Abiraterone/zytiga for hormone sensitive PCa

Zytiga and Jevtana are usually employed post-Taxane failure. That is, after the common chemotherapy drug Taxotere or other Taxane agent has stopped working. But it is approved for earlier use, and such use seems to be becoming more popular among medical oncologists.

You mentioned "his urologist."  MOST urologists are NOT medical oncologists; a few are.  In his situation, I would suggest that he STRONGLY needs for his lead doctor to be a MEDICAL ONCOLOGIST.  As I said, these are not ordinarily the same thing, except in exceptional, multi-board certified individuals.

Beyond that, I have no slavage therapy expertise, but many of the guys here do, and I'm sure they will write.

desperate for hope said:

Thanks Max

Thanks for your comment Max. I should have clarified- he's a urology-oncologist. They wear two hats around here in Canada. I think when men become castrate resistant they move on to an oncologist. 

desperate,

I am not a person knowledgable in the art of playing HT against metastatic disease, but several guys here are, and I hope they comment.

I do know that HT is commonly used and then backed off, and then begun again, to get maximum long-term benefit, but the when or why in this is not something I have studied.  I did read a study this year that said Zytiga begun earlier than it used to be has shown dramatically improved results, but I don't recall where that study was -- it might well be the same study that you linked above.

max

Desperate,

Know that there is likely a lot of hope in store for your husband. YEARS..... HT allows men to survive a long time.  I had two friends from work die of Pca over the last 10 years or so.  Both lived 13 years after diagnosis with metastatic disease, an eternity, compared to most other types of cancer.  And both had good quality of life; the first 11 or 12 years were active, fulfilling times for both. The last year was ugly, to be blunt.  One used Zytiga and Jevtana; the other died before they were available.  I remember when one of them had his PSA go over 1,000. Chemo then dropped it to about 300, and it was like he was cured inour opinion. Odd, celebrating a PSA of 300, but it probably gave him close to a year, even in that situation. I recall that his PSA climbed from 60 to around 600 in about 6 months once, when the disease got severe and was ravaging him.  Another friend, cured from PCa years earlier via surgery, told me once over the phone, "He got his numbers wrong. There is no such thing as a 600 PSA." But there is.   I have seen men here report PSAs of 1,200, and read of a man in a journal that was in my urologist's office who hit 3,000 once and lived.  How, it's hard to imagine.

You absolutely do not know what tomorrow holds for him or you, what tomorrow will bring in new advancements. But there is reason to believe that tomorrow will be a good day for the both of you,

max

Desperate,

I am sorry for the situation. I applaud you for the researches you are doing to help your husband, however, I think that his doctor's opinion is the best for the moment. Probably your husband present HT protocol is sufficient to hold the bandit without the need of further intervention at the moment. Surely one risks deterioration in other health issues (side effects) if the HT is administered continuously in long periods (over three years), that also may cause earlier setting of treatment refractory.

Zytiga is just another drug in the HT arsenal to fight the bandit. It can be used alone or in combination with the drugs he is taking but earlier intervention with Zytiga would not alter his disease status. Traditionally this is administered as a second-line therapy providing further control on the advancement of the disease. If taken in combination with other HT drugs the quality of life of the patient deteriorates because it adds side effects to the ones already established, causing further suffering. In other words, one may get an earlier better control but such can be expected to fail earlier too.

In fact, the hormonal therapy tries extending the control, in sequential approaches using several ways to block androgens from reaching the cancer (its feeds on the stuff). Some interfere with the manufacturing of the testosterone and some interfere in the way that cancer absorbs it. Lupron and Zytiga are of the first group. Lupron stops the factory of testosterone (the testis) and Zytiga interferes in T manufacturing from cholesterol. Antiandrogens like Casodex and Xtandi (another second-line HT drug) interfere at cells AR receptors (the mouth of the bandit) avoiding these from absorbing the stuff. The therapy works well for a number of years until one becomes refractory.

Intermittent methods in taking these drugs seem to provide control while allowing periods free from the drugs side effects, improving the quality of living of the patient. It also fakes the cancer making it to cause refractory much later. You may know that refractory of HT drugs occurs when the cancer start producing its own androgens due to the lacking of it, for survival purposes, therefore becoming independent of the testosterone produced naturaly.
Zytiga manages to prolong the efficacy of HT because it also manages to interfere in the manufacturing process used by the bandit to produce its own androgens. This is one of the reasons why the drug is reserved for using after refractory sets in the initial therapy.

Intermittent approach also provides a period of recovery by the other body systems that use androgens for its activities. The testosterone is essential in bone formation, muscle activity (any tiny muscle in the body like the heart, etc) and in the general health and well-being status of other organs. It prevents osteoporosis.

The studies you refer in your initial post indicate that Zytiga can be used as prime HT successfully, meaning that one can use its blockade characteristics at the bigining of the hormonal treatment, instead of other methods of blockade. It does not imply that it substitutes the other drugs but that it complements the treatment.

Best wishes in his journey.

VGama