I have been PSA undetectable for around 3 years post stage 4 dx and 10 rounds of chemo. My prostate is still intact.
However my last 4 readings have been:
<0.1 (undetectable) nov
0.1 Jan
0.2 march
0.3 (latest last week) June
Is it possible to calculate PSA doubling time when it’s this low? On one hand 0.3 is peanuts and doesn’t even meet the criteria of NADIR +2 for reoccurrence. Nor is it likely a scan would be helpful.
But on the other hand this would indicate a doubling time of 3 months?
In official medical parlance PSADT is calculated when there are at least 3 PSA values above 0.1.
Lower than this and in order to avoid pedantic discussions regarding terms and values, I call it "PSA rate of rise".
Now that we are clear with the terminology nonsense, your values show a monotonous and steep upward trend. IMO, absolute values -being low- don't alter the significance of this trend, whatever that may be.
You can try this online calculator: mskcc.org/nomograms/prostat...
Thank you
Have you been on any ADT drugs? If your PSA continues to rise it may be time for Lupron and possibly radiation.
Yes I was diagnosed directly at stage 4 with widespread spinal Mets. I’ve been on Lupron from the beginning and have completed 10 rounds of Docetaxel. At the end of chemo my PSA was undetectable and my Mets were no longer visible on basic MRI. So this would be my first change in activity in 3 years.
Have you been on xofigo? There are also other ADT drugs; casodex, zytiga and xtandi to name a few.
Nope. I’m just on zometa and lupron right now. With chemo behind me.
I know there are a lot of possible next steps. But my MO at 0.3 PSA said he’s not thrilled but to see the next result first.
Nadir+2 is a benchmark for biochemical recurrence only after prostate radiation. There's nothing in your profile. When you say "stage 4" - where were metastases detected and how many?
I was originally dx at stage 4 with extensive spine Mets and some significant lymph node involvement. No organ Mets. When I asked how many, i was told “too many to count”. But overall it was a high tumor load and included bone marrow involvement.
It was surprise diagnosis at 55 and found due to presenting with severe back pain and a PSA of 11. PSA was on the low side but it had been moving fast. 3 months before it was 3.5, so again the Cancer came as a surprise. Initial biopsy was plain adenocarcinoma and “high grade”.
My MO started me on lupron, Casodex, and chemo. Dropped the Casodex very soon after the concern about initial treatment flairs were over. From there I continued just lupron and chemo.
MO initially said we would do as many chemo rounds as I could take. That turned out to be 10 before the side effects were too much.
However, the response was excellent and at the end of chemo, my PSA was undetectable, my bone marrow biopsy looked fine, and the MRI of spinal Mets showed they were no longer visible on the sensitivity of the MRI. It was absolutely astonishing.
It’s been 3 years, and I’m only on lupron and zometa. I have not had scans in 2.5 years since PSA was zero. MyPSA is now starting to move For the first time but it’s hard for me to know if it’s really that significant going from 0.1, 0.2, 0.3 when I still have a prostate and biochemical reoccurrence or castrate resistance is nadir +2. That’s along way off even if I go for my next PSA test and get a 0.5 or 0.6.
I asked MO about a new scan, he said not yet. But likely after next reading. But with low PSA and if it’s not neuroendocrine it likely won’t pick up anything anyway.
So lastly, should I be thinking of the next step in treatment even if I don’t meet biochemical reoccurrence? It would be nice to head it off before the numbers get there. But on a conflicting side I do want to meet the insurance and disability requirements for castrate resistance if that is really where I’m at. I’m 58 and terrified at being later off with my fatigue and brain fog and would rather retire on disability if that’s where I’m at.
It's not neuroendocrine - it responded perfectly to Taxotere (neuroendocrine doesn't). Have you had a germline test? They are inexpensive - I recommend Color Genome Dx. You can also have a biopsy of one of your bone metastases. Be sure to stain also for PSMA if you do.
When to declare "castration resistance" is a matter of judgment and insurance company agreement. In many clinical trials they use 3 consecutive increases reaching over 2.0 or evidence of metastatic progression. But I've seen insurance approve it for patients just based on small increases like yours. It seems to depend on your oncologist and the trust the insurance company has in him (a good reason to have a top oncologist - they can usually get you better drugs earlier).
In general, earlier is better. If insurance agrees that you are mCRPC, you can move onto Xofigo+Provenge now, followed by Zytiga or Xtandi. Then, you can try Jevtana. There are also many clinical trials.
Xofigo+provenge would need to be approved for mCRPC correct? So the sooner I can get insurance to approve the better then?
Yes - see if your oncologist is willing to argue for it.
If you should decide to consider either early Xofigo and/or Provenge, now would be a good time to start learning about each of them. (Google using search words "full prescribing information" and visit their websites.) They both require coordinated "procedures" rather than just taking oral medications. Many men here have had one or the other or sometimes both.
As for Zytiga or Xtandi, now would also be a good time to go on-line and to check your current Insurance Drug Formulary status. Check if either of them is in a higher Tier or requires a Prior Approval procedure or has a Rationale statement for treatment approval & any restrictions or requires a Specialty Pharmacy for direct delivery. If so, you can review and print them out ahead of time, and have some time to plan and to discuss them with your Oncologist ahead of need. The better Oncologists are quite familiar with such approval "hoops" to jump through, and have experience in getting those treatments started. Most of the drug provider websites also have "Getting Started" sections, and ways to help confirm/obtain insurance coverage, too.
Good Luck!
I’ve been undetectable just over four years now.. Any rise is alarming. Although it’s all still very low. I wish you well in dealing with this . I’m watching in the wings and pulling for a solution for you . Good luck ....Scott
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