Most of the oncologists that I have talked to date consider a PSA of 2 ng/ml as the threshold for classifying a patient as castration resistant and before commencing the next line of therapy. A PSA doubling time of <10 months, elevated LDH and ALP values and metastatic progression are other criteria.
It is logical to assume that commencement of next line therapy when the PSA is low (e.g., 0.5 – 2 ng/ml) is more efficacious than when started at a later stages in the disease when PSA is higher (e.g., 2 – 10 ng/ml) , assuming that PSA correlates with disease burden (except in neuroendocrine disease). I am having difficulty finding papers that compared the outcomes of therapies, such as chemotherapy, abiraterone, enzalutamide or SBRT, which were started late vs early. If any member is aware of published literature describing the aforementioned, it would be greatly appreciated.
In my opinion, the next line therapy should be started when the PSA is increasing with a doubling time <10 months and less than 2 ng/ml. Furthermore, it would seem to make more sense to start abiraterone therapy, for example, when the PSA is increasing and before it reaches 2 ng/ml.
Comments would be appreciated.
Cheers,
Phil
Gleason 10 Stage 4 Metastatic Responding Well to Treatment
Adding second line hormonal therapy?
