Stage 4 prostate cancer treatment options

Posted by safari1949 @safari1949, Nov 17, 2019
  1. I have recurring prostate cancer and it has found its way to 5 different bones, including my left shoulder and two ribs on my right side. I started 6 month Lupron shots but have been told that because it is stage 4 I need additional treatment. My oncologist is recommending either Abiraterone (Zytiga) for 33 months or 6 treatments of Docetaxel chemo. She says that they look to have very equal success. With the Zytiga I will also have to take steroids, probably prednisone which I understand includes possible liver damage. Six chemo treatments seems like a better approach but I have heard Zytiiga talked about in a very positive manner. I understand it can be expensive and I do worry my prescription drug coverage could change its formulary and raise my cost significantly as well. I’ve already had that happen with a drug I take for Parkinsons.. Just looking for some general input regarding peoples actual experience either way.

Hi Safari1949
I am 74 and in good health. I started lupron, Zytiga and Predinson in March 2019 with one month (February) of Firmagon (4 shots). My PSA in Feb. was 3,194 and today the PSA is 0.10. There are side effects but with Exercise and a good diet they are not that bad. I have not had Chemo. but it might be in my future. What I have read is it is best to hold Chemo. until later. There are a lot more drugs now for us Stage IV people so I would suggest you do a lot of research before you make your decision. Good luck with your decision (there is no wrong answer) and sorry you are a member of our community.

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Thanks for your thoughts. I do exercise almost every day, religiously and try to eat right. We plan on talking to a nutritionist too get as much info as possible. I'm 70 and am also concerned about potential liver damage. How often are you checked for side effects?

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Hi, I have not been check for side effects but do take Milk Thistle for my liver.

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@healer74 and @safari1949, welcome to Connect. I'd like to bring @donnelson @philnob @fmh1 and @alanr into this discussion about stage IV treatment decision-making.
What exercise activities do you like to do?

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@colleenyoung

@healer74 and @safari1949, welcome to Connect. I'd like to bring @donnelson @philnob @fmh1 and @alanr into this discussion about stage IV treatment decision-making.
What exercise activities do you like to do?

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Most of the year I ride my bicycle at least 20 minutes and some days 45
minutes. If not I do 20 minutes on elliptical. I also work out with some
yoga, light free weights, my bowflex, a little punching bag total about 25
minutes. Ii do this almost every day I can. I miss a few days when we
vacation but will generally use the hotel weight room or my membership at
Planet Fitness where available. I always stretch.

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3 to 4 times per week I have a work out routine that my Phy therapist set up for my specific metastasis. This is 45 to 60 minutes. On the other days I walk 1 to 2 miles. This is my goal but sometimes life gets in the way!!

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@colleenyoung

@healer74 and @safari1949, welcome to Connect. I'd like to bring @donnelson @philnob @fmh1 and @alanr into this discussion about stage IV treatment decision-making.
What exercise activities do you like to do?

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Hello, this is philnob. I use the stationary bicycle, and the stair climber at my fitness club.I also take yoga classes and practice yoga
on my own. I hope this helps.

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I'm a Lupron user for the past two years and feel quite blessed that my issue is being managed quite well to this point. I receive an injection every 6 months. Very little side effects with the Lupron, some hot flashes, which have reduced in frequency over the 2 year period, and possibly experiencing some cognitive issues but that could possibly be an age related problem, I'm 78. PSA has been staying less than 1. I do exercise fairly vigorously 2-3 times a week and do other activities most other days. I'm in good health and have maintained my weight, approx170# for the last 10+ years. Also maintain sensible eating habits. Have discussed Zytiga as possible course if PSA begins to rise so have an interest in its cost, side effects and efficacy. Predisone will be part of the Zytiga treatment. Has Zytiga gone generic? Have had prosecetomy, 2010 , radiation and chemo over the years buy only Lupron when PSA started going up about 4 years ago. Just recently started taking Alendronate, the generic for Fosamax, for bone health. Last scans about 6 months ago look fairly clean some evidence of metastasis but that has remained unchanged for last 2-3 years. I would like to remain part of this conversation and will contribute any info I can. Thank you all and best of success in you courses of treatment.

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I am currently in my third cycle of taxol after diagnosis with metastatic disease. The literature is clear that taxol+ADT is effective. There is also literature on the newer agents that suggest efficacy, but there has been no clinical trial comparing the two head to head. It is also the case that Zytiga can be used if the cancer progresses to castration resistance after taxol. I am not enjoying the side effects of taxol, but I have only three cycles to go, and I am hopeful that the therapy works to reduce tumor burden.

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@herbg

I am currently in my third cycle of taxol after diagnosis with metastatic disease. The literature is clear that taxol+ADT is effective. There is also literature on the newer agents that suggest efficacy, but there has been no clinical trial comparing the two head to head. It is also the case that Zytiga can be used if the cancer progresses to castration resistance after taxol. I am not enjoying the side effects of taxol, but I have only three cycles to go, and I am hopeful that the therapy works to reduce tumor burden.

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Welcome, @herbg. What side effects are you experiencing and how do you manage them?

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Hello Safari, I am also stage 4 prostate cancer to four places; Lumbar 1, Thoracic 11, Left scapula, and Right pelvic area. I have been on Abiraterone/ Zytiga since August. I have my blood checked every 2 weeks to make sure my liver is not in danger. So far, my enzymes are holding at acceptable levels.
My PSA number came down from 56 to less than 1. My understanding is that somewhere between six months, and two years the metastatic cells will eventually build up an immunity to the Zytiga. I will eventually discuss other options with my Oncologist. Best regards, Philnob.

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@alanr

I'm a Lupron user for the past two years and feel quite blessed that my issue is being managed quite well to this point. I receive an injection every 6 months. Very little side effects with the Lupron, some hot flashes, which have reduced in frequency over the 2 year period, and possibly experiencing some cognitive issues but that could possibly be an age related problem, I'm 78. PSA has been staying less than 1. I do exercise fairly vigorously 2-3 times a week and do other activities most other days. I'm in good health and have maintained my weight, approx170# for the last 10+ years. Also maintain sensible eating habits. Have discussed Zytiga as possible course if PSA begins to rise so have an interest in its cost, side effects and efficacy. Predisone will be part of the Zytiga treatment. Has Zytiga gone generic? Have had prosecetomy, 2010 , radiation and chemo over the years buy only Lupron when PSA started going up about 4 years ago. Just recently started taking Alendronate, the generic for Fosamax, for bone health. Last scans about 6 months ago look fairly clean some evidence of metastasis but that has remained unchanged for last 2-3 years. I would like to remain part of this conversation and will contribute any info I can. Thank you all and best of success in you courses of treatment.

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I have had a similar experience with prostatectomy and then external radiation in 2009 right after I turned 60. My psa staid down for almost 9 years and started going up. It was 2.88 then 6 months later 6.22. Because it doubled in 6 months they had me start Lupron about 3 weeks ago and since the cancer has spread I started the Zytiga with Prednisone 5 mg daily this morning. Not sure what to expect. We were shocked that the cancer had metastasized so much with no symptoms and a low psa. My monthly cost is about $37 for both meds. My urologist and oncologist agreed that the best course for longer term is to take the treatment now rather than wait for my psa to rise again. However I won't really establish a base line until next week when they want more blood work. They will be doing a bone density test soon as a base line. Hang in there and enjoy the holidays.

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@safari1949

I have had a similar experience with prostatectomy and then external radiation in 2009 right after I turned 60. My psa staid down for almost 9 years and started going up. It was 2.88 then 6 months later 6.22. Because it doubled in 6 months they had me start Lupron about 3 weeks ago and since the cancer has spread I started the Zytiga with Prednisone 5 mg daily this morning. Not sure what to expect. We were shocked that the cancer had metastasized so much with no symptoms and a low psa. My monthly cost is about $37 for both meds. My urologist and oncologist agreed that the best course for longer term is to take the treatment now rather than wait for my psa to rise again. However I won't really establish a base line until next week when they want more blood work. They will be doing a bone density test soon as a base line. Hang in there and enjoy the holidays.

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Hello, I was wondering if anyone had experienced any weight gain on Lupron. If so, are you able to control it by dieting.
Looking forward to hearing from you. Philnob.

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@philnob

Hello, I was wondering if anyone had experienced any weight gain on Lupron. If so, are you able to control it by dieting.
Looking forward to hearing from you. Philnob.

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@philnob I am wondering the same about weight gain. I started Lupron a couple weeks ago. Within a week noticed weight increase of 3-4 pounds. Now watching diet and exercise carefully, but wondering what to expect.

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@vernonkent

@philnob I am wondering the same about weight gain. I started Lupron a couple weeks ago. Within a week noticed weight increase of 3-4 pounds. Now watching diet and exercise carefully, but wondering what to expect.

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I have been on Lupron for18 months really not affected too much by weight gain. My issues have been fatigue, hot sweats then cold, and sore joints.

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