PSA roller coaster

My onc says we are dealing with a 3-leg stool: how I feel, what scans show, least important, PSA. If two are moving together we get guidance on next steps. After a chemo break, I had pain for the first time and the PSA was jumping. since I responded will to docetaxel last year, and we had some travel plans, we agreed to retreat for 3 cycles. During the 1st cycle PSA continued to jump, reaching 2271. During the scond cycle pain ended and PSA dropped 300 points. During third cycle still no pain, but PSA returned to 2200. Scans showed some progression, especially in a liver met, so we had a decision to make. The onc offered participation in a trial which combines docetaxel with carboplatin and sirolimus or the standard of care cabazitaxel. Since we did not want to be forced to be in Seattle at least every 21 days at this point, since I have made arrangements to have some treatments at Duke, I opted for the cabazitaxel for the time being . After the next 3 or 4 cycles we will re-scan and have new genomic sequencing results and will re-evaluate the trial at that point. Of course, some other treatment or trial could become available in the next 3 months.

I had no side effects from the docetaxel except some peripheral neuropathy. Hopefully I will tolerate the cabazitaxel as well.

4 Replies

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  • God luck and it sounds as if you have thought out your next steps.

    Joel

  • I wonder if the liver met can be treated with "focal" therapy - HIFU, surgery, or radiation(SBRT?). Just to get rid of it.

    Not that it is an immediate threat....

  • I interpret the PSA hitting a high plateau as meaning that there is a lot of prostate cancer that is castrate resistant - a lot of cells that cant be shut up by taking away their testosterone. I wonder when you began to get a clump of CRPC cells - any idea - of course not but...

    The CRPC cells should be vulnerable to chemo, just as any dividing cell is.

    Radium223 for the bone pain?

  • No bone pain, so doc is more concerned with shrinking lymph mets and slowing bone spread at this point.

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