Lupron cause PSA rise?

[ncisc001]

My father is currently on Lupron and Erleada. So far, his PSA has been decreasing. He gets a 3 month check up at Emory and at another local oncologist (for his Lupron). In Sept., his PSA was 0.3 at LabCorp (local Dr.) and in Dec. (3 weeks ago) it was 0.2. In Sept. at Emory, his PSA was 0.21 and today it was 1.5. The only difference is that he always gets his Lupron AFTER he sees his oncologist at Emory and this time, he got it 3 weeks prior to his visit.

My question is .. can Lupron cause a spike in PSA like that? Is it possible for his PSA to jump up from .2 to 1.5 in 3 weeks when it had a downward trend for 12 months? The ARNP wants him to repeat PSA in 6 weeks and scans in 12 (he’s NMCRPC). What do you all think? I’m freaking out that we’re out of hormonal options at this point.

[Hidden]

Yes it's possible to have a PSA rise from .2 to 1,5 in 3 weeks, but it's also possible there was a problem with the test accuracy.

I'd get another test right away, then another in one month to see what's going on. Every 3 months is fine if the numbers are relatively stable, but not in this case IMO.

[Tall_Allen]

Lupron cannot cause his PSA to rise. Good idea to repeat the PSA in 6 weeks (lab errors happen) and, if truly elevated, f/u with scans to check for progression. Probably best to alternate hormonal therapies and chemotherapies. If he becomes detectably metastatic, he may also qualify for Xofigo and Provenge.

[BillNIttles in reply to Tall_Allen]

Tall_Allen, can you elaborate on alternating hormonal/chemo treatments? I have been taking just casodex since February, and my psa is been pretty much holding steady since. Prior to that I took a vacation from treatment all of 2018, following 2 years of lupron, which led to the rise in my psa. While really happy with my response so far, my MO tells me it only a matter of time before I will need to start hormonal treament again, the effects which I hated.

Is there middle ground?

Thank you

[Tall_Allen in reply to BillNIttles]

I was talking about a case where the guy is castration resistant, not hormone-sensitive like you.

[ncisc001 in reply to Tall_Allen]

I just received his testosterone results and it’s at 38. Does that mean Lupron isn’t lowering it enough? Is there another drug that would do a better job at bringing him to a castrate level?

I’ve read that the goal is under 50 but some say under 20. I’m waiting for his doctor to return from vacation but any advice/guidance would be greatly appreciated.

[Tall_Allen in reply to ncisc001]

You can switch to monthly firmagon shots. Maybe that will take it lower.

[JoelT]

Was his testosterone level tested? Is he castrate, pleas have that checked asap - a blood test

[ncisc001 in reply to JoelT]

Hi Joel, I just got his testosterone results and it’s 38. Is that considered castrate?