Small up tick

[Fight11]

I had posted last week my husband had a small up tick in his psa. It was previously 13.3 went up to 14.4. His Oncologist said that’s nothing to be concerned about. Well the last couple of days he has been having some discomfort in his back and hip area. He is on Zytiga and prednisone. I’m concerned maybe this small up tick is a sign that maybe the med stopped working. Should I have his Doc repeat the psa? If the meds have stopped working he has the cdk12 mutation? Are there other meds he can try or would chemo be next? I wish I new more about this. It sure would make it easier to navigate through this journey. Sorry I depend on all of you so much. Thank you so much for all your help.

[GP24]

I would expect a lower PSA value than 13.3 or 14.4 after five months of Zytiga. Wait for the next PSA value now. The next step would be a Chemo with Docetaxel.

[Fight11 in reply to GP24]

Thank you so much

[Fight11]

Would that help with the cdk12 mutation. His cancer has metastasized would it help that as well?

[Tall_Allen]

You can try this clinical trial which will start soon:

clinicaltrials.gov/ct2/show...

They will be re-starting this one, contact Ajjai Alva at the University of Michigan Rogel Cancer Center for details:

clinicaltrials.gov/ct2/show...

[Fight11 in reply to Tall_Allen]

Thank you so much

[Fight11 in reply to Tall_Allen]

Allen do I call them

[Tall_Allen in reply to Fight11]

Call or email the lead investigator shown on the link. Or you can ask your MO to do it.

[Fight11 in reply to Tall_Allen]

Thank you so so much for all your help!!!

[Justfor_]

I have been reading lately this paper titled:

Biological Variation of Total Prostate Specific Antigen:

A Survey of Published Estimates and Consequences for Clinical Practice.

pubmed.ncbi.nlm.nih.gov/159...

It breaks down the total variance into two components:

The analytical and the biological.

It is a bit dated (2005), so, I presume that the analytical (lab) component must have got a bit tighter following technological advancements with time, while the biological one must have remained within the same ballpark.

Without getting into numbers and fine details, IMO your husband's 13.3 -> 14.4 => 8.3% of increase can not be interpreted, by any serious statistical confidence margin, as demonstrating a rising trend, that is, with only two PSA counts.

If you want to be more certain about it, he will have to repeat the test and the more populated his time-series will be, the more the variance will shrink down.

Two worth-mentioning take away from this paper:

1) "... the existence of a systematic physiologic variation of tPSA, also known as diurnal

variation (sleep/wake) or circadian variation (a 24-h period)...."

which tells us that for consistency, blood draw should better be taken at the same hour of the day each time.

2) More than 50% of PSA change is needed in order to confidently rule (95% confidence level) whether a therapy has started or stopped working (check the example of Table 3) .

If you follow the clinical trial designs, this is a very frequently used end-point, i.e. the percentage of patients the PSA of which has been reduced by more that 50%.

[Fight11]

Thank you so much

[Hidden]

What does it do Nalakrats????

[Hidden]

Dinaciclib - thanks

[Fight11]

My husband does !! What is the name of the drug? When is it going into trial!! Told my husband Oncologist about the other trial TallAllen told me about. Thank all of you so much

[Hidden]

No Sir - thanks