Cancer Prostate Cancer Treatment The Use of Zytiga After Lupron to Control Prostate Cancer By Mark Scholz, MD Mark Scholz, MD LinkedIn Twitter Mark Scholz, MD, is a board-certified oncologist and expert on prostate cancer. Learn about our editorial process Updated on October 28, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Doru Paul, MD Medically reviewed by Doru Paul, MD Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Expert Board Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Angela Underwood Fact checked by Angela Underwood LinkedIn Angela Underwood's extensive local, state, and federal healthcare and environmental news coverage includes 911 first-responder compensation policy to the Ciba-Geigy water contamination case in Toms River, NJ. Her additional health-related coverage includes death and dying, skin care, and autism spectrum disorder. Learn about our editorial process Print One of the unique characteristics of prostate cancer is its responsiveness to the withdrawal of testerone. This “Achilles Heel” of prostate cancer was discovered in the 1940s when surgical removal of the testicles was shown to induce cancer remissions. In 1985, Lupron, an injectable medication that accomplished the same thing was approved by the FDA. Lupron works by tricking the testicles to shut down their production of testosterone. Snap Decision / Photographer's Choice / Getty Images Effectiveness Lupron controls prostate cancer for an average duration of 18 to 24 months in men with metastatic disease. When Lupron stops working, other hormonal agents such as Casodex or Nilandron may provide temporary control, but their duration of effect (keeping the PSA down) usually lasts for less than a year. Controversy has raged in academia about whether a simple decline in PSA levels accurately indicates that a patient’s survival will be extended. So these days, the FDA will only approve a new drug if the pharmaceutical manufacturer documents improved survival in a prospective, placebo-controlled trial. Proving improved survival is a much stiffer challenge than simply showing that medication causes a temporary decline in PSA levels. Zytiga is given in combination with Lupron post-Lupron failure and not alone. Zytiga is a designer drug that works by exploiting the discovery that resistance to Lupron (defined as cancer growth despite zero testosterone in the blood) is not a result of the cancer cells having learned to grow without testosterone. Rather, Lupron resistance is a result of prostate cancer cells having learned how to manufacture their own testosterone internally. Its anticancer effect works by blocking an essential enzyme located inside the cancer cell, an enzyme that is an integral component in the synthetic pathway of testosterone. The net result is that the cancer cell is blocked from manufacturing its own testosterone. Side Effects Side effects of Zytiga can include changes in potassium levels in the blood, and in rare cases, liver dysfunction. Zytiga also enhances the action of cholesterol pills like Lipitor and Crestor so their dosage needs to be reduced to compensate. To keep potassium levels in the normal range Zytiga is administered in conjunction with prednisone, a form of cortisone. Cortisone can have side effects too. It is occasionally associated with gastric irritation and stomach ulcers. Higher blood sugar levels can also occur in people who have diabetes. 6 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Wadosky KM, Koochekpour S. Therapeutic rationales, progresses, failures, and future directions for advanced prostate cancer. International Journal of Biological Sciences. 2016;12(4):409-426. doi: 10.7150/ijbs.14090 Federal Register. Determination That LUPRON (Leuprolide Acetate)Injection, 1 Milligram/0.2 Milliliter, Was Not Withdrawn From Sale for Reasons of Safety or Effectiveness. American Society of Clinical Oncology. Prostrate Cancer: Types of Treatment. National Cancer Institute. Prostrate-Specific Antigen (PSA) Test. Federal Drug Administration. Demonstrating Substantial Evidence of Effectiveness for Human Drug and Biological Products Guidance for Industry. Janssen Biotech. Potential Zytiga Side Effects. Editorial Process Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit