mCSPC vs mCRPC? Does my MO have it right?

[ctflatlander]

My MO says I'm mCRPC and I think my PSA elevation is due to radiation bounce. I'm Oligo and 75 YO and questioning his assessment.

PSA

34 6-2017 started casodex

20 11-2017 started Lupron (still on Lupron)

3.5 1-2018 started zytiga

.7 8-2018 level for 3 months

.9 10-2018

1.4 12-2018

1.4 1-2019 IMRT to prostate & bed

2.8 3-2019 added avodart

4.6 4-2019 SBRT to T3

2.2 5-2019 started metformin

.2 6-4-2019 started Xgeva

.1 6-25-2019

< .1 7-17-2019

testosterone < 7

MO says he is treating me as a mCRPC. I've had to start and stop Zytiga along the way. Now down to 500mg daily. I'm AR-V7 negative, ALT/AST rising and he may consider Xtandi.

Here's a picture of my granddaughter celebrating my <.1 PSA!

My MO says .3 and lower is considered non-detectable. ANY thoughts? Thanks to many that contribute to this site including Nal, Tall, Don, Patrick, Fish, and many others.

Bob in Northern VT

[NPfisherman]

Not sure how he reached that conclusion since you are at lowest nadir point now...since you started and stopped Zytiga along the way, and without dates it is impossible to tell...seems like you are doing well on 500 mg--are you eating a meal with it?? That may be why AST/ALT is up....Any previous liver issues....I believe we need more information...congratulations on getting to your new low....

Don Pescado

[ctflatlander in reply to NPfisherman]

Don, I have always taken my Zytiga at the last nighttime pee, around 4-5 Am. Then have my breakfast at least 1 hour thereafter. I started on 1000 mg in Jan 2018 and had to stop with elevated AST/ALT in April , 2018 PSA was 3.5. Restarted Zytiga 1 month later w/ 750 mg, PSA was 1.0 mg. PSA then started climb to 1.4 and AST/ALT were above normal and was told to stop Zytiga. PSA was stable at 1.4 for 2 months and restarted Zytiga at 500 mg. I also started IMRT about the same time. PSA climbed from 1.4 to 4.6 SBRT was given at 4.6 and then declined to where I'm at now <.1 The reason I mentioned my liver function is that based on past charts I see an upward trending of my AST/ALT that is similar. It not at the upper normal but trending there. My MO says we will stop Zytiga and never resume it again if they are at above normal. Thank you for your interest and hope that answers your question.

[Tall_Allen]

I think you are better off having a diagnosis of mCRPC because it increases your current treatment options (for example, the ability to use Xtandi instead of Zytiga).

[ctflatlander in reply to Tall_Allen]

Than you Tall, I will keep that in mind.

Bob

[Hidden]

Castrate resistance means that at castrate levels of testosterone (generally <20), you are starting to have progression. If you are on Zytiga, I don't know how you would know if you are castrate resistant. Did your PSA go up when you went off Zytiga?

I think it makes sense to treat you as if you were castrate resistant and as long as Zytiga is keeping your PSA low, that's the important thing.

You said your AST and ALT are rising. What are they at now? My doctor told me it's rare that it happens from Zytiga. He said he is yet to see it. Have you had any imaging on your liver done?

[ctflatlander in reply to Hidden]

Hi Greg, My PSA never went up when I stopped the Zytiga.. I had a scan that showed a cyst, but told it should be of no concern. My latest AST was 32 and ALT was 45. My MO is not concerned but based on previous experience I am keeping a watch on them.

Thanks Bob

[Hidden in reply to ctflatlander]

Those are great AST and ALT numbers. I'm with your MO, don't be concerned about them.

[cesanon]

"My MO says .3 and lower is considered non-detectable

1. I think that is sort of a non-issue. Some of your prostate cells probably survived the IMRT. you have some metastasis. the real issue is if the PSA is increasing or not.

2. It sure looks like you have been getting good care. Is your Medical Oncologist the one prescribing metformin? Seems like most won't. May I ask who you are using as an MO.

3. In consultation with your Medical Oncologist , it might be worth testing to see what would happen if you temporarily suspended your androgen deprivation therapy.

[ctflatlander in reply to cesanon]

My PCP prescribed Metformin and my MO is Sergey Devistsky. I know his answer will be: we don't want to make any changes. Based on Tall's note, I will have more treatment options if I'm mCRPC.

[tango65]

Difficult to know if you are castration resistant since you are taking zytiga which could reduce PSA in mCRPC.

ascopubs.org/doi/abs/10.120...

If your cancer is considered castration resistant ask for Provenge.

[ctflatlander in reply to tango65]

Hi Tango, My MO was going to prescribe Provenge when It was at .2 in June, now wants to wait until I see progression upward. He doesn't want to make any changes unless AST/ALT goes above normal again. Thanks for the link.

Bob

[tango65 in reply to ctflatlander]

best of luck on this journey. A fellow traveler

[Magnus1964]

Castrate resistant means you no longer respond to any ADT drugs. I would be anxious to be in that situation. Get every day you can out of each drug.

[j-o-h-n]

Granddaughter is cute and smart, she's wearing a Yankees tee shirt as opposed to you wearing a Red Socks one..... Geez Whiz.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 08/04/2019 11:16 AM DST

[ctflatlander in reply to j-o-h-n]

John, We were at the last game at Fenway that the Sox won. Maybe tonight they will win. Thanks for the compliment. I'm surrounded by family that are Yankee fans and have to grin and bear it.

Bob

[j-o-h-n in reply to ctflatlander]

Your family knows talent............... Grin and bear it but don't wear it (tee shirt that is)..

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/05/2019 1:55 PM DST