HUSBAND'S LATEST PSA AFTER ZYTIGA

[spouse21]

PSA now 4.20, down from 7.58 in late November, 2018

Below is my husband's signature showing his history. Due to rapid doubling in PSA last summer, he restarted Lupron in September, 2018 then added Zytiga/Prednisone 2/9/2019, three weeks ago. PSA is going in the right direction. He got the report after our visit with his oncologist, Dr. Matthew Smith, so we didn't get a chance to discuss if this is a decent drop, but we'll take it! It's probably too early, right, for the Zytiga to have really kicked in? He's on a monthly schedule and will see Dr. Smith in early April.

It's only been a few weeks, but so far he's tolerating the Zytiga/Prednisone with no additional side effects than the usual fatigue and mild hot flashes.

Husband 70 yrs (74 now) pacemaker; Agent Orange

9/14: blood in urine; DRE suspicious

11/14: biopsy G 9 (4+5), PSA: 3.32 high Gleason, low PSA, PNI involved

Lupron taken for 33 mos (currently on Lupron again after a year hiatus.)

6/15: 9 wks IMRT

9/15= .14

1/16= .093

4/16= .079

11/16=.05 (nadir)

2/17-5/17=.05

1

1/17= .08

2/18= .20

4/18=0.98

6/18= 3-4 bone mets seen on CT scan

7/18= 3.29

8/28= 9.0

Lupron re-started with a month of Casodex

11/27/18=7.0

Zytiga/Prednisone started 2/19

2/9/19=4.02

[NPfisherman]

Going in the right direction....you will have to wait....here's hoping the fall continues.... if it fails to continue dropping consider adding indomethacin to help overcome resistance=--see below:

ncbi.nlm.nih.gov/pubmed/277...

and if that fails, you might consider switching prednisone to dexamethasone...

ncbi.nlm.nih.gov/pmc/articl...

For now, I would wait and suggest these to your Oncologist if things don't go down a lot further....

As far as his 3-4 bone mets, you may wish to consider the stereotactic radiation trial listed for oligometastatic disease on pg 4 below:

cancer.gov/about-cancer/tre...

Some may say this is not proven yet, but the evidence is building that this increases OS...

medpagetoday.com/meetingcov...

sciencedaily.com/releases/2...

Good luck to you and your husband...

All the best,

Fish

[spouse21 in reply to NPfisherman]

That is so helpful NP. I'm cutting and pasting it into our "if things head south" folder!

[NPfisherman in reply to spouse21]

You're welcome...call me Fish....or by my Italian name...Don Pescado... the Lupron Don... The Don of No Testosterone (gotta say it like an Italian would).... LOL... hope that got a smile out of you...or a chuckle... The 2 suggestions about zytiga--put in your folder for later....as for the bone mets--start exploring the clinical trials...it will take some time to enroll and get started for stereotactic radiation...not sure where you are, but there are 2 trials in Pittsburgh--Dr Heron and Dr Burton... it may help drive the PSA lower and will decrease tumor burden...

Don Pescado aka Fish

[spouse21 in reply to NPfisherman]

Thanks for the heads up on clinical trials, Don Pescado! My guy doesn't qualify for most of them due to having a pacemaker--third one actually--and major abdominal surgery right before the PCa started. But we're grateful to everyone who has participated in trials. Thanks to them, so many more regimes and drugs are available now that weren't standard of care in 2014.

We'll ask about imaging for those mets on our next Boston visit next month. It's not clear what the protocols are for updating images. It's been over a year. We'll see.

Thank you so much, Fish, for your advice.

[Crabcrushe]

Ma'am, I bet you get even happier numbers next labs. Keep me posted! Please thank him for his Service...

Charlie

[spouse21 in reply to Crabcrushe]

Good luck to you, too, Crabcrushe. Thanks for your good wishes.