PSA

[Blair77]

Initial treatment brought PSA from 1044 to 1.6. This month it had gone up to 2.4. He’s done upfront Docetaxel and is on Lupron and Casodex. What does a bump up mean? Is he castrate resistant now???

[Shooter1]

Don't know. Do know when mine started back up added Xtandi and it dropped right back down. For me side effects are horrible, but seems to be keeping me stable at 0.140+/-. PSA.

Doug

[Tall_Allen]

Maybe. That's not really much of a bump - maybe just daily variations. It should be confirmed by another PSA test at least a few weeks from now to see if there is a clear pattern. If so, it would be time to start a second line hormonal, like Zytiga or Xtandi.

[Blair77]

Also I meant to say it was 1.6 to 2.1 not 2.4

[Hidden]

2.1 is still low so I would just keep an eye on it and see in a month. If it doubles to 4.2, then 8.4 in a few months it's time to think about second line in my opinion. My PSA has been rising as well, looks like I'm becoming castrate resistant. My doctor is suggesting radium 223 as the next step before Xtandi or Zytiga. If your "mets" are primarily in the bone, this might also be a good option. These are some things to talk to your doctor about.

[ctarleton]

From my experience, this transition from one major form of treatment to the addition of another form of treatment is where the "clinical art" of recommendations from advanced prostate cancer oncologists and specialists starts to come into play. First of all, everyone is unique. One person may have more or fewer bone mets and/or other types of mets, and they can be in different locations, for example. From here on out, the actual PSA number starts becoming relatively less critical for driving a decision among options, as the totality of all things considered, e.g. mets, symptoms, progression as documented on scans, inherited or tumor tissue genetics, age and performance status, etc., etc.

My original treatment brought a PSA of 5,006 down to 1.0. When it did start back up, it did so relatively slowly. A local oncologist had no problems waiting until a PSA went up to 20 before moving to something else like Zytiga. A specialist at one institution would start me on Zytiga or Xtandi anytime I wanted after my PSA was going up through around 12. He also offered a Clinical Trial for a drug that, in hindsight, proved of little benefit for advanced prostate cancer, compared to placebo. Another specialist at another institution suggested some familial genetic testing to see if I might have something targetable, followed by a Ga-68 PSMA PET scan as part of a clinical trial, followed by Provenge, with an option to enter another clinical trial shortly thereafter, and then a choice of either Zytiga or Xtandi. Anyway, I went with specialist #2 and eventually went on Xtandi after doing all those things except the clinical trial. It was approximately a year after my initial PSA nadir of 1.0, and the added Xtandi brought my PSA back down from 95 to a new nadir of 1.2 in just a few months. I've been on Xtandi for 1 1/2 years now, and my last PSA was 1.8, and "bouncing around" by .2 or so every month or so.

If I had been diagnosed later, I certainly would have done ADT + early Docetaxel or early Zytiga first, and perhaps earlier Provenge. But that was not my reality at the time.

These uncertainties in the face of incomplete information and unique situations are very common and just come with the territory. That makes having a good medical "leader" and "advisor" even more important, as YOU make the final decisions from among all the Options available.

As Gregg57 mentioned, he's thinking about Xofigo perhaps earlier rather than later, in light of his bone mets profile. I still have a number of other treatment options to weigh as I approach a similar decision when my disease again becomes less responsive to treatment. It's a long haul process.... done better with qualified and wise counsel, and lots of support from others.

Hang in there. Keep us posted. Hopefully, his PSA "roller coaster" ride will be a small one with small ups and downs between successful and long-lasting treatment(s) to come.

Charles

[Kevinski65 in reply to ctarleton]

What was your , ' original treatment' ?

[ctarleton in reply to Kevinski65]

It was far too late and my disease was far too extensive and wide-spread to try for any "cure" involving prostate surgery or radiation, so my "original treatment" was systemic Androgen Deprivation Therapy (ADT). I had a short period of the pills Casodex (bicalutamide) to help prevent a testosterone "flare", and then began indefinite shots of Lupron (depot 3 months) to bring my testosterone way down to therapeutic levels. My cancer happened to be very responsive to this treatment and my PSA dropped from 5,006 to 1.0 within 6-7 months. I also had lots of bone mets to start, and I had monthly IVs of Zometa (zoledronic acid) of possible benefit to my bones.

(There are other agents that bring down testosterone besides Lupron. There is also another bone agent called Xgeva (denosumab) that can be given in lieu of Zometa.)

Charles