The speed at which the PSA drops gives us some information

[joancarles]

My PSA went from 1300 to 93. In the first 15 days. from 93 to 3 in the following 15. And in the following months has been falling progressively until reaching 0.18.

This way of descending tells us something?

[joancarles]

We are in the same doubt. Or maybe there is not a single answer.

My initial treatment has been Zytiga.

Thank you very much

Nalakrats

[Tall_Allen]

Yes, it tells you that his type of PC is very responsive right now to whatever treatment he had. In general, a lower nadir PSA is prognostic for a longer continued response.

[joancarles in reply to Tall_Allen]

Thank you very much Tall_Allen! Information of which I did not have knowledge.

[Hidden in reply to joancarles]

It’s a good thing.. hope you go undetectable..and stay that way...

[pjoshea13]

We instinctively wish for a robust PSA response. Unfortunately, that doesn't always correlate to a durable response.

It's nice to see one's PSA plummet, but I'd need the treatment protocol & a relevant survival study to be able to suggest what it might mean.

-Patrick

[joancarles in reply to pjoshea13]

Thank you very much

[Drcrunch]

As previously state, the most important indicator for durable remission is if it goes to undetectible.(<.1)

[joancarles in reply to Drcrunch]

Thank you very much

[Tall_Allen]

I see that your treatment was Zytiga. PSA kinetics are definitely prognostic for overall survival after Zytiga treatment. Shorter time to PSA nadir, lower PSA nadir, and % PSA response by week 12 were all significant indicators of success

clincancerres.aacrjournals....

[joancarles]

Thank you very much for the article.

[tkalaf]

I am in a clinical trial taking the untried mix of these meds:

Degarelix, Zytega, Apalutamide, Indomethicin, and Predizone.

After the 1st four weeks - PSA dropped from 9.1 to 0.91.

After the 2nd four weeks - PSA further dropped to 0.13.

I am less than 2 weeks away from the 3rd measured PSA (prior to undergoing RP).

I am diagnosed non-metastatic localized Gleason 9, with observed PNI.

So considering my diagnosis and lowered PSA, is nerve-sparing possible?

[Tall_Allen in reply to tkalaf]

Does the clinical trial require you to have surgery?

[tkalaf in reply to Tall_Allen]

Yes. Surgery is a 'component' of the trial. It is scheduled early June. The trial will take specimens from surgery for research. I signed on to the trial, yet as with all trials you have the option to leave at any time. So no, it is not 'required'. However I was offered the trial after I had chosen RP, prior to hearing about this trial. Hope this makes sense.

[Tall_Allen in reply to tkalaf]

We will learn a lot about the effects of those early treatments on high risk cancer tissue. I think you are heroic to be part of that. Ordinarily, the surgeon can take progressive frozen sections with a pathologist standing by in order to preserve as much tissue as possible. But with the cancer cells all shrunken and architecturally altered by the treatment, I don't know if it's a useful thing to do or not. What does your surgeon say?

[tkalaf]

Tall_Allen, thanks for the kind words. I am not much a heroic, just someone making the best decision from facts I have and what I've learned. My Feb. biopsy revealed plenty of localized PC, with observed PNI in the right-side. I am fortunate my scans were found clear, yielding a diagnosis of non-metastatic and entry into this trial.

The PNI is the scary part for me now. It suggests my right-side nerve should be removed. My tallest prayer is my surgeon (along with my oncologist) can spare this nerve, based on lowered PSA and what is seen in surgery, as a result from taking this mix of ADT meds.