A small rise in PSA What do you think of my plan

[ctflatlander]

I'm a 76 1/3 yo that has spent 2 1/4 yrs on Zytiga had IMRT, SBRT to the bone and on Xgeva. Psa was <.1 for 8 mos and has risen to .2 Alk Phos looks good. I'm expecting PSA will not go down and plan to try again to get Dexamethasone prescribed in lieu of pred. Will provide my MO in advance of next visit a copy of the Switch trial. I was tested for ARV-7 and I have no positive activity and would like to go on Xtandi next or chemo. Am I not aggressive enough? Just a note, I could only tolerate 500 mg of Zytiga for a 2 yr period which make me think Xtandi may work better. We have to schedule blood work draws now rather than walk in. Next MO visit in 2 weeks and I'm on a 6 week cycle.

We are having a short sugar season although there is a good snow pack in the sugar woods. Maple syrup is not part of my diet anymore but it keeps my body and mind off my health and the virus. We have 3 cases in our county here in VT but afraid its going to climb. Thanks to all. Bob

[Magnus1964]

I wouldn't be too concerned about your PSA reading small increases can be caused by inflammation or irritation of the prostate. If you get 3 rises in a row then make your next move.

[ctflatlander in reply to Magnus1964]

Thankyou Mag

[tom67inMA]

There is variation from day to day in PSA values. I once had a mix-up and two PSA tests were done on the same blood sample, and they came up with two different numbers, 0.07 and 0.08. Going from undetectable to one of the smallest detectable values could just be normal variation.

Asking about Dexamethasone sounds reasonable to me, but I also think it's too early to say it's time to move away from Abiraterone.

On another topic entirely, what county in Vermont? I grew up in Connecticut, been living in Massachusetts for 30+ years, and have a small weekend place at 1600' elevation in Windham county, Vermont.

[ctflatlander in reply to tom67inMA]

Thanks Tom, I've read about your difficult times. Best to you. I'm originally from Monroe, Ct, now live in Calendonia County Vt. on the boarder of Essex, County. I'm at 1500 ft which gives me late sugar runs. Bob

[Tall_Allen]

Love Maple syrup! I'm having some right now in fact with my pancakes. What do you think of Grade B? I was wondering if it has more flavor than Grade A.

I like that you are being proactive about switching to dexamethasone. With a PSA of 0.2, there is some life left in Zytiga for you.

AR-V7 is just one of many modes of resistance. It really doesn't matter that your Zytiga dose was lower; when you become resistant, there is likely to be cross-resistance to Xtandi.

I think it is best to alternate between chemo and hormonals:

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

Also, when you are done with Zytiga, Xofigo+Provenge may be a good option.

[oldbeek in reply to Tall_Allen]

Hey Tall, I am another CA guy here. About class b syrup. I was a beekeeper.. Let me explain usda grades. With honey and probably maple syrup. GradeA honey, usually in stores. Ultra filtered. Brought to 160 degrees F, that kills all enzymes then run through 5 ft of hot diatomaceous earth then through a tube surrounded with liquid nitrogen (325 degree below 0) to 130 f, then bottled. Basically sterile. All enzymes and pollen removed or filtered out. I don't have the exact process for grade B, but grade C is farmers market style, no matter what those jerks have on their bottles, California honey will not go through a filter screen unless it is heated. You want Raw honey, look for legs and wings in it. Grade C will have a white scum on top. that is pollen. I warmed my honey to no higher than 130 f in a tank with stiring paddles. The honey is then run through a 100 mesh per inch screen. ( removes only legs and wings) straight into the bottles. All pollen and enzymes in tact. I would never warm orange honey. It was bottled raw straight out of the storage tanks and will crystalize with in 60 days. It had the orange blossom aroma when the bottle is opened. This is why grade B syrup has more flavor.

[Ramp7 in reply to oldbeek]

On my Grandparents farm in Tennessee, raw honey was the only type available. GranMa used to say that it has therapeutic properties. Your explanation adds to her hypothesis.

I too live in Connecticut, North West corner.

[Tall_Allen in reply to oldbeek]

Thanks- I never understood until now why the honey in stores never had the scent of the flower they claimed it came from. I heard bee populations have been decimated.

[oldbeek in reply to Tall_Allen]

That is mostly from bad beekeeping. The man I taught and sold out to only looses 10% a year. That is the historical average. This last year he made 785 barrels of honey. Our main honey source is form the costal brush variety ,and mostly black sage. Be losses are from taking all the honey off in the mid west then trucking the bees to CA for almond pollination. When they get here they get 2 lbs of pollen substitute and several rounds of corn syrup that is inside the bee hive. I never took honey off after July unless an extreme fall wildflower year like this last year.Our bees go through winter fat on fall mountain pollen. I loved that life, but alas age catches up.

[ctflatlander in reply to Tall_Allen]

Hi Tall, Thanks for your help. We now have 3 Vermont grades since 2015. Grade "A" golden delicate (usually comes with the first run of the season for me and used to be called fancy), Grade "A" amber rich (my preferred syrup), Grade "A" dark robust (preferred by some people, stronger taste) Bob

[Break60 in reply to Tall_Allen]

Hi TA

On a completely different subject what is the name of the CT on estradiol patches being done in conjunction with other arms of a related trial here in the US?

Bob

[Tall_Allen in reply to Break60]

I don't know about any US trials, only in the UK. The trials are called PATCH and Arm L of STAMPEDE which will be analyzed together.

[Break60 in reply to Tall_Allen]

TA

Thanks. I was thinking of stampede. I know about patch which is the basis for my trial.

[j-o-h-n]

Small rise, no surprise.!!!

Easy with the maple syrup, Son!

That stuff doesn't grow on trees, you know!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 04/04/2020 12:32 PM DST