Hey All,
My Dad’s last chemo is 1/28 after which he will continue with Lupron and monitor PSA every 3 months per his oncologist. I’m on board with continuing Lupron but unsure why we would only monitor PSA every 3 months instead of monthly. What is best practice in your experience?
Thank you in advance!!
It was all bad. His PSA was in the 480s. Multiple bone mets on hip, rib and spine. Gleason was 9 if I remember correctly. All we have done as far as treatment is Lupron and chemo. That’s it. He responded well to chemo but now I don’t know what to do next. I’m his medical advocate so I want to ensure I follow the best course of action.
They will be looking for signs of castration resistance, which may not show up for some time. If he is like most men, PSA tests create anxiety. When castration resistance occurs, he will be eligible to receive any of a host of approved medications - Xofigo, Zytiga/Xtandi, Provenge, and Jevtana. He will also become eligible for many clinical trials.
Thank you. Do you have a preference one way or the other over monthly testing vs testing at 3 month intervals?
Maybe ask for a PSA test and a new bone scan/CT at 6 weeks after the last chemo. If his PSA is low, PSAs every 3 months sounds like a good balance between prudent monitoring and anxiety.
I agree. A CT or PET with Axumin may reveal remaining mets. If 4 or less radiation therapy may be an option. Other than that watch the PSA every three months for progression. When that happens your Dad will be ready for the next tool in the toolbox.
Axumin is only approved for a biochemical recurrence after prostatectomy or radical radiation.
They never offered those treatments to my Dad. Is this something I should look into now that his PSA is in the normal range
You'll have plenty of time to discuss treatment options with his MO after he is castration resistant. There may be new options by then.
Same here. Psa of 352 at diagnosis, Gleason 9, extensive bone Mets. Started on trelstar and (zytiga instead of chemo )....Last dr appt was in October. Dr said next psa and appt in February, but my wife insisted on a psa in December, which came back undetectable.
fabulous news, peterd--congratulations.....
Hoping it lasts a long while!!!
There are considerable intangible benefits of having a potential of 4 each 2 month long "windows of opportunity" on the calendar each year that are possibly free of the inconvenience of making and meeting lab appointments, and free from needle sticks and "Prostate Specific Anxiety". It adds up with extended years of survival. In my experience over the past 5 years, my major treatment decisions would not have been greatly affected had I had 3 months vs. monthly PSA testing. My PSA roller coaster graph would have just had fewer data points on it. I'm a "details" kind of person, and actually found some stress reduction in the closer tracking. As the months have grown into years, though, I'm becoming more appreciative of the intangible benefits of looser tracking, and the value of opportunities for all the other aspects of actively living (or just "being") for extended periods on my calendar.
Charles
My PSA tests are every 3 months with a abdomen/ pelvic scan every 6 months. However, my oncologist says that if any new source of pain arises_and_persists, to come back and see her.
I’d give serious consideration to adding Zytega now. The recent studies showed early lupron with Zytega extended survival by 40%. It Also showed early chemo (with multiple Mets) with lupron Also extended life close to the same. No studies on all three. But logic dictates to me at least that early use of all three is better than using them sequentially. That’s what I did on the advice of my doctor. I got a second opinion at UCLA and they said while it made sense, and they’d like to see a study on it, they could not advise it until a clinical trial should benefit to early use of all three. I’m not waiting. Down to .01 so far so good.
Schwah
I'll also be going onto Zytiga after chemo. Other studies show that the lower testosterone and PSA get, the better the prognosis. Hit the cancer hard and fast and you just might kill the majority of it.
There's also Xgeva to help strengthen the bones. It doesn't extend life (at least not by itself) but does help prevent fractures.
The only downside to these treatment are cost and more side effects.
I have Mets as well so. The doctor put me on monthly Xgeva shots for the bones and Dailey Xtandi pills as a anti cancer pill. Good luck fighting the monster. Oh. 29 months and counting 😀
Talk with your oncologist and determine a length of time that everyone agrees with. Waiting three months can also cause anxiety. Maybe 8 weeks is a compromise for now?
I a believer in checking the PSA monthly, I go in every month to get a full blood panel, eligard and Xgeva shots. 34 months and counting. 🙏🙏
Not too sure what’s next if anything 
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