I know i have asked similar questions in the past. We are almost sure that my father has NEPC since his Chromogranin A has increased from 249 to 456. After 1st cycle Of Jevtana and carboplatin we were really hoping to see some significant-drop in PSA and CGa. His PSA went from 16.4 to 17.2 a very minor increase. Is this a normal flare? Is chemo even working? What’s the next step if it doesn’t? The MO reassured me that it’s most likely a flare and we will understand more in a few weeks. My father is tolerated the chemo well, 2nd time only severe constipation, which we can totally live with!! Well actually he COuldent stand it- but I meant that there are means to relieve these issues!! Lol. Other then that he is icing his hands and feet. No neuropathy, and no loss of taste buds. Mild hair loss noticed, and he looks more anemic to me. Please let me know if anyone has had similar responses to chemo.
Neuroendocrine PC on Chemo Jevtana & ... - Advanced Prostate...
Neuroendocrine PC on Chemo Jevtana & carboplatin
I have not heard of Chemo causing "flare".
The term is commonly used in conjunction with LHRH agonists (Lupron, Eligard....)
As follows: The pituitary is stimulated, which causes a short term increase in LHRH, which increases testosterone production, which causes increased expression of the PSA genes; ie increase in PSA protein synthesis.
LHRH ant(i)-agonists do not do this.
Unclear what the mechanism would be for chemo causing this.
More likely is that prostate cells continue to function at some level.
These cells may not be dividing, since dividing cells are the target for chemo.(??)
Why they would "be more active" is a question, in this rationale.
ncbi.nlm.nih.gov/pmc/articl...
It’s a Chromogranin A flare not PSA
ah.
you did say "His PSA went from 16.4 to 17.2. Is this a normal flare? ".
But you are actually conceerned about the Chromogranon.
Yes, that’s not much of an increase. His doubling time was 3 weeks so actually his PSA was stable. I also read that if your on a proton pump inhibitor that can cause an increase in CGA
You might know this already, but with neuroendocrine type cells, you need to focus more on "tumor markers" other than PSA which will only be expressed in the remaining hormone dependent cells. So the CgA is a very important marker, but there are others. Here's an article on the subject:
The University of Iowa seems to be doing the most in the area of NeuroEndocrine Tumors. They are trialing a European treatment called PRRT, that uses targeted radio isotopes (beta radiation), targeted to somatostatin, a protein expressed predominantly by NET.
There has been "a lot" of work to try to use an alpha-emitter as the warhead. Apparently the compounds fall apart too quickly, and so you would get freely circulating radioactive nucleotides. Hard to sell this as a good thing. I thought I saw that somebody (U of Michigan??) was trying "actinide". An alpha emitter would produce much much less collateral damage, but it is not available "as yet".
I hear that one vendor gave up after many (ten?) years of trying.
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