A little over 9 months into my father being on zytiga and prednisone and his PSA came back today at 0.06. It has been 0.02 up until then.
I feel like this means that he may not be castrate resistant yet, but he is starting to. I messaged his doctor and requested an Aximum scan and then possibly radiate any of the spots that are present on it.
Is PSA doubling time even relevant at this point? I just know that this is not good news. Only 9 months in and having a rising PSA would put him on the short end of the stick.
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BarronS
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He is getting PSA testing but it’s slowing rising the urologist said we need to see an oncologist and stop the zytiga I just wonder other the tests. Will the oncologist give him?
Not necessarily, There are other ADT drugs. Having one drug fail is not the end. He can move to other ADT drugs, i.e. casodex, xtandi etc. Depending on he age and general health, he might be a candidate for radiation or chemo.
For what it's worth, at my last visit I asked my MO about PSA values, because I knew when my latest value became available online later that day I'd freak out if it wasn't undetectable, and he had previously warned me that PSA can bounce around a bit. He said something like 4.0 would be considered a biochemical recurrence.
If he didn't have an ultra-sensitive test there would be an ongoing series of <0.1 results and you'd be happy.
I'm pretty sure he said 4.0. Does the fact that I still have my prostate matter? Perhaps he knew I'd panic well below whatever number he said and multiplied it by 10?
If PSA continues going up, discuss doing imaging when PSA is around 1 (Ga 68 PSMA PET/CT has the best detection rate). If there were few metastases it could be possible to do direct treatment of the metastases and see what happens. If this is not possible, he could do chemo. Chemo could re sensitize to abi or enza. After chemo he could try enza. If there is not response there are the clinical trial with the modified niclosamide which could re sensitize the cancer to abi or enza:
Perhaps a biopsy of one metastasis could be possible and they could study the genetic make up of the cancer and determine if there are mutations which could be treated with specific drugs such as keytruda, olaparib etc.
Wow, that's a really good summary of the major options after Abiraterone. It doesn't even include "far out" options such as high dose testosterone that can be tried when things get really desperate.
Correct me if I’m wrong, but that reading is very good , mine is usually 0.05 , once in a while it will jump up a couple of numbers, Doctor says it’s just a glitch in the test. My dad was at 340 now at 2.9 we’re very happy about that one.
I believe I read some of your posts and think that you have been stable at 0.05 for quite awhile now? Many of your bone mets have completely resolved and scans came back clean?
Father got a scan a few weeks ago and it showed mets to 3 different locations. Going to see if he can get those radiated. They all seem to have been persistent.
Yes my PSA has been stable for some time,but the Mets have not decreased in size, they have not gotten any bigger so I guess it’s a waiting game now. 🙏🙏🙏
I was on Zytiga/Prednisone for 6 mos before my PSA started to rise from 0.12 to 0.55. Also had RP during this time. Switched to Olaparib as result of genetic testing, which identified I am BRCA2+. After 2 mos my PSA is undetectable.
I think it is definitely not the beginning of the end for your father. There are options. Keep researching and asking questions. Knowledge is power.
Please don't thnk that way, my P.S.A. is at the lowest it has ever been since receiving treatment 5 years ago. It's 0.217, much higher than your Dad's and I feel fine, if it stayed that way forever I would be jumping for joy. There are plenty of different treatments left in the bag for your Dad, it could be something and nothing.
My husband's has gone from just under 8 to 12, back to 8, then just over 9 to 7.5... all down from >677. Our oncologist says it just means to watch... he isn't concerned because it is moving. And sometimes down. It has been two years this month and hasn't gone below 7.5. But mets shrank and ge feels good so we are happy to live with it.
I think you need to wait for more PSA counts to really see a big picture. 💙
Thank you for the information. I just fear that my father is not going to have as many options when it comes to chemo because the has system mastocytosis, which is invasion of his bone marrow with mast cells. This causes immature red and white blood cells and he has anemia.
The oncologist at MSK said that after when ADT ends after 18 mths it is normal to have PSA rise and they don’t get alarmed until it is between 1 and 2.
Thank you for the response but he was diagnosed M1 with 5 places of bone mets. He has only been on ADT for 9 months. PSA nadir was <0.02. First rend upwards of 0.06.
Hi BaronS, I agree with everyone else! It's beautiful that you're looking out for you Dad. Go out there and enjoy a bit of the weekend. Hopefully the weather is as nice as it is in Chicago today.
Your title header, “I think that is the beginning of the end” says it all.
You are experiencing the number one reason for patients not to have an ultra-sensitive PSA test. Panic for what is usually normal fluctuation. The point is he is undetectable with a standard <0.1.
The purpose of a PSA test once one is diagnosed with PCa is to judge the effectiveness of a treatment and to check for recurring cancer. The clinical value of ultra-sensitive PSA tests outside research laboratories is open to some question; and frequently debated as to usefulness in clinical practice. For example, a rise could simply be a calibration issue!
It boils down to any further treatment would not be considered in any event until that PSA rose above 0.1ng/ml, and even then not until that rise continued in elevation. This is the reason that my research medical oncologist does not use uPSA. And, it reduced anxiety in the patient. Besides the doubling time formula used by many were designed for tPSA (Total PSA) and not uPSA (Ultra-sensitive PSA). Isn’t commercialization of “new advances” in measurement of PSA great............ especially, in a clinical setting where many do not understand established thresh holds.
Consider this study that carries an important caveat for the use of ultrasensitive PSA tests - hopefully men will become aware of this before making any precipitate decisions based on what may not be as accurate a test as they believed:
J Urol. 2011 Oct 17. [Epub ahead of print] Poor Agreement of Prostate Specific Antigen Doubling Times Calculated Using Ultrasensitive Versus Standard Prostate Specific Antigen Values: Important Impact on Risk Assessment. Reese AC, Fradet V, Whitson JM, Davis CB, Carroll PR. SourceDepartment of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California.
Abstract
PURPOSE: In men with biochemical recurrence after radical prostatectomy, a rapid prostate specific antigen doubling time is associated with adverse outcomes, and is often used to guide the type and timing of salvage therapy. It is unknown whether prostate specific antigen doubling time calculated in the ultrasensitive range (prostate specific antigen less than 0.2 ng/ml) accurately reflects measures performed in the traditional range (prostate specific antigen greater than 0.2 ng/ml).
MATERIALS AND METHODS: We studied 394 men in a national disease registry of men with prostate cancer (CaPSURE™) who underwent radical prostatectomy, experienced biochemical failure, and had prostate specific antigen doubling time assessed using ultrasensitive and traditional prostate specific antigen values. Agreement between these measurements was assessed using Cohen's kappa score.
RESULTS: Median ultrasensitive prostate specific antigen doubling time was 11.9 months (IQR 6-29) and median traditional prostate specific antigen doubling time was 240 months (IQR 18-240). Agreement between ultrasensitive and traditional prostate specific antigen doubling time was poor, with a weighted Cohen's kappa score of 0.04 (95% CI -0.02-0.10). Using a dichotomous prostate specific antigen doubling time cutoff of 9 months, there was a statistically significant difference between ultrasensitive and standard prostate specific antigen doubling time (exact McNemar p <0.01). Ultrasensitive prostate specific antigen doubling time was more or less rapid than traditional prostate specific antigen doubling time by more than 15 months in 244 (62%) and 35 (9%) patients, respectively.
CONCLUSIONS: Agreement between prostate specific antigen doubling time calculated using ultrasensitive vs traditional prostate specific antigen values is poor. Ultrasensitive prostate specific antigen doubling time is often significantly more rapid than traditional prostate specific antigen doubling time, potentially overestimating the risk of clinical recurrence. Until the significance of ultrasensitive prostate specific antigen doubling time is better characterized, the decision to proceed with salvage therapy should not be based on prostate specific antigen doubling time calculated using ultrasensitive prostate specific antigen values. PMID:22014796 .
Me? DX’d with PCa in 2003; metastatic in 2004. I have over 120 PSA tests since 2004. I enjoy my <0.1........
Barron you sound so Barren.... You know that the day we are born is "the beginning of the end".... So take a deep breath and relax for a moment because there are many more options/treatments for your Dad. Keep the faith and smile as much as you can.
You sure beat the 0.1 psa I've had for a while now. Starting to think the lab they are using for me doesn't go below 0.1. Last scans seemed to show extensive bone mets dormant for now, like sleeping assassins. Quite frankly, the other age related issues the scans brought up bothered me more than the prostate cancer. Doesn't bother the dr. of course. Sounds to me like everything is going your way. Enjoy.
PSMA might be helpful as it is more sensitive than Axumin. The trouble in the USA is this is NOT yet FDA approved and studies often require a rising PSA with values of 1.0 to 2.0. I know Mayo Rochester, MN, UCSF & UCLA are doing PSA studies .... there are others too.
Barron nobody beat that dead horse harder than me. No test available to psa levels like your dads. If I did the test you are doing mine goes from .02 to .06 through the year. That’s why TA is telling you to use the psa test that some use that start at .1. So if you get less than .1 it shows up as 0.0.
I get mine done at md Anderson in Houston and KU Med in Kansas. MD Anderson uses the .1 so I go with them. I think the finer test just isn’t that accurate so give it a try. You are going to find that waiting on a psa test will drive you crazy and if you think these doctors have any idea what is going to happen in the future you are wrong. They tell you what studies have shown but can not relate it to an individual. Good luck
SWITCH TO 0.5mg per day dexamethasone from prednisone, either now or if PSA continues to rise. This could give you another year on Zytiga although as others have said the PSA is still basically undetectable so trend up is not for sure!
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11 months of vacatión and going strong, I think
Am I at the end of life? Chemo failing.
Wants to end treatment 
Radiation or operation with mets and beginning ADT only once symptoms arise?
Round 3 of docetaxal June 4th. I almost dont want it to end. 
