Advanced Prostate Cancer
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Psa rising again.kindly advise

My grandfather was diagonsed with PC in 2015 at that time PSA was 76.he had TURP in 1998. After PC detection he is under treatment of Bicalutamide and Triptorelin 11.25mg after every 3 months and PSA reduced to near 0. Bicalutamide stopped in 2017.But we get diagonosed last month and PSA was about 1.3. Its rising again. I am worried about it . Does we continue with same treatment or should go with another. He also had 2 bone scan, which were clear.Kindly help.

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I'm not a doctor, but some things to discuss with his doctor:

Stopping Bilcalutamide. Bicalutamide can end up feeding the cancer so if it were me, I'd stop that and see what happens first. If the PSA continues to rise, you could discuss the use of a second-line ADT agent such as Zytiga or Xtandi. These often work when PSA starts to rise after primary ADT drugs. Low PSA and lack of mets are good indications.

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Thanks for the reply. Yes Bicalutamide has already been stopped in 2017. Last month PSA was done it was 1.7. Triptorelin 11.25mg has been injected this month. PSA is scheduled for next month.

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I missed the part about stopping Bicalutamide in your post. Do you have an idea how fast the PSA is the doubling?

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In about 14 months PSA has doubled.

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That's long. With his age, low PSA, long doubling time, no mets all of that is favorable for him. There's no rush to do anything, in my opinion. He could also talk to his doctor about second-line ADT agents. I'm not saying to blow it off, I just wouldn't be too worried if it was me.

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Thank you soo much for your valuable response.

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I have been watching my PSA for 10 years now. My Doctors don't worry until my doubling time goes below 90 days. My lowest DT was 42 days. Watching PSA will drive you crazy. Ive always been told that its not the number but the change in the number. Look up doubling time to get a better understanding. Stay sane.

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P.S There are calculators on line to help you calculate DT. I dont know how accurate they are but i use them to let me know when things are changing too fast. Chart his PSA. When the line goes vertical get some help. Also it will take about 3 to 4 PSA reading to get a good feeling about what is happening. A slight rise just might be part of his PSA cycle. It could still might good down. Hope this helps.

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Two drugs were recently approved in the US for men in this situation (non-metastatic, castration resistant) - apalutamide and enzalutamide. I don't know if he can get them in his country.

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will ask questions if his psa is only 1.o keep the same treatment if it goes past 4.0 then other treatment is needed. since the average male runs with psa from 0-4.0 just monitor it and have monthly psa readings since it was 76 before. me after 10 yrs my psa is 28 so i feel good started a new treatment called PROVENGE.

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