Zytiga vs Xtandi fight is on- Update on Paul

Why would you not prefer Xtandi? I'm glad he's finally getting the FACBC PET. Hopefully, they'll be able to biopsy something to give you more to work with.

Hi Beth. The biopsy showed all samples had underlying 5% of Gleason 5 which I wonder about. Not sure what the test would be for neuroendocrine.

His P53 mutation makes cancer proliferate as well and we still don't know if it's the cancer or if he acquired this at another time. He had it in other cells so not just cancer.

I hope we don't have to fight for the new scan but feel we might after what the onc said the other day. I am ready.

As far as Zytiga vs Xtandi emory doc seems to think Zytiga would be better given all that had happened to Paul. He didn't elaborate other than say with the prednisone it will probably have him feeling a lot better than he does now.

One thing is nausea and vomiting that cones out of nowhere fairly frequently and coming more often.

Insurance companies don't look at these things the way cancer patients do...They will look at the doctors office notes (written every time he sees the patient) and make a decision as to whether the treatment, scan or drug will provide any material benefit to the patient..If all they see is a major expense and no real benefit, yes indeed they will dig their heals in and refuse to cover it if at all possible...

If Zytiga and Xtandi were approved for wider use, starting them earlier in the treatment protocols, it would bankrupt the insurance companies...

kukukajoo-

Unbelievably frustrating, considering the stakes. When I go on doctor visits with patients and I know that some things may be new or controversial, I try to get the patient to email the doctor key journal articles in advance of the meeting. That way everyone is literally on the same page by the time I get there. Of course this assumes that (A) the doctor allows patients to email him such stuff, and (B) he will look at it before the meeting. I've found that the doctors who respond best to this approach are the ones who least need it Sometimes ya just can't win.

K,

Zytiga worked well for me, UNTIL it shut down my liver.

I've been on Xtandi about 15 months. PSA is starting to go up, but slowly.

Xtandi is about $2k more per month, so my insurance made me start with Zytiga.

Yes they can do genetic analysis of archived biopsy tissue, but as you suspect, it will tell you little. There are huge genomic changes that have to occur before the cells can metastasize. What you have to know at this point is the genomics of the metastases. And even those are not homogeneous within an individual - you're shooting at a moving target.

Hi there. So far they're saying no biopsy yet on nodules. Still under 1cm. I guess we wait? Maybe the facab scan will show something. I would think a bronchoscopy with lavage would give some answers with all the nodules? Waiting on regular onc to come back from vacation.

I'm taking it easy for a few days as not feeling great. I think my infarcted spleen may have awoke some or the clot moved as been having some pain last few days. It's not horrible but telling me to slow down so I'll listen.

Tonight I'm catching up on my religion class. .. women of the bible. Not a reader of the bible but finding it nice change. It's a pretty easy class compared to others I've slogged through and halfway done.

Soon I need to find a clinical site or I'm going to be stuck and it's going to hold up my degree. Thinking of getting my California license so I go there to do the 45 hrs and visit too. Not sure yet.

Tonight and tomorrow are hopefully nice and quiet so I can recharge a bit.

Csp sorry to hear you're in same boat. I'm hoping to look in to the lu177 trial at cornell.

142 thanks for the info. It seems it's personal on who fares best on the two. I worry so much about starting anything new as Paul seems to have the worst things happen to him. Scares me and causes anxiety. Have they said what's next for you?

I think regardless of the choice he'll also take prednisone. It can't hurt.

Good news indeed. Hope the next scan brings more good news.