Advice

[Bball]

My 80 yr.old husband was diagnosed 1/2016 with apc with numerous Mets to bones. PSA 4.5 alk phos 4,000. Treated with Casodex,eligard, and zometa. After a year PSA remained <.1 but alk phos elevated. Active Mets in back we’re radiated and switched to xtandi in July 2017. Also switched to xgeva Spring 2018. Things have been stable since the change on drugs until 3 months ago when PSA rose by.1 each of the last 3 months so it is now .4 and alk phos up from 150 to 180. MO says these changes aren’t significant. I’m still concerned about the PSA rise after almost 3 years. Thoughts? thanks

[tango65]

You could consider to discuss with the MO the possibility of doing scans to see if the metastases are progressing. If there were they could treat him with chemo or abiraterone and see what happens.

[Bball in reply to tango65]

Thanks, scans are scheduled for next month.

[Drcrunch]

Psa is discordant with alk phos, meaning at that low psa the alkaline phos should be within normal range. Have you been checked for neuroendocrine type.

[Bball in reply to Drcrunch]

No but I will ask about it. Thank you

[AlanMeyer]

I'm not sure what the MO meant by "significant".

I would think that it is time to start thinking about and planning for other treatments, though it may not yet be necessary to start them immediately. Some other possible treatments include chemotherapies, new anti-androgens, immunotherapies, and the new radionuclides.

I don't know whether your husband is taking any of the supplements recommended for prostate cancer (see cancer.gov/about-cancer/tre... and I also like the postings on this topic by Patrick O'Shea - search Google for "pjoshea13" or ("foods/vitamins-supplements" "pjoshea13"). Good diet and supplements probably won't halt cancer progression but, for some men, might slow it down.

I also suggest that you prepare a list of questions for your next meeting with the MO. Here are some possible ideas:

- What do you mean by "significant" when you say the PSA rise is not significant?

- Assuming that the patient's PSA continues to increase, what level of absolute PSA, or of PSA velocity (the speed of growth, often measured in "doubling time") do you think should signal the start of other treatments?

- What next treatments would you recommend, in what order?

- Immunotherapies (Provenge, Keytruda, others?)

- Next generation anti-androgens like Erleada?

- PSMA linked or other radionuclides - Lu-177, Actinium-225, etc.?)

- Docetaxel or other chemotherapy?

- How would you choose among the possible treatments? What criteria would be important?

- At what point would you suggest additional diagnostic scans? PET, MRI, other?

I suggest that you write down your questions and leave space after each one to write down the doctor's answers. You might even try recording the session in order to be sure you can remember what the doctor said. You can find "apps" for your smartphone that will do that, or you can buy a little pocket sized tape recorder. I ask a doctor's permission before I turn on a recorder, but the couple of times I've done it the doc hasn't objected. I explain that it's hard to remember everything.

If you're not sure the MO is the best you can find, you might want to get a second opinion. I suggest going to one of the National Cancer Institute "Designated Cancer Centers" if there is one within reach of you. See: cancer.gov/research/nci-rol... .

In spite of your husband's age, if his health is otherwise okay, I think it may be worth looking at more treatments. Some of the new treatments might add a year or two or even more in addition to what he would get (probably some years) with no new treatments.

I wish the best of luck to you both.

Alan

[Bball in reply to AlanMeyer]

Thank you very much. We have gotten a second opinion at Vanderbilt. I will research your suggestions.

[Tall_Allen]

That is an excellent response on his alkaline phosphatase! Some types of PC just don't put out much PSA - you just have to pay more attention to the alkaline phosphatase as your key biomarker. If the cancer is becoming Xtandi-resistant, you can switch to Zytiga - but check for radiographic progression first. Also consider adding Celebrex.

[Bball in reply to Tall_Allen]

Thanks very much.

[j-o-h-n]

80 is the new 65...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2019 5:37 PM EST