24 months post chemo - rise to 0.2 PSA

[BigM62]

I am 24 months post chemo - I have been undetectable PSA for those 2 years. Just today I got the dreaded call that my most recent reading had gone from undetectable to 0.2. It was voicemail - so they didn’t indicate what I should do? Keep my next appointment in 6 weeks? Or to schedule something new to talk to the MO about next steps? For those of you who have been down that road, did the doc want to see you right away?

[Zetabow]

Mine only lasted 9 months but my MO said it would last 9 to 15 months so it was no shock when he said the PSA was on the up at 9 months. I always do my blood test 3 days before my appointment so he wouldn't know any changes before then anyway.

He suggested Radium 223 as my next treatment because of my extensive bone Mets to whole skeleton but wont start anything until my PSA reaches a threshold, my next appointment is 17th April so it seems no rush or panic as it's creeping up slowly.

My pain specialist called my Wife yesterday and said they will start bone strengthening treatments next week, I don't know exactly what treatments yet, I will see her on the 4th for more details.

Good luck

[tom67inMA]

0.2 is still low, not time to panic. I'll let others advise on when your next check should be.

Consider yourself lucky, you're getting advanced warning that something is going on, so you can eventually change treatment plans before things get out of hand. My PSA may be still be undetectable, but I have significant symptoms of what appears to be a third cancer that took me and my doctors by complete surprise.

Deal with things as they come and try not to worry ahead of time. You never know what life will throw at you next. Make sure you have a few good laughs today.

[Tall_Allen]

He will probably want to wait until your PSA reaches 2.0 or doubles quickly, and he will likely ask for a bone scan/CT to confirm progression. If so, Xofigo might be a good choice, and here are some other next steps to talk to your MO about:

pcnrv.blogspot.com/2019/12/...

If any metastases are large enough to biopsy, that may lead to some clinical trials.

[BigM62 in reply to Tall_Allen]

I started my journey with a high tumor load in my spine. So straight to chemo and Lupron. It worked really well and my PSA went to undetectable for 24 months. Last scan (1.5 years old now) no cancer was visible - although of course just your basic MRI - in my spine and all Mets are resolved. So from there we have only monitored PSA and this is the first rise.

So I do think that it’s a good time to get new baseline scans. I’m assuming MRI is not good enough. Is there a scan to ask for?

I had assumed my next step would be Zytiga and that it would begin immediately after a PSA rise. Would there be a benefit to waiting till the PSA gets to 2.0?

I was really really close to spinal cord compression and had terrible back and nerve pain when this was discovered. So I’m terrified of “waiting” for PSA to rise unknowingly getting spinal compression and back pain again.

Lastly, why xofigo at this stage? Like I said I assumed Zytiga, although of course will need to see what MO says as well.

I called to see if doc wants me to come in now to discuss. Or if he wants a repeat test in 6 weeks first. Waiting on that response.

[Tall_Allen]

You didn't have a technetium bone scan? You're not likely to be able to see progression at your low PSA. Are you taking a bone strengthening agent (Zometa or Xgeva)? Xofigo can attack the cancer in your bones.

[BigM62 in reply to Tall_Allen]

Yes zometa. No on that type of bone scan.

[Tall_Allen in reply to BigM62]

That's unbelievable! You should definitely ask for one.

[BigM62 in reply to Tall_Allen]

Ok! That can be done now right? No need to wait for higher PSA?

[Tall_Allen in reply to BigM62]

It won’t show active sites until PSA reaches much higher. It may show sites where the cancer has already shrunk. Did they do the mri of your spine based only on pain?

[BigM62 in reply to Tall_Allen]

Yes I was diagnosed due to back pain and a regular ortho did an MRI. And one of the large Mets was biopsied to determine it was prostate cancer. And then I had a few more mris over the progression of my chemo etc. I haven’t been imaged since my PSA went undetectable after chemo.

[Tall_Allen in reply to BigM62]

Unbelieveable that you didn't have a bone scan before chemo. Is your oncologist at a major cancer center?

[j-o-h-n]

Voicemail? Cross that sucker off of next year's Christmas gift...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/30/2020 9:33 PM EST