Drop in psa a bad thing?

[Peterd110]

Initial Psa 352 on August 8. Gleason 9 with extensive Mets. Casodex started August 20 Telstar shot on August 28 PSA on Sept 4 is 89. I thought this was a good result, but I have read some reports that suggests such a rapid response is a poor prognosis indicator, or a shorter time to crpc.

[AlanMeyer]

I'm curious about where you read that because everything I've read is the opposite. The better your initial response to treatment, the longer lasting is the effect.

I think a rapid response is a very good thing.

Alan

[Hidden in reply to AlanMeyer]

Thank you sir!

[Canoehead]

healthunlocked.com/api/redi...

This was originally posted by pjoshea13 (Patrick). It’s so early in the game for you that I would celebrate the good response to initial treatment. This was also a retrospective study, and those often fail to consider other contributing variables. The study also identified time to PSA nadir and the value of the nadir as factors which correlate with disease progression.

[Tall_Allen in reply to Canoehead]

It doesn't say why those patients got ADT,

[AlanMeyer in reply to Canoehead]

I didn't read the whole study but I did look at it and looked at the table showing hazard ratios for various patient characteristics, one of which was "PSA decline velocity >11 ng/ml per month.

It's an odd statistic. Consider two men, one with a PSA of 1,000 and one with a PSA of 25. The first guy's PSA declines at 100 ng/ml/month, the second guy's at 10 ng/ml/month. The problem here is that the first guy's decline in absolute PSA is way greater than 11 ng/ml/mo, but his decline in relative PSA is much worse than that of the other guy. If the declines were at a constant rate all the way to 0, the first guy would take 10 months and the second guy 2.5 months. So who had the faster decline?

This needs explaining. It seems to me that using an absolute number of 11 ng/ml/mo is a weird way to measure PSA decline and may actually only be reflecting the fact that men with high initial PSA values are more at risk than men with low PSA values.

I think that some scientists may not be as careful as they should be at understanding the statistics they publish.

Alan

[Schwah]

I would also ask if you have had any treatment concurrently with the adt? If not you should add Zytega and/or chemo since early Concurrent use of both lupron and Zytega or lupron with chemo has shown to result in much better outcomes. If you already are using Zytega Or chemo with your ADT then those studies are meaningless since they only studied people using ADT only and Theoretically adding the other agent could well be the reason for the faster dropped in PSA.

Schwah

[Peterd110 in reply to Schwah]

I’m expecting my zytiga to be delivered by fedex today

[Win-Pir]

If you are being delivered Zytiga by FedEx I wonder if you have a less expensive source you could share. A first rx for me has a copay of over $2750.00 for 120 tablets. The subsequent ones for the same calendar year cost nearly $600.00 for 120 tablets.

[Peterd110 in reply to Win-Pir]

This month I’m still on my wife’s insurance. My cost on the #120 zytiga 250mg was $0. Next month I will start Medicare so....???

[Frank48photo in reply to Peterd110]

I would check with medicare, there is a copay with medicare of $600.00 for Lupron and $1200.00 for Zyitga. My coverage is with Medicare and United Health Care.

[Break60 in reply to Frank48photo]

In 2028 , For me in SC the Zytiga monthly copay is $588 after out of pocket has reached $5000. Obviously you reach the max in a couple months.

[leo2634 in reply to Peterd110]

There are many advocate sites to look into for financial assistance too. Go to American Cancer research site they have several links.

[Magnus1964 in reply to Peterd110]

Have your doctor check with the Patient Access Network.

[Kimmilemo in reply to Win-Pir]

Did you try contacting the actual company that makes it or reach out to a pharmacy to ask for options? I’ve heard if you reach out to the actual company they sometimes have solutions .

[mcp1941 in reply to Win-Pir]

Those numbers are very close to what I pay. Not looking forward to January when I have another $2700 copay.

[Peterd110 in reply to Win-Pir]

What are your thoughts on taking 1 tablet with low fat meal instead of the 4 on an empty stomach?

[f007]

unfortunetly this is true! Have you been informed about PSMA treatment? This is mostly the best Option after Hormon-Treatment does not work -

[larry_dammit]

My Dads PSA would bounce from the 300 to Teens after a lupron shot. Did that for years, finally the bottom number kept growing bigger. Now stage 4 with Mets. Meaning that if the PSA is going down be happy. It’s when it’s rising that you have to worry. Fight the good Fight

[EdBar]

I always thought a rapid drop was a good thing, that your outcome was better if you hit nadir in 6 months or less. That was the case for me, I was given a similar DX in 2014, hit nadir within 6 months and it's been there ever since. You can click here on my profile to see treatment I've had during that time.

Ed

[Noel91 in reply to EdBar]

I thought that as well.May be there are various studies,I Also found this:

onlinelibrary.wiley.com/doi...

I am not a native English speaker so may be I missed something.

[EdBar in reply to Noel91]

Interesting read, my nadir was below >0.2, so maybe that’s why I’ve had an extended run on ADT. I’ve also had my prostate radiated and chemo per CHAARTED so a lot of variables. My nadir is running at <0.016.

[Peterd110 in reply to EdBar]

I guess I really don’t understand PSA values anyway. On my initial lab draw, the hospital ran a psa level AND sent off for a psa level. So off of the same blood draw, the hospital’s psa value was 352 and the lab they sent the other sample to came back 268. I know different labs are going to vary some but.... that’s about 1/4 less off of the same sample

[joekaty]

I’ve wondered about this. My husband’s initial PSA decrease was very drastic and fast- last year was admitted at diagnosis in August and PSA was 556. At discharge (his only ADT was a shit of degarelix) it was around 250. However, after Lupron only about 8 months Lupron failed...wondered if initial fast decrease also shortened time of Lupron effectiveness?

[HopingForTheBest1]

While PSA is a well known and accepted indicator, it is essential to also have a scan (preferably a PET scan in my opinion) as there are cases where PSA was down but scans showed cancer growth.

[Peterd110 in reply to HopingForTheBest1]

I am 1 month into this so, I’m doing initial scans now

[Grouser in reply to Peterd110]

I am two months in to the Eligard shots my urology oncologist said the Alumium PET would not be of value after I started the treatments . Thoughts?(PSA dropped from 6 to 1.8 in two months.

[Peterd110 in reply to Grouser]

Your scans 3 months ago were clear and your psa is dropping. Why do you think you need a PET scan?

[Grouser in reply to Peterd110]

I have lots of body pain .

[Ddroy22]

In my dad's case, the psa reduced from 20.9 to 0.19 in three months when his treatment started with cab comprising of zoladex and casodex. Following months his psa rose to 0.8 and 2.1. His pet scan showed few active regions in bones. He is now under zytiga and xgeva. His gleason score is 5+4 with widespread metastases in bones. I just hope this treatment is successful for a long duration.