18 months and PSA incrdasingeklo

[CountryJoe]

Hello Friends. CountryJoe again. I have stage 4 PCa with Gleason of 9 and metástasis in bones of spine, hip, ribs and shoulders. Have been receiving bicalutamide tableta and zoladex for 18 months with some RT in weight bearing areas. PSA went from 104 in Dec of 2019 to.24 in June of 2020 and recent bone scan shows diminished bone mets. But in late august of 2020 my PSA rose to .259 as I reported at the time. I repeated the PSA 2 weeks later and it rose to. 266,- very small numbers, but it looks like a clear tendency to rise now. Are there other medications I can request for continúed ADT in order to avoid chemo? I have appt with MO tomorrow.

[Hidden]

Chemo.

[Magnus1964]

Looks like casodex (bicalutamide) might be failing. You could switch to zytiga. I understand your apprehension towards chemo. I have been in this fight for 28 years and so far I have not had chemo.

[noahware in reply to Magnus1964]

Yes, and in the possible event of bicalutamide failure, it might actually be feeding the cancer and the rise in PSA. So another option would be to not switch meds yet, but simply stop taking the bical to see if there is a PSA response.

[Hidden in reply to noahware]

Agree, step one is stop taking Bicalutamide and see what happens. It could be starting to feed the cancer.

[Hidden]

Chemotherapy may be your best next treatment option, it's not something to be avoided in my opinion. The side effects are tolerable for most.

My experience overall was good although I was initially afraid of it. Anti-androgens have cross-resistance so if you give them a break and switch to chemo, you can sometimes come back to them later with better results than doing them one after the other. That's something you can disucss with your MO.

[CountryJoe in reply to Hidden]

Thanks Gregg

[CountryJoe]

Thanks so much, guys, for your responses. They are always hope inspiring.

[Tall_Allen]

Standard of care in the US would be Zoladex plus one of the following (docetaxel, abiraterone, enzalutamide, or apalutamide) - are any of them available to you in your country?

[CountryJoe in reply to Tall_Allen]

Thanks TA. I will check.

[Concerned-wife in reply to Tall_Allen]

We hadn’t heard of Zoladex. Why is that better than Firmagon or Lupron?

[Tall_Allen in reply to Concerned-wife]

Not better - it's just the GnRH agonist he's using.

[CountryJoe in reply to Tall_Allen]

Hola TA and all. I had my appointment with the MO todayand, similar to what TA said a few days back, he said to only focus on the first digit of my PSA. That's . 2, but he gave me a 2 month next appointment instead of the usual 3 months, so he must be a bit concerned about the gradual rise.

[larry_dammit]

Good luck warrior, those numbers are good but alway worried me when they bounced. May just be a reaction to the meds 🙏🙏🙏🙏

[MateoBeach]

Yes stop the Casodex and see if the PSA drops as is often the case when the cancer adapts to it.

Second, ask about (for) Provenge which works better early and with low PSA values. Also works better combined with chemo (docetaxel) and or with radiation.

Sooner is better. And don’t skip chemo out of fear. It is hard, yes, but not too hard. Don’t leave it on the table CJ.

[Hidden]

I don’t know all of your circumstances. And your decisions will most probably differ from mine..... and that is ok........ when faced with metastatic prostate cancer in 2004, I made my decision based on this question: is it better to attack the cancer while the tumor burden is minimal and your body is strong or wait for chemotherapy (systemic treatment) when the cancer has spread and weakened from the ravages of our disease?

Your decision.

Gourd Dancer

[j-o-h-n in reply to Hidden]

A no brainer............. (right up my alley)....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 09/03/2020 7:27 PM DST