Next step

[APK3]

Just finished up with chemo. Went from 139 psa @ dx to 1.66. I didn't make it to the non detectable team. Not sure what to think as many here with higher psa's have gone down lower. I'm currently still on Orgovyx and Nubeqa. Should I ask for more rounds of chemo as I've done 6 ? Will my PSA possibly continue to drop on my meds ? Any similar results from you guys that didn't get to undetectable but continued to drop ? Any advice of what to do next ?Thanks for any reply.

[Nusch]

If I were you I would go for antoher PSMA Pet/CT scan to compare developement of metastases. Maybe surgery and/or radiation would be an option from here.

[God_Loves_Me in reply to Nusch]

Great Suggestion and also Agree

Ask for PSMA Pet Scan and CT scan

- if you have less than 5 mets than go for SBRT Radiations

- Also think about debulking surgery if mets are less than 2 or 4

- How about provenge ?

[APK3 in reply to God_Loves_Me]

Thank you both for your replies. I actually had a Psma pet scheduled for tomorrow but got a call from Ascension Health which said due to the recent hack of their system and requested ransom payment demands, all psma scans are to be rescheduled . They had no idea when they would be able to proceed as it affected 100 of patients.. Unfortunately their the only imaging center in these parts that do them. So I took a number like at the tag office ..Crazy times.

[Tall_Allen]

What determines whether debulking is beneficial is 3 or fewer metastases on a bone scan/CT (not a PSMA PET/CT) on the original diagnosis. Did you have a bone scan/CT?

prostatecancer.news/2018/09...

[APK3 in reply to Tall_Allen]

Yes..I did have a bone/ CT after the 3rd infusion. I was dx with several, so I assume I have more than 3 per the report. Had several mets that had no further uptake but a few with a small increase in size. MO said he believed it was the chemo working on them as far as how they looked on the scan....In regards to the PSA. Would additional chemo be warranted or can the Orgovyx and Nubeqa continue to reduce it? Thxs for your time.

[Tall_Allen in reply to APK3]

No point in debulking then.

The decision on continued docetaxel infusions is really up to you and your doctor. Some patients who have minimal side effects have as many as 10. They stop it to give you time to recover. Remember that chemo only kills actively growing cancer cells, and you probably don't have a lot left. Maybe switch to Jevtana if you want to keep going? But expect diminishing returns - PSA of 1.66 is really a very good response.

[APK3 in reply to Tall_Allen]

I tolerated the 6 rounds. It wasn't fun. I'm glad I did it. I was apprehensive based on my ignorance of the treatment. Having said that, I'm not sure I'd want to go through more for just a small decrease in the PSA... Appreciate.

[God_Loves_Me in reply to APK3]

What about SBRT radiation for remain spot ?

[APK3 in reply to God_Loves_Me]

I was going to bring that up with my MO.. Since the Psma is delayed I'm not sure my MO's thoughts. I have an appointment next week Will pick is brain on the next move.Thank you

[Tall_Allen in reply to God_Loves_Me]

For what purpose?

[NanoMRI in reply to APK3]

Sharing experiences. Six years ago my salvage extended pelvic lymph node surgery removed six cancerous mets, very successfully, enabling me to defer ADT for the past six years and as of today, still NED. A close friend, Robert, post CR, had six pelvic mets identified on PSMA. He went for salvage extended pelvic lymph node dissection - 31 cancerous nodes removed. His extensive medical team firmly believes the debulking bought him additional years and a better chance to get after remaining cancer. He is doing great. All the best!

[APK3 in reply to NanoMRI]

Thank you Nano for your response and food for thought.

[God_Loves_Me in reply to APK3]

Please schedule advance appointment with radiation oncology so he can start treatment

[APK3]

I don't have an RO. Probably should look into that. Just the Uro/MO at the urology center and the MO at the infusion center. I think my MO can clarify how many mets that might be of need. I personally can't decipher that based on the scan report.It doesn't say x amount. Thanks for your suggestion and time...God_Loves_Us.

[pakb]

You can look at my profile for my husband's stats. It took him 6 years to get below 1.

[APK3 in reply to pakb]

Thank you for your reply.

[pakb in reply to APK3]

Hoping you're psa continues to drop- we rely on the scans to give us a better picture than PSA. 💙

[APK3 in reply to pakb]

Thanks again pakb. I did check out his bio. It does the brain good to see he's getting on with life . I plan on doing the same. Just waiting on a reschedule of my Psma Pet currently and will proceed accordingly.✌️

[MarkBC]

I had chemo shortly after diagnosis. My PSA started at 103.0. When six rounds of chemo finished, it was around 1.5 It continued to slowly decline during the next year until it reached a nadir of 0.17. It continued to stay low with only my ADT injections for about another 3 years. Hopefully you get a similar good result.

[God_Loves_Me in reply to MarkBC]

Very positive response

[APK3 in reply to MarkBC]

Appreciate your sharing your situation Mark.

[EdBar]

Debulking using radiation seemed to help me and I had numerous mets, I too had early chemo (6 rounds which sucked). You can read my profile, I went on to being undetectable for 6+ years, I’m still playing whack a mole now that I’ve become detectable again and so far PSA has dropped each time.

Ed

[APK3 in reply to EdBar]

Thanks for your reply Ed.

[Vangogh1961]

I didn't go undetectable until a couple months after chemo and right before I started radiation. I was low mets, only 3 so I had the pelvis done.

[APK3 in reply to Vangogh1961]

Thanks 1961. Here's to you staying undetectable.

[diatom]

Chemo only helped me for six months.

I had my first tx of pluvicto two weeks ago.

[APK3 in reply to diatom]

Good luck with your new treatment. We are indeed all different with how the beast progresses.

[Tacho]

Hello All,

I was diagnosed in November with metastasized to pelvic and lymph nodes and one on chest. My PSA was 163 on 12/30/23, got my first Lupron shot and started me on Xtandi. Follow up on Feb PSA down to 53, follow up in March PSA down to 23 and 2nd shot of Eligard and last follow up in April down to 6.49. I have scheduled for next Eligard shot on 6/17/24 and praying it goes below 1...still on Xtandi. Side effects are back aches, joint aches and hot flushes/night sweats. No radiation or chemo yet as oncologist, urologist and radiation doctor want to wait until it drops to 0. Hope I am on the right track.

Keeping up the fight