Stopping two of the three adt drugs.

FebruaryJohn22026

In 2018 had cyber knife treatment for prostrate. PSA was 8.2. Everything fine until last summer when my PSA went from .4 to 3 in a short period. PET scan showed no prostate activity but one spot on lung. Was put on Relugolix by my urologist and also abiraterone and prednisone by another cancer lung doctor. PSA is 0.0. Had another cyber knife treatment for lung. My ct scan looked good.

Question. My wife says my memory and mood are digressing. We are thinking about stopping abiraterone and prednisone to see if that helps. Lung doctor say my decision and we can go back on if PSA rises. Anyone with thoughts on this? Thanks!

Clevelandguy

Hi,

I took Prednisone once but it really disrupted my sleeping enough that I stop taking it. There is another newer ADT drug(Nubeqa (Darolutamide)with milder side effects that does not require Prednisone. Some of the newer ADT drugs have less side effects vs the older ones like Lupron. I would check with your doctor(s). Great your scans are looking normal.

Dave 3+4

swl1956

I agree with Dave above. I believe taking one of the second generation drugs will offer higher efficacy than just taking ADT alone. Most of our symptoms are caused by absence of testosterone, but taking the second generation drugs can add to the undesirable side effects. I've been on Relugolix and Abiraterone / prednisone for a year. It's working great (undetectable PSA) and I've been tolerating it fairly well, but have been experiencing fatigue, difficulty sleeping, and some cognitive decline. My medical oncologist has agreed that the Abiraterone and prednisone may be exacerbating these symptoms. She has stopped the Abiraterone and weaning me off the prednisone. The plan is, once off the prednisone (about 3 weeks) I'll be starting on Nubeqa (Darolutamide) which is supposed to have advantages over other second generation drugs such as higher efficacy, less cardiovascular issues, less brain fog. Like Dave, I'll be glad not having to take any more prednisone.

FebruaryJohn22026

Thank you for the advice. I have sent my doctor with questions about Nubeqa. I will get back on here with his opinion. Thanks!

swl1956

https://www.youtube.com/watch?v=qFK23Na9RfY&t=672s

Gamethehate3

VascodaGama

https://csn.cancer.org/discussion/329974/stopping-two-of-the-three-adt-drugs

I wonder if Abiraterone has anything to do with your experiences in that digressing of memory and mood swings. These are typical side effects from LHRH/GnRH agonists and antagonists like Lupron/Eligard (leuprolide), Firmagon (degarelix), Orgovix (relugolix), etc.

These drugs mess with the endocrine system, affecting the pituitary functionality (anterial&posterial).

Abiraterone is an inhibitor of the enzyme CYP17A1, therefore avoiding the production of androgens (testosterone, etc), by working on intertumoral and intratumoral approaches. It is included in the group of drugs classified as antiandrogens.

Apart from abiraterone, other second generation antiandrogens such as Xtandi (enzalutamide), Erleada (apalutamide), and Nubeqa (darolutamide), work intracellularly by blocking the "binding" of androgens to cell's AR (androgen receptors).

These all work to prevent the androgen effects, that is, feeding the bandit.

Prednisone is a corticosteroid used to reduce  inflammation. It prevents adrenal androgen production (other feeding material for the bandit). That is good but, corticosteroids affect the hypothalamus whose job is to controll depression, sleep, body temperature, body clock, etc, etc, which most probably are leading to those symptoms you comment above.

I wonder if we PCa survivors could take abiraterone without prednisone. In the past, many have taken Ketoconazole alone (the predecessor of abiraterone), but because of its hepatotoxicity (liver damage) and drug-to-drug interactions, this antiandrogen stopped being recommended.

Well, abolishing abiraterone in your protocol, means that you will lose the benefits of that drug that cannot be substituted by other AR antiandrogens.

I was taking Erleada together with Eligard but six months ago the oncologist stop it. He was worried on some influence of the drug in my CKD situation. Well, even without the antiandrogen the PSA continues undetectable (<0.01).

Best wishes and luck in your journey.

VG

swl1956

https://csn.cancer.org/discussion/comment/1726230#Comment_1726230

Hi Vasco,

Do you think that along with ADT, replacing Abiraterone / prednisone with one of the second generation antiandrogens such as Xtandi (enzalutamide), Erleada (apalutamide), or Nubeqa (darolutamide) might not be a wise move just to avoid the side effects from prednisone?

VascodaGama

https://csn.cancer.org/discussion/comment/1726239#Comment_1726239

Sincerely, I can't tell if switching to an AR antiandrogen it fills the need of abiraterone initially chosen to pair with the ADT drug. There is a difference in the "action" and purpose of the drugs. Abiraterone looks into avoiding the production of other androgens (adrenal, etc) too.

We should ask: why did the oncologist decided on such protocol?

Surely, the patient can try verifying if an AR can fill the purpose, discussing the matter with his caring team. Also, we should consider that part of those symptoms may be a cause of the ADT effects.

Getting old sucks. Let's enjoy as much as we can.

Best

VG

Josephg

I agree with Vasco. That is a decision that you should discuss with your medical team. These drugs cocktails are not selected at random, and any changes to the drug cocktails still need to achieve the original desired objective as set forth by your medical team.

I might also add that in my non-medical opinion, I doubt that you, and maybe not even your medical team as well, know which specific one of the drug cocktail is causing your specific adverse side effects. Is it one spedific drug, or a combination the specific drugs in the cocktail? And, to my limited knowledge, changing the drug cocktail may reduce the adverse side effects, buy they will not go away in their entirety.

swl1956

Thanks Vasco / Josephg!

I stopped taking abiraterone three weeks ago and have been weaning off prednisone during this period. Currently just taking relugolix. Yesterday was my last 2.5 mg prednisone. I can't say I've noticed any huge reduction side effects yet, however I have been sleeping better the last couple of nights which seems to be helping with fatigue. Of course it's just anecdotal and too soon to tell, but I suspect it's the prednisone that was causing the sleep issues. I must admit I am concerned about switching to darolutamide even though it was at my suggestion to due so hopefully to minimize the difficulty with sleep, fatigue, and mental fog. From what I've been reading ADT along with Darolutimide is more effective and has a better safety profile than abiraterone, however switching half way through treatment seems to be a gray area. I will be having another discussion with my MO this Thursday. I guess she might suggest staying with abiraterone if no big improvements have been noticed after cessation? I'm also paranoid that during the few week lapse of not having a second generation drug in my system might my cancer be progressing? 😥

VascodaGama

@swl1956

I think that you shouldn't take the issue so negatively. After stopping this combi, you will start experiencing the difference in a matter of one week. The half-life of Abiraterone is approximatly 20 hours, and Prednisone is shorter with a half-life of about 5 hours. This means that your body will start reducing the plasma of these combi drugs in 24 hours. In just one week you may feel differently.

To verify if the combi was providing significant benefits in the treatment you may stay on mono ADT for 3 to 4 months, checking then, the PSA, Testosterone, Androstenedione, FT4, TSH, Liver lipids, and kidney markers.

I doubt that you would see a significant deterioration of your present status. You can then start the antiandrogen of your preference and compare symptoms and results.

I wish you the best in your journey, above all peace of mind.

VG

swl1956

https://csn.cancer.org/discussion/comment/1726257#Comment_1726257

Thanks Vasco! The information and your insight is much appreciated. Being a glass half empty kinda guy it's difficult for me to think positively with this Pca stuff, but I am trying. You seem to remain upbeat even after all that you have been through. I'm curious if this has always been your nature or did you experience an epiphany at some juncture?

Josephg

https://csn.cancer.org/discussion/comment/1726260#Comment_1726260

Of course, I'll let Vasco speak for himself.

Regarding your question, for me, 'PCa Peace' came to me when I finally accepted the fact that my PCa Journey was likely a lifelong journey. In the early years, I thought that my PCa would be cured, and it would be out of my body and life forever. 4+ years into my PCa journey, and 3 years from my first remission after IMRT and 6 months of ADT, my PCa became active again, and I was again in that difficult place mentally and emotionally.

So, I went into treatment again with SBRT and 2 years of ADT. It was during this time of treatment that I recognized and accepted the fact that my PCa journey was going to most likely a lifelong journey. Once accepted, most of my mental state and emotions stabilized (apart from the ADT effect, of course), and I felt a growing inner peace that allowed me to focus on my quality of life as a person, and NOT focus on my life as a PCa patient. This inner peace grew and matured into what I referred to as my 'PCa Peace'.

In full transparency, I still get a bit edgy in the week before each of my PSA test blood draws. :-)

I wish you the best of outcomes on your PCa journey.

swl1956

https://csn.cancer.org/discussion/comment/1726267#Comment_1726267

Thanks Josephg!

I guess like most things in life that are hard which does not t kill us gives us the opportunity to become stronger if we accept it. I have not yet reached "Pca peace" but I am in a much better place than I was after diagnosis a couple years ago. I am still hoping for a long remission and possibly a cure, but not naive to the possibilities that might not be what's in store. Thank you for your insight on reaching Pca peace! You are an inspiration, especially so having been through all that you have.

VascodaGama

https://csn.cancer.org/discussion/comment/1726260#Comment_1726260

At beginning, we all go through the same experiences. Then, just as Josephg says, at sometime in our journeys we gain trust and learn in accepting our newer we. It becomes easier to strike the bandit down to the canvas.

Regarding "epiphanies", Well..., I have had many of those moments when playing Japanese chess (Shogi) and, suddenly something complex becomes clear. I call it 'experience', but it could be a sudden flash sent from a 'supernatural'. 😆 Lol

And yes, truthfully speaking, there are some occasions when I think that my mum is watching me from over there.

You will do fine. You can fill your glass and soon you will celebrate another success of your journey.