My dad was diagnosed with PC Jan 2015 he has been on Lupron and xgeva and his PSA was low went for his monthly blood test last week and PSA was high above normal range for lab values Dr office called and said we need to draw blood and retest I'm worried is his PROSTATE CANCER getting worse I don't know how to look at this before I tell him he doesn't speak English I help him out with appointments so I'm worried myself and I don't want him to get overly worried with the holidays coming up. Any thought are welcomed. And helpful.
Thank you,
Olivia
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Olivia007
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Olivia, Lupron eventually fails in most men, but the length of time can be very different. It sounds like this might have been a contaminated sample, but even if the PSA is rising, don't lose heart. There are other treatment options. I have been an advance PCa patient for nearly ten years. My PSA started rising almost immediately after surgery. We started with Zolodex (similar to Lupron), then moved on to other things when that wasn't doing enough. You may want to read up on Xtandi and Zytiga. I've been on Zytiga for two years with decent results.
While a rising PSA is a warning sign, the doctor may want other tests, like a CT scan and bone scan before deciding what to do next. I have been on Lupron for over 2 1/2 years, and progressed to Zytiga then Xtandi for as long as they worked before my first chemo in May of last year. While the cancer continues to progress, I am fortunate to continue to feel well and remain active. Best wishes!
I would keep using your current treatments of Lupron and xgeva and retest again in thirty days and see what the PSA is doing, stay calm and re test, if your current treatments stop working then there are other treatments ahead in your future, you are not done yet
your doctor and you will decide what is next, me personally I am now on chemotherapy
and that is working for me right now, my psa went from 45 to 4.9 with chemo.
so hang in there and keep fighting , enjoy every day, life is good!
Lupron started to fail me about six months ago. I'm now on my fifth month with Zytiga. My PSA went from 29 to 1 in two months. I have no side effects at all. I'm fortunate that I had a good liver from the start. I don't know how, the way I inhale beer. But, my oncologist checks my blood monthly. Other than that, I agree with Yost.
Yes, it is possible that his cancer is progressing, but it is also possible that it isn't progressing.
The first goal is to establish what is actually going on in him. Lupron is designed to make him castrate, sometimes it does not get a man to castrate levels which is required to have a successful treatment. So, do have a confirmatory PSA test but also have the doctor take his testosterone level (blood test that should be made when he as the confirmatory PSA test). If the PSA is confirmed, but he is not at a castrate level then there can be additional manipulations performed to get him to a castrate level.
You should also have the doctor add the drug Casodex (bicalutamide) which is an anti-androgen.
I also wonder why he is currently on Xgeva. Usually we try and hold off with Xgeva until he is castrate resistant. We do this to help and delay the possible long term negative side effects that sometimes accompany Xgeva.
Hello Joel thank you for your response, my dad is on Xgeva because his cancer did metastisize to his bones. So the doctor said it would help his bones. We will get another blood test on the 9 of December and go from there. Thank you for responding.
Hi Joe, we got our second PSA blood test back and it was 3.64 it was high than 3 weeks ago so the Lupron the doctor suggested we start Provenge? But we will talk about this more on the next office visit. I wonder why he wont suggest Zytiga? Any clues to why not another injection? But Provenge? I want to do my research before our next appointment. Thanks Joe
If he is in fact castrate resistant then Provenge is his best next step.
First, before it is decided that he is castrate resistant make sure that his testosterone level is in fact under 20 ng/dl. If not, the problem might be that he has too much testosterone still in his body. In this case it is best to modify the drugs to get his testosterone to a castrate level.
Also, has he been given Casodex (bicalutamide)?
If he is castrate resistant then Provenge is his best next treatment. Provenge works best when the PSA is at very low numbers and there is minimal cancer in his body. The longer it is delayed the less effective it will be. A course of Provenge only takes one month then he could move onto Zytiga or Xtandi.
If you want to learn more about Provenge go to the Advanced Prostate Cancer Blog (advancedprostatecancer.net) and search Provenge.
Thanks Joel yes his testosterone is and has been low. I dont understand why the doctor wont try another ADT injection before the Provenge? or how much time on earth will it give us the lupron was ood for almost 2 years. This is mentally exhausting Im trying to know as much as I can beofore our Doctor visit. Thanks again
If in fact his PSA is going up while he is castrate then he should move on to another treatment, my personal opinion is that for him Provenge is an excellent choice. Also please be aware that It has a very low side effect profile.
Also, you should also know that he should continue to get Lupron forever along with another treatments he will take going forward.
I understand that seeing him progress is hard, but he is better off getting what he needs.
Hi Joel my Dad will be finishing up his Provange next week last treatment so far he has had no side effects. We went to the doctor and he said after the provange my dad should start xtandi or the other one. I was a bit in shock! Because I thought provange was supposed to stall the cancer now he has to not only still continue shots of lupron. take pills too why did we even do provange? Why can't we just continue with shots and let Provange take its course why does he now have to be put on pills. My dad hates taking pills. And I don't get why they have to be on pillls after we went through all this with provange only to what take pills? What's the purpose I feel stupid that we went and got CT SCANS 8 hours worth of testing then we had to put a port in his chest cause his one vein didn't look good so the nurse suggested we get the port another 8 hours at the hospital now the treatments and then I get told he. Will be now put on pills I was speechless only when I got home I had a million questions to ask the doctor because I I though Provange this $100,000 treatment was going to do something without the need for the next step until we needed to but now pills and still cintinuation of Lupron? I'm so confused.
Your doctor is correct. Provenge will take a long time to work its magic, in the mean time, you do not want the cancer to continue to progress, so it is best to move on to either Xtandi or Zytiga along with ADT drugs.
In response to your other issues, understand that your father has cancer and that will mean that if he wants to delay the disease as long as possible he will be taking treatments, including scans to monitor and pills, for the rest of his life. Unhappily this is what his future will include. However, this also means that he will live longer to enjoy all the other great things in life, like being with you.
Hello, my brother has advanced pca. I do not know if his testosterone level was measured. Why is this important? Thanks.
Also, I plan to bring him to Dana Farber perhaps next month. Before I make a definitive appointment, I would appreciate getting the name of a doctor there that you might recommend. Thanks again.
Hi Olivia, I appreciate your help with this disease. I had metastases 6 years ago and have had 72 radiations. My oncologist put me on Lupron every 3 months and Xgeva every 6 months. My PSA has been 0.00 for 6 years. I still have single cell cancer, but they can not form tumors because they can not multiply (can not subdivide). So the cells have affinity for my pelvic bones and attach inside. Then they sink into the bone and leave a small pock mark (like an acne scar on your face). Over time the bone is weakened and that is why I have Xgeva injections which is for osteoporosis to harden the bones. Now I have only have one shot of Xgeva per year. The reason the cancer cells are single cell is because Lupron tells your pituitary gland to stop making all androgens (male hormones). The cancer cells have a sensor area called the AR (Androgen Receptor) that stimulates the cell to replicate and form the double helix. So without androgens the cancer cell can not replicate very well. Unfortunately the pituitary gland may not be responsive to letting the Lupron "fool" it, and other drugs can be used. There is no "for sure" way to stop this disease, so we all keep in touch with each other for the new information available. Stay in touch and we wish your father well.
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