What is mCRPC

[ewhite999]

I’m getting mixed signals on whether or not my cancer is castration resistant. My PSA went down to zero after chemo but has risen to 20 over the past year while on Lupron. My oncologist said that since my bone mets have not returned I am not castration resistant. However, I got a second opinion and they said since my PSA is rising that means I am castration resistant. The proper categorization matters because I am eligible for the abiraterone olaparib trial if I am castration resistant. Has anyone else been down this road? Any thoughts on how I should be categorized?

[tango65]

If PSA is going up with a testosterone at castration level, the PC is predominant castration resistant.

[JamesAtlanta]

Hi there,

Based up the definition I see on the attached site, you are castration resistant.

ncbi.nlm.nih.gov/pmc/articl...

Please make sure you are being treated by a medical oncologist who specializes in PCa. Sounds like the advice you are getting from your second opinion is much better than your current MO.

I’m sure others will provide more advice for you. Hope this is helpful.

James

[gusgold]

a rising PSA while on Lupron usually means castrate resistance. Have your T measured if you have castrate levels you got the Big Boy

[pjoshea13]

The title of your post is "What is mCRPC"?

You write: "My oncologist said that since my bone mets have not returned I am not castration resistant."

You clearly are resistant to Lupron [CRPC], but perhaps your onc is saying that you are not mCRPC, since there is no evidence of mets?

Does the trial require mets?

-Patrick

[ewhite999 in reply to pjoshea13]

God question. I don’t think so but I’ll check on Monday.

[leswell in reply to ewhite999]

Thanks for the Post. CRPC and mCRPC need clarification for many, us included. Very helpful replies. Loved your typo, ewhite999. It’s a good/God question, for sure.

We were promised genetic mapping by our competent urologist but don’t know yet if any mutations have been found. We will follow your Post! Mrs. S

[Hidden]

Here's the definition from the NIH:

Castrate-resistant prostate cancer (CRPC) is defined by disease progression despite androgen depletion therapy (ADT) and may present as either a continuous rise in serum prostate-specific antigen (PSA) levels, the progression of pre-existing disease, and/or the appearance of new metastases.

I'm not sure there is one specific PSA level where you say: right now you became castrate resistant. I'd say if you've had 2 or 3 doublings over 4, that would be enough to say you have CRPC, but that's my opinion.

How fast is your doubling time?

[Ewhite99 in reply to Hidden]

Here are my monthly PSA counts with # of days between each...

PSA0.27 0.31 0.45 0.72 0.95 1.53 2.02 3.08 4.93 7.6 10.16

28 28 28 28 34 40 34 65 27

[Hidden in reply to Ewhite99]

Looks like your doubling time is around 2 1/2 to 3 months. From the numbers you gave us, it would be my opinion that you have CRPC. I agree with genetic testing to see if there are any "actionable" mutations.

[Tall_Allen]

As others have said, you are definitely BOTH metastatic and castration resistant. Perhaps you need a new MO if he doesn't know a basic thing like that? Have you been tested for somatic and or germline mutations in the DNA-repair genes? That can give you a clue as to whether olaparib will work for you. For the somatic (tumor) mutation, they have to biopsy a metastasis. For the germline (inherited) mutation, there is an easy to do and relatively inexpensive spit test. Here's some info about it, and the clinical trials that are open for patients with germline DNA-repair defects:

pcnrv.blogspot.com/2018/02/...

[Ewhite99 in reply to Tall_Allen]

I believe the test you mentioned is the next step for the trial I'm considering. It's a bone biopsy that determines if your DNA fits the bill for the trial.

[Tall_Allen in reply to Ewhite99]

You mentioned that Lupron has shrunk your bone mets, which is great! I wonder if there is enough tumor left there for their test. I guess you can only go for it and see.

[ewhite999]

Thanks!