rising psa

[tarasteph]

I have had prostate cancer for 18 yrs. Had prostate removed and radiation.

Five yrs later psa went up to 17. A bone scan was clear. went on Luprone, PSA went down. In 2008 went on Eligard. PSA started to rise in 2016 was put on hormone pills, in last two years have changed that treatment 3 times. Bone scans have been clear. The PSA has continued to rise it is at 13 now. They have stopped all treatment and want to do chemo drip. There is a mass where the prostate was, it has been there for at least 13 years and has not changed in size. My question is it unusual that the cancer has not mastiiscised in 18 yrs. Is it possible the psa is going up for another reason then cancer. In the last year the PSA has gone from 2.5 to 13.

[Tjc1]

18 years is a long time congrats!

[BigRich]

If you don't want to take chemo now ask your doctor if you can add Zytiga and Predisone to your Lupron.

Rich

[Tall_Allen]

There have just been two new drugs approved (Erleada and Xtandi) for non-metastatic castration-resistant PC, which is what you have. Docetaxel (chemo) has only been found to be beneficial when there is a high volume of metastases.

You probably do have metastases, they are just too small (micrometastatic) to be seen by most imaging. Have you had an Axumin PET scan? Unfortunately, 18 years ago they didn't give enough salvage radiation. There is no other reason for your PSA to go up.

[podsart in reply to Tall_Allen]

Tall_Allen

Are there any scenarios where Docetaxel use makes good sense? Seems counterintuitive, one would think that a “weaker” Pca would be more susceptible.

[Tall_Allen in reply to podsart]

It seems like the metastases have to progress to a certain point before taxanes become effective. Second-line hormonals are effective earlier.

[podsart in reply to Tall_Allen]

thanks

as a hypothetical, if you ,say ,fail on xtandi and your psa is extremely low- using a taxane might not be the best strategy? would an exception be to enable a rechallenge of this kind of xtandi scenario for such a case?

[Tall_Allen in reply to podsart]

In a percent of men, taxanes are able to reverse AR-V7-based resistance to Xtandi. Another avenue being explored for reversing AR-V7 based resistance is BAT:

pcnrv.blogspot.com/2016/09/...

[podsart in reply to Tall_Allen]

thanks

[jrr02]

Similar for except only 10 years. You should go through cat scan and mri to see if anything shows as bone scan not effective for micro metastasis. Then proceed to pet scan as final diagnostic. Insurance seems to require cheaper tests before they approve pet scan. Do each with and without contrast for best results. We found tiny spot on L3 disc and on scapula. Manage with Zytiga and prednisone with quarterly injections of Lipton and Xtandi. Slowly lowering PSA from 6.6 to 4.3, every little bit is a victory. Exercise is critical to fight fatigue and maintain quality of life. I am 69 and doing everything I have always done.

[jrr02 in reply to jrr02]

Lupron not Lipton

[larry_dammit]

Lost my father in law last month, he had his prostate removed 7 years ago, PSA started rising . They didn’t do a full panel or ct scan on him until to late . The mas can change and become aggressive at anytime. Good luck. Fight the good Fight

[adlerman]

I didn't have my prostate removed 16 years ago- cryotherapy used on Gleason 8- PSA under 0.01 for 16 years.

I see a lot of cases of failed RP here. Maybe urologists need to take a closer look at other options than RP.

[Shooter1 in reply to adlerman]

Failed or successful RP. Who's to say. Found stage 4 , aggressive, invasive, fast growing, incurable after RP. Scans had shown all contained and removable. Wrong, but major bulk was removed and pain was gone. Just in a spider web of all neural and veinous bundles out of prostate area. PSA up 10 pts in 6 week after RP, but felt better than before surgery. Chemo, ADT followed. Working so far.