares" --- and my PSA fluctuated up during those times. It's easy to ask for a testosterone test --- my oncologist tracks it, along with PSA every month ---

I'm currently on ZYTIGA --- a "cousin" to the XTANDI you are on currently, you might say. It never hurts to ask for an occasional testosterone test, just to ascertain whether your ADT hormone shot is truly suppressing the testosterone to a great degree --- which can help control the P.S.A. levels.

Stay in close consultation with your doctor --- my oncologist noticed that we didn't have my testosterone worked all the way down, so that's why we tried the other forms of ADT hormone shots --- and now my testosterone has stayed below 10 for months, which has helped suppress my P.S.A. --- along with ZYTIGA.

My best to you, looking forward,
Iowa State University ~ CYCLONE FAN
Posted 5/11/2016 12:06 AM (GMT -5)
Teamchris,
So sorry you are seeing the rise in PSA. Our oncologist always looks for two consecutive rises before declaring a failure. With your husband's bone Mets there are so many tx options from radiation, radium, chemo, zytiga...I would see what Tall Allen thinks and discuss next plan with your oncologist if it were my husband knowing what I know now. If that makes any sense. Try not to get worried. PSA is still quit we low and there's good chance the lesions are reduced from xtandi and HT.
Beth
Posted 5/11/2016 1:31 AM (GMT -5)
Teamchris,

Unfortunately, Xtandi and Zytiga have a lot of cross resistance -- if one fails the other usually won't work very long. Estrogen patches sometimes work surprisingly well. It looks like Taxotere worked very well, and it can be repeated.When that doesn't work anymore, Jevtana might. Xofigo works great on bone mets. Provenge is available too.

There are lots more medications in clinical trials - hormonals (like ARN 509 or VT-464), immunotherapies, and growth factor inhibitors.

- Allen
Posted 5/11/2016 3:30 AM (GMT -5)
Teamchris,

One data point is no data point. I know it is hard to sit around and wait for the next PSA results to come in (I guess we all know how that feels...) but it might be the best you can do for now. If the next PSA value is again clearly higher you might want to do a scan to find out where the activity is happening. Try to do a PET/CT scan with one of the more recent, sensitive technologies such as such F18-Choline, C11-Acetate, or Ga68-PSMA.

The results of the scan will give you the basis to decide what to do next. If there are various active spots you might consider another round of chemo. If the new spots are all in the bones Xofigo could be a good next option.

But of course we all hope and keep our fingers crossed that the next tests show a declining PSA!

I am a bit in the same boat as you (similar diagnosis, age, treatment - see details below), probably one step behind you. I just started Xtandi and hope that it will work - hopefully for a long time. So I am very interested to hear how you will be doing - keep us posted!

Kind regards, m.
Posted 5/11/2016 9:31 AM (GMT -5)
Thank you for the replies. I appreciate every one of you. What does the Xofigo do to help the bone mets? Does it take them away or help with the pain? The medonc has never even mentioned this to us. We see him tomorrow so we will ask about this.
I am hoping he can calm our anxiety. It just sucks that we get so encouraged that something is working but it only works for a couple months. I guess it's all part of this journey that none of us wanted to be on. Thanks again for your support.
Posted 5/11/2016 12:30 PM (GMT -5)
It does both - it reduces bone mets and the pain they cause. It's perfect for cases like yours where there are "innumerable" bone mets. The active ingredient, radium 223, is chemically similar to calcium, so it is drawn to areas of active bone growth (like bone mets) and emits short-range alpha rays that destroy the met. Because bones create all our blood cells, the worst side effect can be reduction in the red cells, white cells and platelets, so that has to be monitored carefully after each injection.

- Allen
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