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Metastatic Prostrate Cancer - 82 yrs - Xtandi vs Arbiterone?

srs1212
Posts: 2
Joined: Feb 2017

MY dad's 82 years old and we live in India. He has been on Caluran tablets since 2011 and we introduced Firmagon to his treatment fince Oct 2016. The PSA is still on the rise and is at a 199. The cancer is metastatic. My dad is quite asymptomatic and leads an active life style with immense amount of traveling. The doctors here are suggesting Xtandi. A second opinion has given us arbiterone. So confused right now!! 

I want to make sure that we are on the right track. Xtandi is reletively new in India and not many people have taken it here. I would like to hear about the possible side effects of Xtandi.

Also, I want to know if Arbiterone is supposed to be given with a steroid?

Please help!

 

Warm regards

srs1212

VascodaGama's picture
VascodaGama
Posts: 3013
Joined: Nov 2010

in Zytiga+prednisone and Xtandi are different drugs working differently and can be taken together in combination or solo as one protocol. Such a protocol can add (taken together with) a LHRH agonist (like Firmagon). Caluran tablets (bicalutamide) is similar to Xtandi but Xtandi is more refined. This is a drug used to substitute bicalutamide (Caluran, Casodex, etc) when the former stops to be effective and cancer flourish (PSA starts to increase). Zytiga works by prohibiting the manufacturing of testosterone from cholesterol. Prostate cancer survives by feeding on androgens (testosterone) and these treatments try to block such feeding or try to avoid the production of the stuff. Firmagon manages to stop testosterone production at the testis but the cancer manages to start producing androgens by itself to survive. This is when the patient experiences refractory to the treatment (your dad's condition). At such a stage, doctors typically increase the dose of the antiandrogen 50 mg to 100 mg/daily (Caluran), or substitute it by another antiandrogen (Xtandi).

 In any case, your father should be followed by a specialist because these drugs cause side effects that need to be controlled. Zytiga also must be taken under certain norms (requires prednisone and that cannot be stop put, needs to be phased out). You can read details in these links;

https://www.zytiga.com/taking-zytiga/how-to-take

https://www.xtandi.com/

When cancer metastasizes to bone patients also need bisphosphanates to help in bone loss. This is typical in advanced PCa treatments. I recommend you to have a bone density scan to verify any osteoporosis status. This is also to be discussed with his doctor.

Best wishes,

VGama

srs1212
Posts: 2
Joined: Feb 2017

Thank you so much! He has started off on Xtandi now and we are hoping for it to work well on him.

Old Salt
Posts: 720
Joined: Aug 2014

Which drug to take (abiraterone; Zytiga) or enzalutamide (Xtandi) should be discussed with your Dad's medical oncologist.  It's not a trivial decision and I can't recommend one over the other for an 82-year old man with, what appears to be, castrate-resistant metastatic disease, but otherwise in good health. The combination (abiraterone + enzalutamide) can also be considered; there's an ongoing clinical trial in the USA to see if the combination works better, but results won't be available for quite some time. Of course, with the combination, the side effects also add up.

Perhaps your Dad could try one of the drugs and, if the side effects seriously diminish his Quality of Life, switch to the other one. Or, depending on his temperament, he could fight 'tooth-and-nail' and try the combination right from the start.

I don't recommend bisphosphonate therapy unless a DEXA scan shows that your Dad has serious osteoporosis right now. These drugs (and Prolia as well) have side effects of their own.

And yes, it's my understanding after doing some reading that abiraterone (Zytiga) has to be taken with prednisone.

I hope that your Dad's good quality of life can be maintained for many more years.

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