Concerned -- Husband's PSA Doubled 4 to 8 between 4th and 5th Chemo Treatment

[Barbara345]

Concerned and questioning --any experiences/info? Husband Barry's PSA doubled from 4 to 8 between his 4th and 5th of six scheduled chemo (Docetaxel) treatments. It had dropped from 6 to 4 after first chemo treatment, and stayed at 4 during the next 3 treatments. Before chemo, it dropped from 60 to 6 after 2 months on Lupron (which he is still on). Oncologist has scheduled bone and CT scans for Feb 11th, the day before his last scheduled chemo. I'm already researching what to do if his pc is declared resistant; and want to "hit the ground running" if needed. His chemo hasn't given him many side effects so far, but I also want it to fight the cancer. Oncologist may take him off chemo and put him off something else if PSA keeps rising. He was diagnosed in late August with PC and lots of bone mets.. Almost no symptoms. I wouldn't be so concerned if this had happened after his first chemo because I know flares can happen then, but after 4th treatment? Thanks!!

[Dachshundlove]

Hi Barbara

My husband’s psa rose several times during chemo (I believe we had two reductions in psa during 7 rounds of chemo)

His oncologist added carboplatin after the 4th infusion. With that, PSA stabilized and then dropped again.

His Dr now has him on Zytiga and we are getting ready to start prep for radiation Monday.

My husband was diagnosed stage 4 in may. He appears to have pretty resistant cancer.

Your husbands response to Lupron is awesome! It sounds like he is very hormone sensitive so that it great!

Good luck to you— this is a tricky disease. And the big things in life are not up to us.

[Tall_Allen]

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

[Drgucancer]

I would be interested to know what treatments he’s had so far, his Gleason score, and what is the extent of his disease (ie bone , lymph nodes or both) not unusual for psa to fluctuate on treatment. Never never never stop a drug on PSA alone . Ive had patients with rising PSAs for years with no progression. Last thing u want to do is use up ur treatment options too quickly for a non-curable cancer. Taxotere is one of the early treatments and typically many other options including new classes of drugs. I often add Avastin (not approved but can get for free from company) but works when taxotere has stopped working.

[Drgucancer]

You would only add carboplatin or cisplatin if concern for neuroendocrine prostate cancer (ie liver or lung mets or elevated nse or chromogranin) other options : jevtana, combination xtandi +zytiga even if failed individually, check point inhibito with cabozantinib, a radiopharmaceutical, test for dna repair mutation the a parp inhibitor would possibly benefit

[Barbara345]

Thank you. He's Gleason 9, diagnosed Stage 4 August 20th. He had Casodex for a month starting Sept 3rd, Lupron Depot continuously since approx Oct 4th --- he's still on it ---- and 5 treatments of Docetaxel, taken every 3 weeks from November to last (5)th treatment Jan 21st. He has his last chemo scheduled for Feb 12th.

His medical oncologist has ordered CT scan chest and abdomen and full bone scan for Feb 11th, the day before his last scheduled chemo, to get more info on what's going on. He doesn't rely on PSA alone either, and from my reading I wouldn't be comfortable with a decision based on PSA alone, but am happy there will be a follow-up scan.

He has numerous bone mets filling pelvis and spine; definitely high volume. Questionable about lymph nodes. There were four tiny spots on lungs on his Aug 29th scan; they'll be looking now to see if this is significant.

He had no symptoms at all when diagnosed and still has virtually none --- even the chemo didn't slow him down much, although he's had to rest more and gets hot flashes.. He walks up and down our 300 foot elevation every day, rain, snow, always (we live at the top --- we're rural and drive a distance for his treatments). He lives an active life (we both do).

In the meantime I'm researching whatever I can to find options in case we need them. Definitely genetic testing..... I'm not assuming anything's wrong, but preparedness is the key.

Thanks for all the help and info.

[Barbara345]

Thank you!!! This helps a lot. I looked at Foundation One, glad to hear about the specific items you mentioned. I'll definitely look into them. The scan was ordered because of the rising PSA, to find out early if there's cause to change course. I'm not assuming anything amiss, but want to be prepared to "hit the ground running" if something is.