PSA response

[Blair77]

Husband Dx on 1/25 PSA 1044 first Lupron shot 2/17 PSA on 3/28 down to 103. This is about a 90% reduction is that about an average response?

[Dan59]

It is a huge response, mine was 148 and dropped to 30 after 2 months on Lupron only,So his is a better percentage drop in a shorter time, was 11 years ago. Is he on bicalutamide and dutasteride to complete what is known as triple Andogen deprivation therapy (ADT3) with the Lupron for maximum blockade. We need to get this down below 4 and I think it will happen. Early docetaxol chemo has been shown to improve survival with early adt. You are just at the beginning of this with lots of drugs in your back pocket, many new ones n past 5 years and many more coming out. Best of luck, you are not alone here , soon others will reply.

Dan

[Blair77 in reply to Dan59]

He is just on Casodex and Lupron. He will be starting docetaxel next week. We have met with 3 different doctors and been told 3 different treatment strategies so it's really confusing! Hoping to get the PSA super low!

[JoelT in reply to Blair77]

You have made the best treatment choice. There is clear evidence that newly diagnosed men with advanced and aggressive prostate cancer (your husband) do have a survival advantage by initially under going a short course of chemotherapy (6 sessions) along with hormone therapy.

Is he also receiving Casodex (bicaludamide)? It should have been started prior to the Lupron and given his very aggressive disease it would be a good idea to take it continuously along with Lupron.

There is no evidence that adding dutasteride to the ADT combination does extend life, like all other drugs it does come with side effect potential. I know that there will a number of people who will disagree with this statement, but don't disagree without showing me the evidence. If it is there I would really like to know about it.

Joel

[Blair77 in reply to JoelT]

Joel

Yes, he's on Casodex 50 mg.

[JoelT in reply to Blair77]

Good

[Dan59 in reply to JoelT]

I have been on Avodart/dutasteride almost from 3 months out, 10 years 7 months on it continuously , I wish to block the much more powerful form of testosterone dihydrotestosterone ,as snuffy said "very benign drug with a possible side effect of growing hair on a bald man". At very least it has helped keep my water works working well, I think it helped with my long survival. I know it has been argued in these forums forever between Charles , Chuck and many others , and the last thing I want to do is argue about anything. I did it the whole time , and it worked for me. This link is a study out of Harvard where they added dutasteride to HDK and increased the time to median time to progression from 8.6 months with just HDK/HC to 15.7 months by adding dutasteride. 7 months is a pretty good boost in CRPCA. I do not think studies have been done with initial adt, but I suppose I just went with the advice of Snuffy, Liebowitz , Lam, Sartor, Sholtz and Strum.

ascopubs.org/doi/abs/10.120...

[AlanMeyer]

I agree with Joel. You've got the right doctor doing the right things.

Best of luck.

Alan

[Hidden]

That sounds like a very encouraging and hopeful response. It is nice to hear good news on this forum. Keep sharing.

[ctarleton]

Yes, response can be rapid. 3 years and 5 months ago I started ADT with Lupron with a starting PSA of 5,006.4 and very extensive bone and lymph node mets, plus severe pain in two places. Within one month PSA dropped to 84.1 and severe pain melted away. Within four months PSA dropped to 2.4 and below, reaching as low as 1.0 after about one year.

Charles

[Break60 in reply to ctarleton]

Charles

Great response but .4 added to 5006? Got a bit of a kick out of that detail🙂!

[Dan59 in reply to ctarleton]

That is a great response too, I am happy for you

[Dan59]

Thanks for your response Nalakrats

[herb1]

Blair77: I would just like to comment that my blood boils when I see psa (or other values) printed by supposedly knowledgeable scientists, or even doctors with such absurd precision! It does make me a bit concerned about whether these people have their brains in gear when they show you these numbers. Don't get me wrong, you've done great, but your numbers are, at best, from 1045 down to 103. Ignore the remaining digits...at least.

herb

[Sisira]

Blair77,

It is quite interesting to look at PSA especially when the numbers sky-rocket and nose-dive with the initial hormone deprivation therapies ( ADT ). The best story I have so far come across is from the website of "YANANOW" PCa Support Group. This particular survivor living in Perth Western Australia was diagnosed in July 2008 at the age of 72 with initial PSA 7000ng/ml. Most aggressive PCa of GS10 staged T4. Within months, Casodex and Lupron brought down his PSA to 4.6ng/ml ( 2008 - 2009 ). In 2010 again his PSA rose up to 72.0ng/ml. In 2011 he entered a Trial and was treated with an IV infusion of Ipilimumab taking PSA down to 40ng/ml. But in 2012 PSA went up to 280ng/ml and he was taken off the Trial.In 2012 his PSA went up to 8300ng/ml when his Onco confirmend that he has reached mCRPC. When he was planning to undergo Chemo Therapy, quite unexpectedly he suffered a heart attack which kept him off PCa treatment for nearly 6 months. The next PSA check up in 2013 showed a shocking number of 15000 ng/ml! Up to 2015 he received Chemo on and off strategically with 4 monthly Lupron injections, monthly Zometa and later introduction of Zytiga which incredibly managed to bring his PSA down to 460ng/ml. Fortunately he has not suffered or affected by the symptoms of a stage 4 mCRPC but remained active with a very positive attitude. Throughout, he had been using several anti cancer foods an supplements as alternative medicine that many of us have heard of. He has last updated his story in February 2017. His PSA once again had gone up to 11000ng/ml which was successfully brought down to 460ng/ml with 4 rounds of Chemo but before long has again gone up to 3600ng/ml. He is now waiting until his PSA reaches 6000ng/ml to initiate a Chemo regimen as advised by his most trusted Oncologist. As of today he is 81 and I would like to end up his story with his own words which concluded his last update : "When I look back at the time my PSA reached 15000 I fully believe that the man upstairs is looking after me"

This is how PSA can shock us and fascinate us. But with an aggressive advanced PCa, don't feel complacent with low PSA values. Even when the PSA can be brought down to Zero by ADT blockades, please remember the most aggressive type of PCa can have small populations of PSA negative cancer cells and for them hormone treatments are irrelevant because they are hormone insensitive/refractive. You have not indicated sufficiently the important pathological factors of your husband's PCa such as the Gleason Score and the cancer Staging ( TNM ). I am an advocate of early Chemo Therapy ( with proper combinations for synergy ) in the treatment of advanced aggressive PCa ( GS 8,9 and 10 ) and also depending on the pathology at diagnosis. It is more advisable to hit the cancer as hard as possible with all the strong weapons you have. I fully agree with Nalakrats. Don't give any chance for the cancer cells to breath. Testosterone is not the only oxygen for them. These cancer cells, if you leave them can later become chemical factories for their own survival. Therefore act fast.

Thank you all for reading the above story on PSA. We need hope as much as we need good medicine and treatment.

Blair77, keep us posted with more details about your husband's progress. This is the best PCa Support Group on Earth! ( At least for me )

Sisira

[Blair77 in reply to Sisira]

Thank you Sisira! What a hopeful story of 9 years! My husband has a Gleason of 9 and Stage Iv with bone mets. He's 47 so I'm hoping we can beat this for a long time!

[Sisira in reply to Blair77]

Blair77,

You seem to be a wonderful wife. I am glad that the story I related have several key learning points for you and matching with your husband's pathology. Yet relieving that apparently your husband is in a more favourable condition compared with the subject. But your husband's age being 47 has a long time frame to fight this battle. There is a brother who has joined us last year named Paul from Australia who too was diagnosed at the age of 49 with almost the same pathology. He is interacting with us very intelligently and making his choices for managing his disease in a very impressive manner. Each individual case is different because PCa is a genetical malfunction and the hell is created by the DNA. Although the responses to various treatments can vary from person to person, we can share our knowledge and experiences. Please try to catch Paul and we have some well known friends too who are very knowledgeable on the subject of PCa and ever-ready to help. Some of them are Patrick, Nalakrats, Dan59, Gusgold, GourdDancer, Yost - just to name a few and the list is not exhaustive.

Cheers

Sisira

[Sisira in reply to Sisira]

Sorry, I forgot to include Alan Mayer's name in my list. Further,in my opinion Dan59 is also a very competent mentor and a good motivator. I think 11 years ago he was diagnosed at the age of 42 with a much worse risk profile than your husband's. We have much more respect to these guys than to our Urologists and Oncologists!

Sisira

[Blair77 in reply to Sisira]

Wonderful to be in a helpful place!