Psa Jumps, but no signs of a failing sytem....

[mjv222]

Goodevening everybody, this is Marcellus from the Netherlands. I was diagnosed in April 2020 with advanced PC with high volume metastasis (only in the bones). PSA 1380, ALP 566. Started with ADT Zoladex in May 2020 which led to a spectacular decrease (660 in June, 260 begin July). Because of the high volume (CHAARTED, STAMPEDE) ADT combined with 6 rounds of docetaxel, first treatment in July 2020. PSA level declined to 4.4, ALP 160. After the 6th treatment my PSA slightly increased to 5.0, ALP 170. Unfortunately after a three weeks, the check up showed that the PSA has increased to 13.0 and ALP reached a level of 226. All other bloodvalues are in balance and no progression has been seen on the scan (it even showed decreasing aggressiveness in the Pelvis), I understood that the scan also showed some bonerepair (sclerosis?). I have no pain what so ever, LDH, ASAT and HB values are excellent and I am in a good shape. I have some difficulty to understand this image. What do you make out of this? Could bone recovery be the cause of this jump or lies trouble ahead.....Many thanks, Marcellus.

[Shooter1]

Pretty good results from docetaxel. My case PSA started back up in middle of chemo and added xtandi. Drove cancer into remission but really beat on the rest of my body, (9 cycles) and then just xtandi. Cut dosage after 6 mo acct side effects, but recovered and life is good. Best of luck to you with your treatments whatever you choose in the future....

[GP24]

If you start out with a PSA value of 1380 and multiple bone metastases, you have to expect trouble ahead. You could add Abiraterone now. Or discuss a possible Xofigo treatment with your doctors. Or drive to Germany for a Lu 177 / Ac 225 therapy.

[LearnAll in reply to GP24]

This is old theory that high initial PSA means aggressive cancer. Recent studies in last 10 years have clarified that INITIAL PSA does not indicate poor prognosis.

It is Nadir PSA which is what really matters as far as survival is concerned.

Means where PSA starts is not important BUT where PSA ends after treatment tells about length of survival

There is a member here on this forum who started with PSA 3000+ and is doing OK after many years. I read about a man who had PSA of 27600 and lived for over 5 years.

Focus on Nadir PSA. It should go to 0.2 for best prognosis. Adding Bicalutamide or abiraterone or Enzalutamide to your current treatment can take your Nadir PSA to less than 0.5 and that's what we need.

[GP24 in reply to LearnAll]

Marcellus never mentioned his Gleason score. A PSA value of 1380 and multiple bone metastases at diagnosis usually indicate a Gleason 9. This is aggressive cancer. He will need a good treatment to control this cancer.

[LearnAll in reply to GP24]

Gleason Grade CAN only be determined if a pathologist put biopsy tissue under the microscope and saw the type of differential in the epithelial cells of prostate.Mere high PSA value can not tell Gleason Grade. Believe in Microscopic reading only.

[Tall_Allen]

You may want to get a test for bone-specific ALP. But what is really important is whether your metastases are progressing on scans and whether you are having any clinical symptoms of progression. If so, it is time to move on to Zytiga or Xofigo. Good idea to have a metastasis biopsy too.

[dhccpa in reply to Tall_Allen]

How is a metastasis biopsy done?

[Tall_Allen in reply to dhccpa]

They stick an 18G needle into a metastasis and withdraw a core of tissue.

[dhccpa in reply to Tall_Allen]

Thanks I'll ask the doc about it.

[tango65]

If there is not evidence of progression in the scan you could discuss to wait and see if the PSA continue to increase versus starting a new anti androgen. If the PSA continues to increase the cancer could be considered castration resistant and you could qualify for Provenge, a vaccine which offers a survival advantage.

Discuss having a liquid biopsy. The probability of getting enough cancer material to study the genome of the cancer is high given the PSA values and the presence of multiple bone mets. This study could identified genetic mutations susceptible of treatment with specific drugs such as keytruda, opdivo, olaparib, rucaparib etc.