PSA doubling time

Hi all

Just thought I would ask is there any collation between PSA doubling time or aggressive PC and how long hormone drugs will last.

Im currently having salvage radiotherapy but my doubling time was 4 to 5 week and my gleeson score was 4+3 when i had my prostate removed March 16.

I know everyone is different I just thought I would ask

Cheers

Gary

31 Replies

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  • HI Gary,if your doubling time for psa is 4 to 5 week mate?there is movement with psa?pending on what your psa reading was during yr doubling time mate?and normally they only give us maximum two years hormone injections mate?aim same sisuation to mate?aim st Barts London tomorrow for Radiothereapy induction mate and on the 9 first hormone injections Prostap mate? Got 6 and half weeks sessions Radiothereapy

  • Hi Nuray good with it all m8

    I just wondered if having a short PSA doubling time would mean the hormone drugs would have a lesser affect or if that didn't matter.

    Cheers

    Gary

  • Gary the hormone injections should stop yr body producing testosterone?which the cancer needs to thrive on m8t?change yr diet cut all sugar as cancer thrives on sugar and red meat dairy all those things aren't helping you at all mate?Ive changed my diet m8t greens all veg any thing green cancer hates stops them multiplying m8t?read up on cancer and diet?

  • This is great advice and my beliefs and practices are the same.At first it seams drastic. But I belive nessessary...

  • PSADT < 6 months is scary fast. A month is virtually terminal, and justifies doing everything remotely possible to extend your life. Surgery, radiation, ADT, chemotherapy, calorie restriction, intermittent fasting, medical marijuana, and Dr. Leibowitz's three-pronged protocol (Google it) all come to mind for starters. You need to pursue all the above this week if you want any chance at a few more years.

    Think about it. If your PSA is 1 and your DT is 1 month, by this time next year your PSA will be 4,000. IF your ADT (hormone therapy) works well, it will buy you some time, but it also drives prostate cancer towards castrate resistance, which is terminal.

    Get cracking.

  • I agree ,you have to do everything you can without hesitation .Be your own doctor.Try everything!

  • Thanks guys i have cut out sugar altogether and eat a lot more fruit & veg as I am currently having salvage radiotherapy i can only hope this kills ir off for sometime before starting any drugs.

    Cheers

    Gary

  • It's a battle to survive and not for the faint of heart..But many ,many people had it worse and some have gone into remission for good others for many years .For me they project a return in 4 yrs,told that maybe I can make 5-6-7 if lucky by being vigilant in my own care, as I have been from the start.Go with you gut and stay aggressive if you have an agressive disease.You can win.

  • Alan Myers does know what he's talking about.For sure,heed his advice.Very informed..

  • LuLU

    Don't accept maybe 7 years. I understand all the nutrition, which is good. But don't neglect mainline medicine either, a good urologist or oncologist on the medical team is wise. I was given 5 years with my profile; however, that was 18 years ago. Your wise to read and be part of your medical team.

    Rich

  • Hi big rich how aggressive was yours if you can remember that far back lol.

    Gary

  • CAN YOU PLEASE GIVE A BRIEF OF YOURSELF---SURELY EXCELLENT RECOVERY BY GRACE OF GOD---MUST BE MOTIVATING FOR OTHERS. THANKS SO MUCH

  • Gary,

    I'm not an expert and can't give you any advice beyond a suggestion for something to talk to your doctor(s) about.

    You haven't said what your last PSA reading was. If, for example, you went from a PSA of 0.01 to 0.02 in four weeks, I'm inclined to think that you don't really know your true doubling time because, at that low a level, concentrations of PSA in the blood are so tiny that precise measurement is not possible. Also, the tiny amounts of PSA created in the adrenal gland are a factor. On the other hand if you went from a PSA of 4.0 to 8.0 in four weeks, you are probably looking at very serious numbers. The fact that you have been offered salvage radiation (it's not usually offered to men for whom distant metastases are strongly suspected), and that your Gleason score is 4+3 and not, say, 5+4, makes me suspect that your PSA numbers were low and hence might not be as awful as the calculated doubling time looks. But, of course, I could be totally wrong.

    Now for the suggestion.

    Assuming that the radiation does not solve the problem (the odds are generally less than 50/50 that it will), I suggest that you ask about the possibility of getting early chemotherapy along with ADT. Here's why: First, the CHAARTED and STAMPEDE clinical trials (look them up) suggest that, for men with aggressive cancer, a combination of ADT + chemo extends life significantly longer than ADT followed by chemo after ADT failure. Secondly of course, if your doubling time is indeed short, that's an indication of aggressive cancer and makes you most liable to benefit from early chemo.

    I don't know why patients with aggressive cancer do better with early chemo, but I can make an educated guess. Chemo damages or kills cells that are dividing. A short doubling time indicates that a high percentage of your tumor cells are dividing at any given time and hence are vulnerable to chemo.

    If your doctor says "Well ... let's just try ADT and not worry about chemo for now", and he won't read the trial results, I'd go and start the ADT but start looking for a second opinion to see if starting chemo before the ADT stops working is advisable.

    Another option is ADT plus immunotherapy. I think some day that will turn out to be a real winner, though for now immunotherapy drugs are still new and not fully developed and it's ADT + immunotherapy is experimental. We don't yet know whether it's as promising as theory might make it seem.

    Finally, it's not a bad idea to noodle around on the clinical trial websites.

    Best of luck.

  • Hi my PSA went from .1 to .2 then .35 then .7 before my Radiotherapy started

  • Assuming those numbers are a month apart then that does indeed look like a one month doubling time.

    Best of luck with the radiotherapy.

    Alan

  • Mine went from 1-2, to 14, to 29, over 5 weeks. 3 psa's. I'm real happy Zytiga works.

    Joe

  • Stampede Clinical Trial was essentially set up from the Charing Cross Hospital Oncology team here in London. Google (as you know) Stampede Clinical Trial. Results say hit the bloody cancer fast and hard. My Onco lead on the team. She's great. I am not on the trial but sure I benefit from results. I used to box, hit hard from the start and give yourself time to see what you are facing. Charted also for us patients to study as you recommend. David

  • Hi Alanmeyer my PSA went up after my RT from .7 to 2.1 ;-( and i have been told i cannot have chemo with ADT as my cancer has not yet spread to the bones or lymph nodes.

    My last PSA reading has gone from 2.1 to 2.9 so i does seem to have slowed.

    Cheers

    Gary

  • Chubby42,

    I'm no expert, however if you were given salvage radiotherapy and your PSA went up in spite of that, I would think that indicates that you DO have metastatic disease, i.e., cancer that has spread to the bones or lymph nodes. If the prostate region itself was radiated but the cancer grew anyway, it seems likely to me that the cancer that was growing was not in the radiation field. It was somewhere else. Otherwise the radiation would have blasted it.

    I don't know if chemo is the right thing for you or not, but the reason you were given for why it's not didn't convince me. Maybe you should see another oncologist for a second opinion, especially in light of the CHAARTED and STAMPEDE trials which appear to me to indicate that early chemo combined with ADT extends life longer than waiting.

    Best of luck.

    Alan

  • Hi Alan yep i couldn't agree with more, ill try to see another oncologist but on the NHS not sure.

    It does make a lot of sence in what your saying.

    Cheers

  • Altho the RT must have hit something as my PSA doubling time went from 4 weeks to 3 to 6 months ive only had the one slower reading so waiting on more blood test over the next couple of months.

  • Doubling time still matters in your case I think. I don't know much about it because my husband started at Stage IV with distant bone metastasis, so he was beyond surgery (no point in taking out the prostate because the cx was not just there or nearby) and beyond radiation (same deal). He was 5+4.

    Then he burned through Taxotere (on CHAARTED protocol -- new therapy of doing chemo early rather than later) with Lupron and Casodex, and also immunotherapy treatment, all in about a year. That's the aggressive part. He went to CRPC within about 14 months. Doesn't sound like you are near that yet. He has been stable and good for over a year on ADT - Xtandi/enzalutamide. I've been hearing/reading 18 months is typical for first round of ADT. After that, there is abiraterone + prednisone (in his case).

    Lupron/Casodex combo can work for many many years in some people.

    The doubling time is used as an indicator of aggressiveness but you'll have to find out the parameters.

    If there is an UsToo group near you, that could be really helpful. At least by us, it is mostly men who are struggling to make the right decisions for in the middle or advancing or recurrent prostate cancer, so you can hear from people who have made different decisions.

    As I said to someone else, though, if you feel like your doctor is not giving you good answers about these questions, really try to switch oncologists to someone you can talk to comfortably.

    Hope that helps some.

  • Sorry ,that question is beyond me,others will know .Was not a candidate for sugery. The fact that you were is good.It means that it's hopefully contained inside the prostate.I was told that all of these ADT drugs will fail in time,then they would move me to others.I don't understand. is your P. S. A. Doubling ?Please let me know.One good thing for us is if we extend ou time there's new stuff coming out all the times.so in a few years ,I belive more and hopefully better thingsWill come up ..

  • I too was told at DX that I was not a candidate for either radio or surgery. Too many bone mets (30+) and pelvic girdle lymph nodes all ravaged. Sufficient radio to kill bones cancer would kill me. Now just 1 bone met left after 3 years all pelvic girdle clear. No new mets. PSA down from 200 to current 0.06. I am an optimist like most of us and our carers but very aware of what may be waiting for me. David aged 71 fit and well. No

  • I love to read stories like this. 30+ bone mets down to 1. 200 PSA down to .06. All proof that sometimes the medicine does just what we hope it will do. It give encouragement to others.

    Alan

  • I know for sure DAN59(DAN-please correct me, if its wrong), positive, firm, motivated---in ten years--still counting-skiing- metastatic, psa 50, Gleason high, just no need to feel discouraged. with strong positive mind, you can change organics inside, each case is unique, but lots of medicines, please stay in touch with expert doctors, I have seen splendid results with mskcc, md anderson, dana faber. two school of thought, chemo+adt or adt alone. however in low volume, thin metastatic spread, less than 5 lesions in bone, only adt preferred with SBRT.

    be aggressively strong, you may live as long, as you are determined to !!!!!. be blessed.

  • Thanks for the replies people my PSA went from .1 to .2 then .35 then .7 all 4 weeks apart, I was told with a gleeson score of 4+3 I was medium aggressive it seems to be worse than that to me.

    .7 was the last reading before i started radiotherapy still have 2 weeks to go on that.

    Cheers

    Gary

  • lupron (GnRH agonist) or possibly faster acting degarelix (GnRH antagonist) should be (i feel) taken as soon as possible. A doubling time of a month means that something somewhere is growing very fast. A PSMA scan to locate a possible single site would have to be considered as a very helpful option, to guide local therapy, one might hope.

    EDIT: (ah yes) You need to verify that the doubling time is indeed a month, after the current treatment. If you are seeing an oncologist and radiologist, I feel confident that they are aware of most of what we are aware of. Maybe not the J591 trial, and like that.

  • I had prostatectomy (with PSA 8.5 and Gleason 10) 9 years ago. When PSA rise began again, I had radiation therapy 8 years ago. Went on double continuous ADT 27 months ago (with PSA risen to 5.4): Bicalutamide daily and 3-month Eligard shots under Johns Hopkins clinical trial. Undetectable PSA since then. Next appt April.

    Yes, doubling time indicates progression. Gleason score indicates aggression. Talk to the Oncologiest.

  • Chubby with the "Cheers" salutation I guess that that you are in the U.K. My treatments was in the States. Alan Meyer mentioned early chemo. I know Alan and he knows that I am one who benefited from aggressive treatment with chemo.

    Gleason 7 (4+3). After seeds and external radiationmy PSA never came down. At about ten months after primary treatment, PSA rise from 6.5 to 18.00 and finally 32.4 with metastates at two sports if my spine. I immediate had an injection of Lupron and a month later started a six month chemo trial. That was thirteen years ago. I remain undetectable and haven't had an injection of Lupron since February 2010.

    It sounds like you have Advanced Prostrate Cancer and inquiry into a chemo and hormone regime is not out of line. In summation, I went from 2-4 years life expectancy thirteen years ago to, I'll die of something other than PCa. I am 79 years old. Good luck. And, stay aggressive and keep kicking the bastard.

    Gourd Dancer

  • Hi gourd dancer your right I live in the UK but i am from Australia.

    Thanks for your reply 13 yrs is dam good m8 hope I can go that far as well.

    Cheers

    Gary

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