Just came from Dr..and PSA continue to go up marginally after initial dropped from 2.33 ( July) to 0.73 to 0.837 and now 1.038. Started on Xtandi in Aug.
Will be doing PSMA/PET/ CT scan in Jan 2021. And Dr has also just sent some samples of the tissue to do some genetic test. From there he will decide on the next path forward. Any suggestion from anyone will be very much appreciated.
What's the point of the PET scan? It won't make any difference in your therapy. Xofigo and Provenge might be a good next step.
In your case I would just say: "do what your doctor says". To me this seems to be a good plan. By the way, Xtandi will increase the sensitivity of the PSMA PET/CT.
In past, you mentioned that you had Lytic bone lesions. After blocking Androgen totally.. and using docetaxel chemo...initially Your PSA did dip to undetectable. And now, it is starting to go up again. In view of above pattern and the fact of Lytic lesions on bones...the possibility of Neuro Endocrine or Androgen Independent conversion can be suspected.
I will do a germline testing and get 3 NE biomarker tests (1) Serum Chromogranin A
(2) Lactate Dehydrogenase and (3) Neuron Specific Enolase to make sure you do not have Neuro Endocrine transformation. If still not clear, will go for a bone resorption bio marker such as Urinary Collagen Telopeptide (NTX)..This is an indirect way of knowing if you harbor Lytic Bone Lesions. They takes longer to show up on your scans. However, A very experienced Radiologist can see them even on Digital X Rays.
Hi Bellyhappy,PSMA PET scan being the most sensitive scan available currently for PCa can be helpful in identifying the source of the metastatic lesion causing PSA rise. With your low PSA the tumor burden is low which means you may just have a single or possibly 2 lesions. This metastatic lesion can then be targeted with an intense focused radiation and response followed by declining PSA within a month after radiation.
This “shot gun” radiation approach can be used successfully Repeatedly till the location or number of metastatic lesions make it impractical . you will also have to find a radio oncologist willing to and experienced in doing this approach.
This approach may buy you more time with low burden disease till we have more promising treatments available eg immunotherapy beyond Provenge.
I am currently pursuing this approach as I opted against hormone ablation.
Hope this helps.
-Silverlight
PARP inhibitor Olaparib, phase 3 study findings (PROpel)
MRI prior to HDR Brachy and HDR intensity.
PSA holding low!!
