PSA levels rising, Oncologist says to consider alternatives

[Philly13]

I posted a couple of nights ago to no reaction. After 8 months between 4-2.7 PSA has risen to 7.3 in May and 6.4 in June.

healthunlocked.com/advanced...

The previous post contains the background. In April we were considering getting to the end of the year and taking an ADT vacation. Now that my PSA has stayed elevated for a month, between 6.4 and 7.3, he is suggesting that it is probably time to consider alternatives treatments as Zytiga seems to be failing.

I am switching to dexamethasone from 5mg of prednisone immediately.

He is looking into Cosmic clinical trial to see if I qualify, and considering Xtandi, Taxotere, and Jevtana.

I have tolerated Firmagon and Zytiga comparatively well, and feel good with plenty of energy.

I would appreciate ideas, thoughts, and information. I began Frimagon/zytiga/prednisone in may of 2019. I am not beginning to study the next steps. While I feel urgency to move to something that has a chance to be more effective, there is no emergency. The goal is a decision by the end of July.

Thanks

Philly

[noahware]

It might be helpful for others in replying if you filled in your profile... hard to put your recent developments into full context without a concise summary and timeline of your entire course of treatment.

I do agree, it seems like time to move on from current treatment, but I am unfortunately not well qualified to advise on that.

[Philly13 in reply to noahware]

Thanks. I will fill it in.

[Philly13 in reply to Philly13]

Done.

[tango65]

When the cancer stops responding to one of the new anti androgen, the next step seems to be chemo with taxotere or Jetvana. Chemo could re sensitize the cancer to zytiga. It seems other anti androgen may work better after chemo than after a failure of a new anti androgen.

Then there are clinical trials with modified niclosamide which could re sensitize the cancer to zytiga or Xtandi.

clinicaltrials.gov/ct2/resu...

You should consider Provenge, which I believe could be done with chemo and if you have bone metastases and you do not have visceral metastases, Xofigo could be used.

Then you could consider treatment with Lu 177 PSMA and or AC 225 PSMA if the cancer metastases are expressing PSMA. You need a PSMA PET/CT (Ga 68 or 18F DCFPyl) to determine if the cancer is PSMA positive.

There are some clinical trials for Lu 177 PSMA in the USA:

clinicaltrials.gov/ct2/resu...

Perhaps you could qualify.

Consider to discuss biopsies (direct biopsy if possible) or liquid biopsy to determine if the cancer has mutation which could be treated with specific drugs such as olaparib, rucaparib, keytruda etc.

Best of luck on the journey.

[Tall_Allen]

I may be misunderstanding, but it sounds like you had some metastases zapped, which lowered your PSA. And your metastases continued to grow while on Zytiga, indicating that it's failing.

Did you mean the CONTACT-02 trial of Cabozantinib in Combination With Atezolizumab?

clinicaltrials.gov/ct2/show...

If so, looks promising, although each ingredient separately doesn't do much, maybe together they do.

Chemo would be a good choice too.

[Philly13 in reply to Tall_Allen]

I haven't done much reading yet, but Cabozantinib and Atezolumab are the same in the Cosmic study. I will respond after comparing the Cosmic Clinical Trial to CONTAC-02.

The 3 Mets were zapped in June/July 2018. PSA went way down, then PSA increased some between February and April of 2019, whereupon I went for another Auximen scan, indicating significant elevation in the presence of MET. Then PSA exploded over 3 weeks from about 5 to over 47. I started Firmagon in May of 2019 and then Zytiga about 3 weeks later.

Auximen scan in 2020 had no metabolic activity, but there was growth in the size of lesions that did not light up. Shortly after that, PSA started to rise.

1/2/2020 4.7

1/23/2020 4.3

2/21/2020 4.4

3/24/2020 4.6

4/21/2020 4.5

5/19/2020 7.3

6/16/2020 6.4

May 19th seemed out of synch. June confirmed an elevated level.

My oncologist called the test Cosmic. Study of Cabozantinib in Combination With Atezolizumab Versus Sorafenib in Subjects With Advanced HCC Who Have Not Received Previous Systemic Anticancer Therapy (COSMIC-312). I read the definition of HCC. The words are meaningless for me at the moment. I will learn more about it tomorrow.

I have decisions to make.

Philly

[Tall_Allen in reply to Philly13]

HCC=hepatocellular carcinoma, not prostate cancer

[Philly13 in reply to Tall_Allen]

Thanks. I looked it up again and see it is only about the liver. I am puzzled because I am certain he said Cosmic. My oncologist only treats Prostate cancer.

My wife listened to the appointment, so I know I didn't mishear the word.

Weird.

[mcp1941]

Zytiga is also failing me and I am going to ask my MO to switch to Dexa. Do you know what the dose of Dexa is?

MikeP

[tango65 in reply to mcp1941]

0.5 mg/day.

pubmed.ncbi.nlm.nih.gov/300...

They need to check electrolytes, blood pressure and if edema develops.

[mcp1941 in reply to tango65]

Thank you Tango. My MO does a complete blood work-up every 4 to 5 weeks.

[tango65 in reply to mcp1941]

Best of luck on this journey.!!

[Philly13 in reply to tango65]

Thank you. I am starting Dexomethasone today, which also happens to be my 39th wedding anniversary. This study seems hopeful. More than 50% improve. I hope this bet is a winner.

Philly

[tango65 in reply to Philly13]

best of luck on your journey.!!

[BaliDream]

At diagnosis at start of 2018, PSA 2275....stage 4, Gleason 8 w/Mets...Moffitt Cancer Center immediately started me on 6 rounds chemo, Lupron every 3 months...went on clinical trial afterwards, until PSA rose after 8 months...went then to Provenge....currently on Zytiga and Prenisone and Lupron.

[Brackenridge in reply to BaliDream]

My father is also being treated at Moffitt - would you mind sharing your doctor’s name?

[BaliDream in reply to Brackenridge]

Dr. Jingsong Zhang

[HopingForTheBest1]

Zytiga/Prednisone failed me after six months. Thanks to genetic testing, I was found to be BRCA2+. Based on precision medicine, I was told that switching to Olaparib (a PARP inhibitor) should be an effective treatment. It sure has been for me, as my PSA has been undetectable for over a year.

[j-o-h-n]

I was the only one to reply.... and I still hate Philly....

Good Luck, Good Health and Good humor.

J-o-h-n Friday 06/26/2020 7:31 PM DST