Hormone Therapy failing?

[Dani2861]

Hi all,

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.

[Tall_Allen]

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.

[whatsinaname in reply to Tall_Allen]

Tall_Allen,

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.

[Tall_Allen in reply to whatsinaname]

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.

[whatsinaname in reply to Tall_Allen]

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.

[Zytigadude in reply to whatsinaname]

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.

[Dani2861 in reply to Tall_Allen]

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.

[Tall_Allen in reply to Dani2861]

You'll know more next month. If Zytiga didn't work, chemo should begin ASAP.

[Hazard]

I started ADY in 2017. My PSA had just risen from 2.5 to 7.5 in 6 weeks and doc said 'don't worry I het get PSA back to 0.1'. So he gave me a 3 month shot of Zolodex and told me me to come back in 3 months.

3 months later PSA had dropped but only to 2.5. Doc said 'I've seen worse come back in 3 months'.

So I went back in 3 monthd nd by then PSA was 15. I am one of the unlucky ones with primary ADT resistance. Moral of this story is:

1. Monitor PSA very closely if you suspect ADT resistance. 3 month tests are routine but very unhelpful in your situation.

2. Get on docetaxal ASAP. After my 2nd test result, doc stuffed around for 6 weeks monitoring PSA, ordering scans etc. By then PSA had risen to 47 when II started docetaxal. Luckily I have had a good response and PSA went down to 1.8 after 6 rounds of chemo.

Good luck!

[Hidden]

Sorry that your dad S not doing well. I am surprised with what I read that he did not at the minimum have adjunctive chemotherapy three months after his primary treatment especially with a double digit PSA and a Gleason 8. Did he not have scans prior to his surgery? Usually, well maybe now now - at least 15 years ago one did.......

In my opinion there is a very high probability that he had mets prior of primary treatment or at least micro-metastates with cancer cells floating around in his vascular and lymphatic systems.

Fourteen years ago, my primary treatment failed within a year and I immediately underwent a six month chemo-hormone therapy trial with a research Medical Oncologist. I had mets to L2 and T3 of my spine, PSA went from 6.8 to 32.4 in three months, received my first Lupron injection and six weeks later I enrolled in the trial.

Please consider early chemotherapy while is body is strong and the tumor burden minimal. Do not fear chemo. Although a poison, it is his friend right now. Don't wait. My advice, print out this message and look for my treatment plan (it can be found on google under "Gourd Dancer advanced Prostate Cancer" and in this group under "Gourd Dancer". Print it also. Then take to your next meeting with the Medical Oncologist as talking points and develop a plan of action based on his recommendations. Hopefully your guy/gal is not a generalist and a real pro specializing in metastatic prostate cancer.

Stay positive; shun negativity. I'll say a prayer for him. Best wishes in kicking this bastard.

Gourd Dancer

[Dani2861 in reply to Hidden]

Thank you and everyone else for the very quick and helpful response. We’re still very confused as to whether he is in fact castrate resistant since as Tall_Allen said, the hormone therapy seemed to halt the very aggressive and quick PSA rise he had in the past few months. Regarding the early chemo, the doctor told him that he could either do the ADT with chemo or with abiraterone so he chose the latter. At the time of the RP the scans were clear and probably didn’t pick up on the micro mets as you say. We’re seeing the doc next week and will raise the chemo option. Thanks again for the support.