Any thoughts on my next treatment plan?

I truly appreciate any thoughts on my current situation: I had a prostatectomy seven years ago followed by radiation leading to an undetectable PSA for two years. Then, PSA came back and I went on Lupron, Zytiga and Prednisone for 9 months along with ($2800) PSMA scans at UCLA and in Phoenix and radiation which resulted in my PSA decreasing to .03. Hoping for a two year vacation, unfortunately, I only got a two month reprieve until my PSA reappeared at 0.24...and two months later the PSA was 1.87.

My MO now says that maybe Lupron (and I suppose other meds) should be given again when the PSA is 5.0 or to give me off-label Luekine to increase my white blood cell count.

I am in a quandary and to be honest, scared. Would someone have thoughts regarding my situation? Thank you!!!

[Tall_Allen]

Is your WBC low?

What did your PSMA scan show,and what was treated with salvage radiation?

With your rapid PSADT, ADT is a good idea, but intermittent ADT may not be a good choice with low metastatic burden.

[Hidden in reply to Tall_Allen]

My WBC is 6.4 (on a 4.1-10.9 scale); in the previous months it was 5.5, 6.1, 6.4 and 7.5. The PSMA scan had showed lymph and bone mets both of which were radiated.

Not sure what you mean by "but intermittent ADT may not be a good choice with low metastatic burden".

Thank you very much.

[Tall_Allen in reply to Hidden]

Why are you getting Leukine with a normal WBC?

How many bone mets?

[Hidden in reply to Tall_Allen]

I'm not getting it yet; it was only considered by my MO Turner-possibly to keep me from going through Lupron, expensive scan, etc. maybe until my PSA was 5. I'm just not sure what he was thinking...I'll have to wait until my next visit in a few weeks. I thank you for your thoughts; wish I could be more sure of what he was thinking.

[Tall_Allen in reply to Hidden]

How many bone mets?

[Hidden in reply to Tall_Allen]

I don't know. In the past they were radiated. (I know that I had one on a lower left rib.) I guess my next scan will reveal such...

[Tall_Allen in reply to Hidden]

It's important to know because whether intermittent ADT is a good idea dependss on it. You have to get and keep copies of all your reports - you are in charge.

[GP24]

The PSA value is rising because new mets appeared. You can try to do PSMA PET and radiation again or start with ADT.

[lowroad in reply to GP24]

You can try to do PSMA PET and radiation again AND (not "or") start with ADT.

[GP24 in reply to lowroad]

Combining metastasis directed therapy with ADT will usually provide better results than radiation only. I understood that Michael wanted to extend the pause of his intermittent ADT. Adding six months of ADT to the radiation is what I would recommend. Then e.g. wait until you get to a PSA value of 5 ng/ml to continue with the intermittent ADT.

[Magnus1964]

Your PSA is still low. Fluctuations that you have been experiencing may be due to other causes, i.e. inflammation. Don't panic. Watch your trends in PSA not small changes. When and if the time comes there are other ADT drugs.

[j-o-h-n]

Change your password every 3 weeks...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/09/2019 7:06 PM DST