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Timing of Lupron and Zytiga/Prednisone in recurrent metastatic patients

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Posted 10/29/2018 3:11 PM (GMT -5)
Checking in as my husband's late November Mass General appointment approaches. As you can see from his signature, my husband's PSA rose after ending Lupron in 2017. Scans revealed several mets. Dr. Matthew Smith at Mass General, prescribed Lupron and said Zytiga would follow but didn't say when. If this was your scenario--resumption of Lupron followed by Zytiga, how soon did the Zytiga follow?
Posted 10/29/2018 8:47 PM (GMT -5)
I'm not a recurrent case but my MO wanted me to start Lupron and see the side effects. Then started zytiga a month later to be able to monitor those side effects separately.
Posted 10/29/2018 9:00 PM (GMT -5)
They had already decided I was headed to Xtandi while I was on Lupron. Insurance caused a ruckus, and I had to go on Zytiga first. But I was never off Lupron for more than a month.

In effect my PSA was going up while I was on Lupron between casodex and zytiga. It was a guess that Lupron had become less effective.
Posted 10/31/2018 5:49 PM (GMT -5)
The standard treatment is to go with Lupron as long as it's working..Then add Casodex. When that fails, more to Zytiga while continuing the Lupron..The idea being to extend the patients life as long as possible..Beginning the Zytiga before the Lupron / Casodex fails may produce a very low PSA number but for how long ? Will doing that extend the patients life over the standard treatment ? I think there are several trials running now trying to determine that...
Posted 10/31/2018 6:47 PM (GMT -5)
As per Gobucks, when I start ADT it will be Lupron followed by Zytiga a month or so later.

The studies seem to be showing that adding Zytiga earlier gives a significantly better outcome than waiting until Lupron, by itself, becomes ineffective.
Posted 11/1/2018 12:31 PM (GMT -5)
My onco had a slightly different treatment path in mind.

When I go castrate resistant and there are NO imageable mets then Xtandi
If their are imageable mets then Zytiga
Posted 11/1/2018 1:08 PM (GMT -5)
Being treated at Dana Farber.
Started with Lupron and Casodex.
when numbers jumped, Lupron alone. (became the treaded crmPC)
Still rising
Lupron and Zytiga now
Next Lupron and Xtandi
After Xtandi (all with Lupron) Erleada, Provenge, Clinical Trails. (This is suject to change based on my situation and new advancements in treatment)
Then chemotherapy.
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