PSA rising after 2 years on Eligard...options?

[westjl2]

Diagnosed with stage 4 MPC in June 2016. Lymph, seminal vestical and Bone Mets. PSA 76 and all 12 biopsy samples had Gleason scores of 8 and above. The PC was too widely spread for surgery or radiation so I was Treated with 6 rounds of docetaxel and am still on Eligard every 4 months. Also participating in the Titan (Apalutamide) Clinical Trial. 95% certain I am getting the real drug due to a very bad and persistent rash. My PSA never went below 1.4. It stayed at that level for about a year but has been rising steadily over the past year to 9.2 today.

I get full CT and Bone scans every 3 months with the clinical trial and the good news is the bone lesions are stable and no visible signs of recurrence in the organs. I feel good and just got back from 5 weeks in Europe! However I also know that a rising PSA is a bad sign.

I would like to hear from others who faced this same situation. Did you wait for scans to show visible progression of the PC before seeking further treatment. If so what was the treatment?

Or did you take a more proactive approach with aggressive chemo and or radiation? My urologist is a more traditional doctor and I will be seeing him to discuss options. I want to be as fully informed as possible.

Thanks for your interest and support.

[AlanMeyer]

I don't know what is the best thing to do. Your case is very serious and the treatment you have received is state of the art.

One idea that comes to mind is PSMA targeted Lu-177 treatment. Prostate Specific Membrane Antigen (PSMA) is a molecule that appears on the surface of many prostate cancer cells. Lu-177 is a radioactive atom that can be bound to an antibody designed to bind to PSMA and only to PSMA. They inject a solution of this stuff into you and, hopefully, it seeks out prostate tumor cells and nukes them with radiation.

The treatment is experimental and only available in clinical trials in the U.S. but it can be had in Germany and, I think, in Australia.

Whether it will help you is uncertain. A test can be performed to find out if you have a lot of PSMA in your disease. If so the treatment can be extremely effective. If not, it won't be effective. Most people are probably somewhere in between and get some benefit. The big advantage for you is that it has nothing whatever to do with hormone therapy so the fact that you have become castration resistant says nothing about your response to this treatment. It's possible that you could get lucky.

Wishing you the best of luck.

Alan

[westjl2 in reply to AlanMeyer]

Thanks Alan. I will look into that a bit more.

[JimVanHorn]

I stayed on Lupron for 6 and 1/2 years and my PSA has been 0.00. So now I am back on active surveillance to see if the cancer is gone. I also had 72 radiations and I wish you luck wit your treatments.

[westjl2]

No I have not yet moved onto Zytiga. That will be the next logical step. I am just not sure if it is best to wait a bit longer or to ask to get on it sooner. I want to see an oncologist as well as my Urologist for their opinion.

[westjl2]

Thanks. I live in Canada and the Prostate Clinic here in Calgary is top notch. Also the Tom Baker Cancer Center. I am just curious as to options so I can be prepared when I meet with the Doctors at these two centres in the near future.

[westjl2]

While the scans may seem excessive they are good in that I am being watched very closely. Not sure going to Zytiga sooner is best but I am inclined to want to move sooner and have them throw everything they have at it. Just wanted to hear from others experience when facing this somewhat inevitable point in the ADT process.