At what PSA did you switch treatments?

[BarronS]

Reading all of these studies, I always see that they have progression free survival. My father is on month 10 right now using zytiga and his PSA ticked up from <0.02 and now is at a 0.06. This would put him on the short end of the stick if this is defined as PSA progression. Yet, I've read that PSA progression is defined as an increase of >25% over nadir but has to be above 2.0 PSA. I've just read a study that most men on zytiga have stayed on it, even when their PSA had risen by greater than 50 points of PSA.

So I was just wondering when people who were hormone sensitive switched treatments. My father has anemia from systemic mastocytosis so I want him to ride the zytiga or xtandi train as long as possible.

[NPfisherman]

Previously, you thought about getting stereotactic radiation to his 3 lesions....he also still has a tumor in his prostate as I recall....Why not get the stereotactic radiation initially, then arrange to get brachy boost therapy later to deal with the prostate tumor....

Also, a switch to dexamethasoine from prednisone may buy him some time since he has asymptomatic PSA progression....

ncbi.nlm.nih.gov/pubmed/300...

Lastly, adding indomethacin may help break any resistance but I would do that after the dexamethasone switch if the switch doesn't totally work.....

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

That's what I would look at doing...

Don Pescado

[GoBucks in reply to NPfisherman]

I have read that you can not just stop prednisone. I assume switching to dexamethasone would eliminate that problem. Do you know?

[NPfisherman in reply to GoBucks]

Yes, when you stop prednisone, you change to dexamethasone...see the article I included in my reply...

[tango65 in reply to GoBucks]

There are clinical trials with modified niclosamide or with indomethacin trying to make the cancer to continue responding to zytiga and to enzalutamide:

clinicaltrials.gov/ct2/resu...

clinicaltrials.gov/ct2/resu...

University of California Davis Comprehensive Cancer CenterRecruiting

Sacramento, California, United States, 95817

Contact: Chong-Xian Pan 916-734-3771 [e-mail]

Principal Investigator: Chong-Xian Pan

University of California Davis Comprehensive Cancer CenterRecruiting

Sacramento, California, United States, 95817

Contact: Mamta Parikh 916-734-3772 [e-mail]

Principal Investigator: Mamta Parikh

[BarronS in reply to NPfisherman]

Thank you for your responses you always give on my posts. I really appreciate you. I actually was digging and found the trial data from the stampede trial and what they would consider progression.

"For patients whose PSA falls below 4ng/ml, PSA relapse will be defined by either 50%increase from their nadir or the PSA increasing above 4, whichever is the greater. Forexample, a nadir PSA of 3.6 would require a PSA of 5.4 to define relapse, while PSAnadir of 2.5 will be considered to have relapsed at a PSA of 4."

So people who get to undetectable levels of PSA during initiation of hormone therapy would not be considered progressing until their PSA reaches a 4.

[LearnAll in reply to BarronS]

Thanks. your statement : "a relapse is when PSA rises to 50% above nadir or goes above 4"

.In this world of so many fearmongers....your information is very useful.

I would like to add that one time high PSA reading should be ignored if trend in PSA stays good and steady.

[NPfisherman in reply to BarronS]

Thank you....it is the best appreciative response I have had since I started...I have stopped posting science for a general overall lack of appreciation for what I post, and have pondered only replying to those that post issues who follow me for the same reason... Perhaps that sounds selfish, but giving my time and feeling unappreciated for my responses is not worth it...I can be a lurker like so many are here...Best of luck with Dad....

Don Pescado

[tango65 in reply to NPfisherman]

I agree.

[BarronS in reply to NPfisherman]

As I told gregg, I don't know you, but I love you and appreciate you for what you are going through. Without people like you and everyone else on this board responding, this board would not exist.

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

Lurker? and a Voyeur too....👀👀👀

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 08/17/2019 8:38 PM

[Shanti1 in reply to NPfisherman]

Hi Don, I am relatively new to this forum, but I would venture to say that there are many silent readers who find great benefit in your posts. If you revert to a "lurker" it would be a great loss.

Warmly, Shanti

[NPfisherman in reply to Shanti1]

Shanti,

Thanks for your kind reply...I am still replying to posts, especially to those who get little or no response to their posts involving medical issues or cancer related issues, and always respond to posts by my followers...I post no longer and the loss is the science on the forum for only a few follow it as hard as I do, but a lack of appreciation for the science finished me...My last post on a CAR-T breakthrough involving a post transfusion vaccine that had a 60% solid tumor cure rate (in mice, but CAR-T usually works for not solid tumors only) got essentially no discussion, and turned into a love fest over fenben....

Quite honestly, I am amazed that pjoshea13 keeps grinding out as much as he does with often few responses...tango65 replied, "I agree" to my statement about lack of appreciation... tango65 puts out science...George71 has posted little science recently and he used to put out quite a bit...puxi also... perhaps, it is lack of appreciation

It is what it is...as they say... still here but evaluating what my role is here and the time involved....

All the best to you....

Don Pescado

[Shanti1 in reply to NPfisherman]

I just followed you, lol ☺

[NPfisherman in reply to Shanti1]

Well, my response is not generated to get followers but to express what I feel is going on at the forum...I appreciate your faith in me and will always strive to uphold that faith....some message me...one daughter, Ankitsharma021290 from India just keeps adding to her one post to message me.....LOL....She doesn't follow me but she is going through some issues with Dad's health, so I always respond...Kinda humorous...It will go a month or so, and I see she sent me a reply....it is a new issue...I give her my best advice...Too funny...

Anyway, have a great day....hope you enjoyed the weekend....

Don Pescado

[tango65 in reply to BarronS]

Do you know in what data are those criteria based?

[BarronS in reply to tango65]

stampedetrial.org/media/111...

This is where I got it from. If you can capitalize on anything I said or correct it, I would appreciate it. Thank you tango, for your participation and help on here.

[tango65 in reply to BarronS]

Best of luck on this journey.

[NPfisherman in reply to BarronS]

Oops...there is one other person who does appreciate me more....marnieg46 in Oz....she exchanges messages with me on her husband...I may go to Oz next year for vacation and say ,"hello" along the way...Take care....

Don Pescado

[Hidden]

PSA alone shouldn't be used to decide when to switch treatments. It's one indication, but you need something else like radiographic progression. So when the PSA starts to rise, you start doing imaging. If there's no progression, keep on the same treatment.

With Zytiga, a rising PSA is an indication to try a different steroid (Dexamethasone) but not change treatments. My doctor told me "We are not treating the PSA, we are treating the cancer."

[whatsinaname in reply to Hidden]

Superb reply, gregg57, thank you.

[LearnAll in reply to Hidden]

Agree with Gregg....all factors should be taken into account /consideration when deciding to switch treatment..(1) Rising PSA (2) Rising testo (3) clinical symptoms (4) overall wellbeing and physical condition. Do Not let fear make you rush to other treatment...fear impairs our judgement. Also, if imaging shows progression..is a reason to consider other treatments.

[whatsinaname in reply to LearnAll]

Excellent stuff, LearnAll. Cheers !!

[BarronS in reply to Hidden]

Thanks for always answering on my messages Greg. I don't know you, but I love you. I love you as a person that is also going through what my dad is going through and as a person with inherent worth. I appreciate you.

[Hidden in reply to BarronS]

Thank you very much! I just remember the profound sense of loneliness I felt when I was diagnosed. I thought to myself that no one should have to feel that way. That has made me want to do what I can to help others. Thanks for appreciating it.

[Hidden]

In my opinion, and many disagree, quit worrying yourself to death. I asked my research medical oncologist, “Why don’t you rely on uPSA results” - ultra-sensitive PSA markers...... his response was, “Do you want to worry? Besides, most patients and doctors do not know how to interpret the results. Treatment decisions do not take place until after, at a minimum 0.1. So we will watched and make sure that you stay <0.1, which is considered, undetectable”. This coming from a Professor of Medicine and Researcher who has taught and researched at three major medical schools and researched at MD Anderson, Methodist Institute, and Memorial Hermann cancer centers. Of the 120+ PSA tests which I have had in the past 16 years, I have never had, nor do I plan to use uPSA for a treatment decision. Again why? Needless worry and zero treatment decisions based on results under 0.1.

Gourd Dancer

[Kittenlover50]

mine was on about 18 mo along with zytiga after he had had chemo, preparing for radiation, during radiation and a year after. Came off both when he had been non detectable and no evidence of disease for a year. That was 5 years ago. Some docs are firm on 2 years, some are taken off, needless to say, if becomes resistant.