Psa doubling time

[Nirman]

My dad diagnosed advanced metastatic prostate cancer 3.2 years back with several bony Mets no pain walks 15000 steps everyday he's been on pamorelin hormone injection + abiraterone ( type of zytiga) + 5 mg Prednisone for last three years but I am concerned about his rising psa last from this last one year the lowest was 0.011 ..for two years it remains there then started increasing this recent whole year .. Can anyone please guide me how to exactly calculate PSA doubling time my dad's PSA was 0.1 and within 4 months it rise to 0.4 and what to do when PSA reaches to 2 what are the treatment options in sequence and anyone here with same psa doubling time but good outcomes.. please let me know...any suggestions any supplement s dietary intervention s along with standard medical treatment s please let me know

[dac500]

Tools are available on line: mdcalc.com/psa-doubling-tim...

[Nirman in reply to dac500]

Thank you

[Hidden]

Typically, Taxotere chemotherapy would be the next treatment after ADT + Zytiga becomes ineffective.

I would be having imaging done and not adding/changing treatments until there is progression as determined by imaging. The PSA is an important indication, but you need to know for sure there is progression before adding/changing treatments.

[Nirman in reply to Hidden]

Thank you Gregg

[Tall_Allen]

You should have 3 PSAs above 0.1, but roughly, his PSADT is 2 months. He can try switching from prednisone to dexamethasone to see if that helps the abiraterone work longer. After that, Docetaxel would be the preferred next step.

[Nirman in reply to Tall_Allen]

Okay that's a good advise thank you Allen

[Nirman in reply to Tall_Allen]

But how about provenge, olaparib, keyrtuda, lu177 when these options should be tried..? Technically he isn't become castration resistant

[Tall_Allen in reply to Nirman]

Right now, he is only eligible for Zytiga, docetaxel and Xtandi. He will be declared castration resistant (for most insurance purposes) when there are 3 consecutive PSA progressions reaching over 2.0 or there are two more metastases detected on a scan. Some insurance companies are willing to allow less than that.

He will then also be eligible for Provenge. When he is declared castration-resistant, he may be eligible also for olaparib if he has BRCA mutation or some of the DNA repair defects found on a germline or somatic (tumor tissue) genomic test. He can get a good and fairly inexpensive ($250) germline DNA test now through Color Genome Dx. Keytruda is only FDA-approved if there is a rare somatic mutation (MSI-hi/dMMR) - it would involve a biopsy of a significant amount of tumor tissue. Lu-177-PSMA is only in clinical trials in the US and they all require him to have used chemo and Zytiga or Xtandi.

[Nirman in reply to Tall_Allen]

Thank you very much Allen you have all the knowledge we require here

[Nirman in reply to Tall_Allen]

Allen Im studying Lu177 Psma I may be wrong but what I found is its really very effective if we use it before any chemotherapy

[Tall_Allen in reply to Nirman]

Well, that probably depends on when chemo is used. In general, earlier interventions are more effective than later interventions. A man with metastases who has chemo when he is first diagnosed, gets maximal benefit from it. Unfortunately, many men wait too long to use it, when it can't do nearly as much good. So, Lu-177-PSMA after (or before or simultaneous with) early chemo may be ideal. Whereas Lu-177-PSMA after later chemo, after the disease has greatly progressed, may be much less effective. Recent evidence is showing that in very late stage PC, the cancer cells no longer express PSMA, so using a PSMA-targeted therapy then may actually impede survival.

In the studies below, Lu-177-PSMA (or Ac-225-PSMA) was more effective when it was used before chemo, but in both cases, the patients were also treated earlier. IMO, it was the earlier treatment that was more important than the chemo.

pubmed.ncbi.nlm.nih.gov/306...

link.springer.com/article/1...

If you want to go to Germany for this treatment, he will be able to get it without chemo, but all US trials (and when it gets FDA approved in a few years) require it.

[GoEZ]

Doubling time is the measure of acceleration of the cancer. The doctors alway seemed to get excited when I went below 90 days. You will need 3 Rising PSA reading. There are several websites that can help you calculate your readings. Just pick one site to use since they get different numbers. This is not a perfect tool but can help you to know when to start pushing the doctors. Remember this tool is a long term tool, most test are taken from 3 to 6 months. Good luck, there is some good information here. It took me a good 3 to 4 years to get a handle on what was going on. Stay strong.

[Nirman]

Thank you GoEZ it seems the PSA doubling time is roughly around three months so it's pretty agressive buy my Dad is getting good response with treatment like he'll do like 3.6 years on abiraterone Which I am not sure but I guess really good response and I hope for future treatments