PSA climbing While On Cabazitaxel Chemo

[sgrama]

Okay everyone just thought I'd throw this question out and see if anyone has had anything similar happening to them. My husband has prostate cancer with mets to his bones. Oncologist started him on Cabazitaxel chemo on June 7th and his PSA before 1st treatment was 657 on May 30th and then afterwards it was 683 on June 26th and then he had his 2nd treatment and bloodwork in A.M. before 3rd treatment was PSA 981 on July 19th. His Alkaline Phosphate level on June 7th the day of first treatment was 211 but now on July 19th it was down to 163 which is still high but lowered from when he first started. Just wondering if anyone out there has had any results like this. Just very worried about the rising PSA despite chemo treatments.

Thanks

[Tall_Allen]

Bone alkaline phosphatase may be a better measure of progression than PSA in very advanced prostate cancers.

[sgrama in reply to Tall_Allen]

That's what I'm sure hoping. On his last scans in May he had mets to his pelvis,spine,some ribs, scapulae, base of skull on spine. He keeps insisting he has no pain anywhere but yet wanted to wear a back brace sometimes. I honestly believe he may be having some aches and pains but just doesn't want to let me know. He also just had the Provenge treatments that ended in April. Oncologist said if the chemo fails next step he'd like to try is Enzalutamide and Radium 223 together.

[Tall_Allen in reply to sgrama]

That sounds like a GREAT plan. The Xofigo may get rid of any background pain he is sensing. I also think that it is ideal to give Xofigo soon after Provenge - the dead cancer cells activate the immune cells that have been amped up by the Provenge.

[sgrama in reply to Tall_Allen]

I never knew that about dead cancer cells activating the immune cells that's so good to know. Actually we were worried about that since he started chemo so soon after the Provenge that it might have ruined anything good the Provenge did. Thanks for letting me know that.

[Tall_Allen in reply to sgrama]

Actually - chemo does that too - it dumps a lot of dead cells into the serum. There are clinical trials ongoing that combine immunotherapies with chemo. Chemo is immune suppressive (it is too often given with prednisone, which increases that effect) - but it suppresses NEW T-cells, not the ones that Provenge has already amped up.

[sgrama in reply to Tall_Allen]

He's not getting any prednisone with the chemo. He also had docetaxel 7 treatments last year that ended in April 2017. Then he was on Zytiga and prednisone for about 5 months from end of August 2017 until Feb this year.

[Tall_Allen in reply to sgrama]

That's just a replacement dose of prednisone he was taking with the Zytiga. I hope that the Xtandi works after the Jevtana - taxanes have been sometimes found to reverse resistance to second line hormonals.

[sgrama in reply to Tall_Allen]

I hope it works also once he puts him on it in the near future. He also is on Eligard injections every 6 months and has been for a few years now. He was getting Xgeva injections monthly since last August until the last 2 months because his calcium level was a little bit low and they wouldn't give it to him until it goes back up. He'll be 77 in Nov. and I worry just how much he can handle even though at the moment he still works 3 days a week as a jeweler. He was diagnosed in Dec. 2005 and had radiation treatments in 2006 and everything was good for quite a few years but now it just seems like nothing seems to keep working.

[j-o-h-n in reply to Tall_Allen]

To TallunderscoreAllen

You know that I've told you this before but you're really a cool dude...Thanks for all you do...

Good Luck and Good Health.

j-o-h-n Wednesday 08/01/2018 7:53 PM EDT

[Daddysdaughter]

My father had a similar trend. He stopped after the third round which I think is a little too soon. After speaking to a different oncologist he suggested that my father should have stayed on it for at least six rounds before stopping. There is also something called a PSA flare you might want to check it out because I believe it does happen sometimes.

[sgrama in reply to Daddysdaughter]

I read about the PSA flare and that's very interesting and I sure hope that's what is going on with my husband and that maybe next bloodwork the PSA will drop. Thanks for the info.

[MelaniePaul]

Hi there.

I think the best thing you can do is get another bone and CT scan. I know that doctors usually want to wait with the next scan until all the Chemo infusions are done, but I think that is not a good idea if the PSA is going up all the time. Ask for a scan to be done now.

My husband's PSA went up while on Chemo as well, and some people said it is because of the dead cancer cells. I don't believe that really and no doctor has ever said that to us. So we did scan after scan to determine if there was more growth in the bones.

If that is the case with your husband, then perhaps the Chemo has to be changed.

Mel.

[sgrama in reply to MelaniePaul]

He had CT and Bone Scan done in May before starting chemo in June. But hopefully he can get another one done soon so we can see if anything is starting to work on the mets to bone.

[PLASTICMAN]

Had similar experience with chemo with docetaxel. PSA was 7.05 when I started and went down to 6.95 after 4 sessions. Nothing to rave about. Alkaline phosphatase however went down from over 700 to about 224. Did not do a 5th session as was feeling pretty rotten what with the docetaxel, Prednisone, Denosumab (Xtega), also Eligard every 3 months, and Xtandi(worked for 4 months) prior to chemo. At this stage of advanced metastatic prostate cancer hormone resistant I don't think much of anything is going to work for very long, if at all. Will probably try Zytiga, see if that works.