Bouncing PSA

[Muffin2019]

Bouncing PSA, it was 3.2 in fall of 2019, 3.7 in February of this year, last one in may of this year came in at 4.6. What causes it to act so erratic and it seems to be rising very slowly. Has anybody experienced this stock market fluctuation and ideas why it is doing this ? Still on 3 month lupron since 2018, the oncologist said if it doubles to like 8.0 with the next tests then goes up to 14 then something is up. The next test will be in August then in November. My scans are due in January of 2021 for my yearly, the past scan this year showed no progression and he said they looked very good. Confused but going with the flow.

[RalphieJr64]

Ahhhh. If your psa doubles to 8.0 then to 14.0 then something is up? Other than Lupron what other treatment are you currently on? I just read your bio. You psa is trickling upward now. Something could be up now. You need to explain a little more.

[Muffin2019 in reply to RalphieJr64]

I had chemo in 2018 that took psa with lupron down to .06 but has crept up over the 2 years. I am under no other treatments, the recent scan in january was very good, the psa was 4.1. He wants to see a stabilization of the psa, that is why he is seeing if it doubles in 6 months, I have another scan next january. Other than lupron I am on a statin, anti-acid med and supplements like turmeric, vitamins and 3000 of D3. Still working part time and very active. He feels that I am not castration resistant yet and choosing active survalence unless it doubles in the next 6 months. Hope this answers the question and any input is welcomed by all the members.

[Tall_Allen]

Not sure what your talking about. Your PSA isn't erratic, it is going up, no? And it is going up while on Lupron, which means you are castration-resistant. You are also metastatic. I don't understand why you aren't taking Zytiga.

[Muffin2019 in reply to Tall_Allen]

I had told him that I would be willing to do casodex first then move up to the more expensive stuff, the scan in January showed no new mets with no progression, the psa was 4.1 last november. He feels that it has leveled off, I have no pain, no symptoms and feel great. He does not feel that I am castration resistant yet and stay on active survalence. My numbers on the other blood work is normal, the lupron has raised my blood pressure a bit. He feels that the lupron is still working and may have to add the other stuff if and when it doubles over 6 months, my next scan is next january.

[Muffin2019 in reply to Tall_Allen]

I looked up the castration resistant definition, I would have to have rising psa along with disease progression and new or worsening Mets. The only is a slight rise in psa, the last scan showed nothing on the other two factors. I think that is why he is doing active survalance and feels it is not castration resistance yet. Could be my nadir is around 3.5.

[Tall_Allen in reply to Muffin2019]

Consider a telephone consult with another oncologist. You only need rising PSA while taking Lupron for a diagnosis of castration resistance - it has nothing to do with the number or size of metastases. In fact, it is possible to be castration resistant and have no detectable metastases at all. For men who are metastatic and castration resistant, adding Zytiga or Docetaxel extends life over just taking Lupron. This has nothing to do with how good you feel.

[Muffin2019 in reply to Tall_Allen]

I had doxetol in 2018.

[hansjd in reply to Muffin2019]

I would be following Tall Allen’s sound advice and seek a second opinion from a PC MO. I believe your situation requires more attention now than you think it does. At the very least you will get confirmation that what you are doing is OK. Or you might be advised to move onto an additional treatment which will extend your life.

[pleinairpainter in reply to Muffin2019]

Second hansjd's and others' encouragement: Please follow Tall_Allen's sound advice to seek a second opinion from a PC MO. From what you wrote here, from fall 2019 until this month: 3.2, 3.7, and 4.6. Your PSA is not erratic, it is not bouncing, but steadily rising over a course of nine months, a reasonable cause for concern.

[Hirsch in reply to Muffin2019]

Your psa should not be rising like it is

You need another drug. Period

[Magnus1964]

This may be the classic PSA bounce. When prostate cancer cells die they give off PSA displaying as a brief increase in PSA. Wait until your next PSA test, it should hopefully be down from your last reading.

[Muffin2019 in reply to Magnus1964]

I thank you, I enjoy your posts, so real and honest, stay safe.

[dac500]

I would take TA's recommendation very seriously. PSA bounce happens after initial radiation treatment for prostate cancer. I don't think it applies for metastatic prostate cancer.

[Hidden]

Your PSA is still low at 4.1 so I don't see the need to rush into second-line Zytiga or Enzalutamide yet. You'll probably want to be looking at starting one of those when your PSA doubles again. Or you could try Casodex for a while as you suggested. Just make sure you get off it if your PSA starts going up because it can feed the cancer.

When my PSA was around that level my doctor said, "Yeah, you're right about there with castrate resistance, but I recommend holding off a little longer before starting Zytiga. You could be on Zytiga for a long time." He was right about that. I've been on it for almost 2 years now. My PSA is currently undetectable. It went right down to less than 1 after starting even though my PSA was around 26 when I started. It was doubling every 3 weeks so we didn't want to delay at that point. I'd be checking the PSA every month for now if it is still moving up. Wishing you the best.

[Muffin2019 in reply to Hidden]

Thank you for your insight, it is where I am.

[Hidden in reply to Muffin2019]

I really hope you will be able to keep from getting stressed over your PSA. It's easy to get caught up in the PSA number and lose sight of the bigger picture.

My doctor told me "We are treating the cancer, not the PSA."

[Muffin2019 in reply to Hidden]

I am following you on this, since the dr never called or messaged me I will forget about it, I like your doctors response, do do any special diet ?

[Hidden in reply to Muffin2019]

I try to eat sensibly and healthy foods in general, but not extreme. I'm not giving up foods I like, life's too short for that and I've given up enough.

Sounds like your doctor is not too concerned at this point and that's understandable as far as I can see. From what you've said, your PSA is low, scans are good, you feel good (other than Prostate Specific Anxiety).

Just have to keep an eye on things and try to relax. It's hard to maintain that quality of life, but worth the effort since that's why we are doing all of these treatments.

[Bodysculpture]

Maybe you can help me to understand treatments as I was diagnosed 2019 November T2 4+5 gleason

My PSA WAS 13.5 when diagnosed after 5 chemo sessions it now 1.6 Docataxel I have 1 more

If my PSA is satisfactory what happens then ?

[SeosamhM in reply to Bodysculpture]

Not to be a simpleton, Bodysculpture, but you just live the best life you can until the next test. Since you are still on chemo, we don’t know what your ultimate low point, or “nadir”, is yet. The nadir will determine the next step, but you may not get there for a few weeks. I personally like a 1.6 while still on chemo and cancer cells are dying and possibly spiking the results.

Concentrate on this for now, knowing that the beast is being attacked, and - another simpleton comment - try not to worry about numbers. It is how you feel today that counts.

I, too, am a 4-5, 3.75 years out from diagnosis. Keep the faith, brother.

[CarrotBoy]

I have heard or read that what you eat can cause your PSA to vary. Focus or eliminate a few risky things from your diet and see if it changes. Avoid or reduce steak (esp well done), eggs, milk, cheese, ice cream and of course sugar. No sugar overloads, but eat slow burning carbs. I only eat sprouted bread and low-glycemic sprouted bread. Also, I've heard to avoid vitamin C and E and Co-Q 10 now, good for prevention but bad when you have a cancer. Good luck.

[Muffin2019 in reply to CarrotBoy]

Thanks, I am on stations so the cq10 has to be taken, I eat red neat only 4 times or so a month, milk I do not use and ice cream is only used in th weed summertime once a week. I have been eating more eggs for the past 2 months but during chemo 2 years ago they encouraged me to have 1 egg a day for protein.

[Muffin2019 in reply to Muffin2019]

I am cutting down on eggs, keep at 2 or 3 a week , I read more than one study showed that over 2.5 eggs a week raised your psa. Have cut back on sugar in January, use honey and natural sweeteners for my oatmeal.

[caltexman]

Tall_Allen is usually very accurate in his analysis. You should ask your oncologist about one of the new drugs like Erleada (apalutamide) taken with Lupron which can delay progression for up to four years according to their studies.

[Muffin2019 in reply to caltexman]

This must be fairly new drug, will look it up to see how it reacts and the side effects. The scan in january was very good, no progression, no new mets and old mets healed. He has not contacted me with any new meds so will see what the PSA is in august.

[DarkEnergy]

I don't understand your cavalier altitude, PSA is rising, why you not understand this? You mentioned, "no new meds", this was just a momentary observation, do you know your Circulating Tumor Cell (CTC) burden?

So, then, you're content when CTC anchors somewhere and grows into a large tumor?

[Muffin2019 in reply to DarkEnergy]

What is the CTC burden, they did a free psa reading ?

[DarkEnergy in reply to Muffin2019]

Look at cellsearchctc.com/, also search "Circulating Tumor Cell", many informative articles, don't know why your doc is in a waiting game, cancer cells can accelerate into a wild fire at any moment.

My PSA readings from a routine checkup was just a bit elevated, 4.7 and holding. Then, after 8 months, blood in urine, PSA 1000+.

My point, go on a strict "Active Surveillance"!

[j-o-h-n]

Sorry but the only comment I have is NO comment...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 05/18/2020 9:18 PM DST