My husband was diagnosed metastatic to bones (back, rib, and hip) and pelvic lymph nodes in April.
He received a firmagon shot in late April and then started lupron 31 days later. He had his first chemo - docetaxal a week later. He just received the 4th chemo treatment yesterday. His psa has dropped from 112 to 4.5. The drop from treatment 3 to 4 was only 2 points. If he doesn’t get to undetectable by the end of chemo and/or the scans don’t look good what may be the next steps? What should we be asking the doctor? We are hoping for good news but I want to be prepared, as much as I can be, if it doesn’t go the way we want.
Based on the blood tests his immune system is rebounding pretty well from each chemo treatment . He is exercising daily and has cut out red meat and way down on the dairy.
This forum has so many great contributors. I have really appreciated reading posts and responses.
Longleaf
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longleaf
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It is good news the way his cancer is being controlled....people do not become resistant to harmone therapy overnight...many people keep responding for 2, 5 and even 10 years with standard ADT meds like Lupron.
Then, when a day comes in future when there is resistance and we go for other meds such as Zytiga as suggested by NPfisherman.
One rule does not fit all because prostate cancer is heterogeneous ..meaning different for different people...there are at least 20 varieties ranging from very mild form to very aggressive form and everything in between.
My husbands PSA was 320, after 6 sessions of chemo (Docy) his PSA only came down to 1.5, Has also had 6 sessions of RT to prostrate, hes metastatic stage 4. it has risen slightly to 2., and now 2.4, our OC wont intervene until his PSA goes up to 5.
We are in the UK and use the NHS at the moment, as we cannot go part private, part NHS. (not allowed) so will see what happens at our next appointment then decide from there our next steps.
Exactly, from initial Dx PSA 1000+ to PSA <0.02 in about 10 months with Lupron and Zytiga.
So, did we settle with the good results, NO! - decided to add chemo, getting my second Taxotere infusion tomorrow.
I'm currently researching Cancer Tumor Circulation (CTC), the continuous motion of cancer cells flowing through the blood looking to anchor somewhere. Hence, the rationale to add chemo while PSA is undetectable...
That's a good response to docetaxel. I can't imagine what kind of bad news you are anticipating. I also don't understand why he is getting a PSA the day after his treatment - chemo kills cancer cells (if it is working) and increases the PSA released by the dead cells.
BTW - There is no such thing "being prepared" for bad news. I think when people do that (and I have done it), they are only rehearsing the pain over and over - it makes it much worse than just taking it as it comes.
I am not asking to be emotionally prepared for bad news. I want to know what treatments the doctor might suggest or what treatments we may want to ask about. We travel a long way to see the mo who is currently setting his treatment and then don’t get a lot of time with her to ask questions or discuss options. We do have to plan because of the distance traveled, jobs and kids in school. We can’t always know what is going to happen but it was helpful to find out that doing saline drip on the nadir could help with side effects. It would have been great to find that out a bit sooner. Some of this can’t be planned for but sometimes you can help set yourself up for better outcomes. We are hoping for the best but having to think about different possibilities. I was just throwing this out there because I wanted to try to know some options and because I have seen a lot of good information.
Also they take the blood for psa just before chemo treatment and we are just doing that because they told us to. Our understanding was that they wanted to get it to undetectable so when the drop slowed down that seemed concerning to us. The mo told him he had between 2 to 20 years so we want to push that closer to 20 if we can.
Your posts always seem knowledgeable and grounding so I appreciate a response from you.
I like what Tall_Allen said about trying to be prepared for bad news. I spent much of the last day and a half in sheer panic and trying to figure out how to deal with a possible recurrence of bladder cancer (see the link in my latest post for all the details). Well, I just got back from my nine month follow-up with the urologist, and he didn't find anything so all that worry was for nothing.
That said, adding Zytiga as suggested above may be a good idea regardless of the PSA number after chemo. Mine was 0.02 after chemo, and went to <0.01 with Zytiga. Now I'm struggling to take my own advice and get back to living life and not spend time and worry wondering what to do when the cancer comes back.
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