Reaching Castrate Resistance? Increase in PSA,ALP.

[Cheerr]

My dad completed chemo in Jan and was on Lupron + Casodex for next 3 months till April.

It’s been 4 months he discontinued Casodex and is on Lupron only. I now have noticed a increase in both PSA and ALP.

April, PSA - 0.015, ALP - 115

July, PSA - 0.066, ALP - 142

Aug, PSA - 0.288, ALP - 190

This is the first time his PSA ever increased since diagnosis. (149 at that time). His Nadir now being 0.015.

Are these the signs of becoming castrate resistant?

Background-

54 years. | Adv Pca with bone mets | 14 months since diagnosis | Completed 6 cycles of chemo | Now on Lupron.

[dac500]

Discontinuing Casodex while on Lupron may lower PSA, not increase it.

[Cheerr in reply to dac500]

Yes that’s right. So doesn’t seem it’s due to Casodex then.

[Tall_Allen]

Has he discussed Zytiga with his oncologist?

[Cheerr in reply to Tall_Allen]

Not yet. We will visit him soon. What shall we ask? For a PET scan ? And to consider starting Zytiga.

[Tall_Allen in reply to Cheerr]

You already know he has bone metastases, so he doesn't need a PET scan. The best way to check for progression would be to have the same scan he had before, so you have something to compare it to. He can have a bone ALP test.

[Cheerr in reply to Tall_Allen]

Yes he last had the PSMA scan in January end. It’s been 7 months. So it’s reasonable for me to want to ask for another scan now I hope.

[Tall_Allen in reply to Cheerr]

You may want to wait until it's FDA approved, which should be shortly.

[Longterm101 in reply to Tall_Allen]

When do u anticipate PSMA imaging being approved by the FDA? It’s been a long time coming

[Tall_Allen in reply to Longterm101]

It was fast-tracked 9 months ago and it usually takes 9 months.

[Longterm101 in reply to Tall_Allen]

Thx TA

Have a nice Labor Day weekend

[Hidden]

You might want to consider the ALP Bone Isoenzyme Test which shows how much ALP is coming from the bones vs. liver. Here's more information:

healthline.com/health/alp-i...

Has he has any imaging done recently to see if there is progression?

[Cheerr in reply to Hidden]

Hi Greg,

Thanks. Yes will try to get the BSALP done.

His last PSMA scan was in Jan end (end of chemo). It’s been 7 months.

Shall I ask for a new scan be taken?. Along with discussing if they can start the next treatment, possibly Zytiga.

[LearnAll]

His PSA and ALP was so good when he was on Lupron and Casodex....then..Casodex was stopped which led to increase in both PSA and ALP.

Why not re start Casodex (with Lupron)...This might work and he will be spared from serious side effects of stronger meds.

[Cheerr in reply to LearnAll]

Thanks. I feel the same that discontinuing it wasn’t a great decision. I’ll discuss this soon with the doc.

[LearnAll in reply to Cheerr]

Cheer, In European countries including Germany Sweden and UK ...oncologists still use Bicalutamide. This is the medicine with least bad side effects. If it is working, we should take full advantage of it. Once its stops working then only go to heavy duty meds.

[Magnus1964]

There are other ADT drugs he could go to. At this point I would suggest abiratorone + Prednisone.

[Cheerr in reply to Magnus1964]

Thank you. We will visit the MO soon to discuss the same.

[janebob99]

I think one definition of castrate resistance is when the PSA increases to 2.0 or greater after having a low nadir (around 0). A very short doubling time (e.g., 3 months) can also be a sign of starting castrate resistance. There are other definitions out there, too, such as radiographic evidence of a growing tumor.