PSA Dropped but Testosterone level unchanged

[JAOP]

Hello,

Just left Memorial Sloan Kettering Cancer Center with my dad. He received his initial 2 shots of Degarelix 28 days ago and was given 1 shot of Lupron today. However, we were just called to bring him back because his potassium levels are too high. Also, although his PSA dropped from 6.04 to 1.6, his testosterone levels remain exactly the same as 28 days ago. Anyway, please see the test results below and let me know the your thoughts:

Blood Urea Nitrogen (BUN), Plasma

27 mg/dL

[6-20 mg/dL]High

Carbon Dioxide (CO2), Plasma

29 mEq/L

[18-29 mEq/L]Please note reference range change on 5/18/16

Potassium, Plasma

5.9 mEq/L

[3.3-4.9 mEq/L]HighPlease note reference range change on 4/4/2016.

Sodium, Plasma

143 mEq/L

[133-143 mEq/L]Please note reference range change on 5/18/16

Chloride, Plasma

107 mEq/L

[98-109 mEq/L]

EGFR African American

>60 mL/min/1.73m2

[>60 mL/min/1.73m2]

EGFR Non-African American

>60 mL/min/1.73m2

[>60 mL/min/1.73m2]The CKD-EPI equation was used to calculate the estimated GFR, and is not adjusted for extreme body surface area. The CKD-EPI equation has not been validated for children less than 18 years, pregnant women, ethnic groups other than Caucasians or African Americans, or the elderly. Estimated GFR is valid only in steady state conditions. Ref: Levey AS, Stevens LA et al. A new Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009; 150:604-612.

Albumin, Plasma

4.2 g/dL

[4.0-5.2 g/dL]

Alkaline Phosphatase (ALK), Plasma

59 U/L

[45-129 U/L]

Alanine Aminotransferase (ALT), Plasma

53 U/L

[5-37 U/L]High

Aspartate Aminotransferase (AST), Plasma

45 U/L

[10-37 U/L]High

Bilirubin, Total Plasma

0.6 mg/dL

[0.0-1.0 mg/dL]

Protein, Total Plasma

7.8 g/dL

[6.5-8.5 g/dL]

Creatinine

1.1 mg/dL

[0.6-1.3 mg/dL]

07/28/2017

Prostate Specific AntiGEN (PSA) View History

Prostate Specific AntiGEN (PSA)

1.33 ng/mL

[0.00-4.00 ng/mL]Results cannot be interpreted as evidence of the presence or absence of malignant disease. Assay info: IEMA,Tosoh AIA.Results cannot be used interchangeably with any other method.

06/30/2017

Testosterone View History

Testosterone

629 ng/dL

[221-716 ng/dL]

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[JAOP]

Me again,

Just wondering if this may be an indication of castration-resistant prostate cancer?

[pjoshea13 in reply to JAOP]

No - castration-resistant prostate cancer [CRPC] is the opposite, where testosterone [T] is at castrate levels but PSA is rising.

-Patrick

[JAOP in reply to pjoshea13]

Thank you Patrick. This is all new to me and I'm trying to keep up with all the possible situations moving forward. Can't help being anxious and scared after all the different studies and blogs I've been reading. I guess I'll be better informed after meeting with the oncologist next week.

Thanks again and good luck to all,

Rob

[Thinus in reply to pjoshea13]

Agree with Patrick

[eggraj8]

One month even three is not enough time to make any judgement about the way the numbers go. If after six months on Lupron, there is not a significant decline in both PSA and Testosterone then you have a concern. PSA should go closer to the non-detect number if everything is working well. I suggest you use the MYMSK app which will give you a graph of PSA and other labs. I find it more useful than the computer site. Remember down and to the right is good, but don't worry about bounces they often happen.

[AlanMeyer]

I'm confused about the testosterone level. The relevant parts here of the report you appended to your posting say:

07/28/2017 Prostate Specific AntiGEN (PSA) 1.33 ng/mL

06/30/2017 Testosterone 629 ng/dL

It looks like there was no testosterone test at the same time as the last PSA test. Is it possible that you're just seeing the earlier test result a second time, not a new test result?

I'm surprised that there was no new testosterone test. If he is not getting good results with ADT the first thing that should be done, I would think, is to find out how well the ADT worked at reducing T levels. Adding Lupron may help, but I'd think that a more info on the T level would be useful.

Best of luck.

Alan

[JAOP in reply to AlanMeyer]

Thank you all,

Alan, you are correct. We were called and asked to return for an EKG because my dad's pottasium levels were high. The doctor explained to me that the Testosterone level was from June 30, when the initial treatment (Degarelix) was administered. He said it takes longer to obtain the testosterone levels, but they still haven't updated them. I will download the app as eggraj8 has suggested and keep you all posted.

Thanks and best of luck to all,

Rob O

[JAOP]

Thank you Joel,

I really appreciate the support and psotoce thoughts. Darryl from Male Care already provided me with support group information. Am I correct in assuming this is the same group?

Rob O

[JAOP]

Hello all,

Had an appointment with my dad's oncologist at MSKCC yesterday and have been updated on my dad's testosterone level. He is happy with my dad's reaction to the treatment...PSA went from 6.04 to 1.33 and Testosterone went from 633 to 6, after one month (initial treatment was two injections of Degarelix). My dad was switched to one injection of Lupron every 90 days, which he received last Friday. The oncologist wants to add the additional treatment of Zytiga + Prednisone next week. He wants to try to get it approved by Medicare but we said we would pay out of pocket, if necessary. Only issue is his potassium is high now (5.6) so he had to follow a low potassium diet, which is very limited. If everything stays on track, 26 sessions (5 weeks) of radiation in October. My dad was diagnosed two months ago with Gleason 8 (4+4) on 8 of 12 cores, Gleason 7 (4+3) on 3 of 12, 1 benign core. According to MRIs and CT Scans, my dad has pelvic and abdominal lymph node metastasis, along with invasion of the left semenal vessicle, and the stem of the bladder. The oncologist says his goal is to cure my dad, although the likelyhood of failure is pretty high. He does not recommend RP+lymph node removal because of the amount of kymph nodes they believe are involved, as well as the difficulty to reach the lymph nodes located near rhe rectum. We will meet with the urologist today. I read in some places that RP is more succesful with aggressive PC than radiation, and am wondering if anyone has lived through a similar situation or has any helpful feedback regarding the accuracy of this information. Please share any helpful feedback.

Thank you and lots of luck to all,

Rob O