My father was diagnosed with PC in Nov 2017, Gleason 4+4 PSA 12 and had is prostate removed in January. His PSA however started immediately to rise from 1.7 in feb, a month after surgery to 7 in March and 21 mid April (tripled every month). His scans showed Mets in the spine and lymph nodes. He started casodex and then got a 6 month Eligard shot beginning of May. He then started Zytiga mid May. His PSA beginning of June was 44 and today his PSA is slightly down to 42. His testosterone is below 0.25.
Does this mean he is castrate resistant? From reading the forums I had understood that most people see a fast drop in PSA after the hormone shot and his seemed to have risen and then only went down slightly, which may also be due to the abiraterone. I’m really worried that we may have gone directly to castrate resistant phase and perhaps he should be receiving different treatment such as chemo. Has anyone here not responded to hormone shots at all? Any insight would be much appreciated. Thank you all very much.
Well, at least the hormone therapy halted the rapidly rising PSA. Sometimes Zytiga produces an initial PSA flare as cancer cells are killed. Maybe give it another month or two to see if it kicks in. They usually like to see radiographic progression too before abandoning it. If it doesn't have a better effect, I think docetaxel would be a great choice. It often works even when Zytiga or Xtandi doesn't, and may even sensitize the cancer to Zytiga.
Is it normal to have a PSA test done so soon after surgery ? I have read that doctors usually advise waiting at least 6-8 weeks.
I have been asked to take a PSA test 3 months after radiation was completed, not before. The PSA nadir in the case of radiation could happen even 2/3 years or longer after radiation was completed, I was informed. Is this correct ? What is your view ?
Thanks very much, Tall_Allen.
3 months is standard after RP. My guess is that in this case, they went into surgery thinking he would need adjuvant radiation or they knew it as soon as they got the pathology report, and they were taking the PSA just for the hell of it.
After radiation - also no point in starting PSAs sooner than 3 months. It took me 4 years to reach nadir (0.1). It can take even longer.
Thanks for the reply, Tall_Allen. Much obliged to you for the promptness with which you reply. Also, for the time and trouble you take. All the very best.
I had my RP done in OCT 2017 with a PSA within 1 month of surgery. I started Zytiga/Prednisone/Lupron FEB 2018 and radiation in Mar 2018. I have had my labs drawn with PSA every month since starting Zytiga. I am finished with radiation and my MO says that I will have labs done every month until he removes me from Zytiga in 2 years.
Thanks very much. Do you happen to know how long this initial flare may last? He started Zytiga a month ago so we were hoping to see more dramatic results, though as you said, the hormone therapy seems to have at least halted the fast rising PSA. Does the fact that his PSA hasn’t dropped and is essentially the same as two weeks ago mean he’s castrate resistant or is it too early to tell? Thanks again. Really appreciate the help. We’re so confused about all these results and were hoping ADT would buy him some time and at least delay chemo. He’s also getting genomic testing but not sure if that will be helpful.
You'll know more next month. If Zytiga didn't work, chemo should begin ASAP.