Hi everyone!
My dad diagnosed oligometastatic at diagnosis after RP in 2014 is currently on ADT. He is turning castrate resistance now. Last year his psa rose to .09 from undetectable levels of <.008 and he was found to have a solitary leison on humerus. He was irradiated and his psa touched to again .008. But now again it has risen to .02 in a years span.
He is under treatment from dr eleni Houston.
She said to have a wait n watch approach.
Suggestions appreciated
TIA
Dr. E was my doctor until she left MD Anderson at the first of this year. I, too, am oligometastatic. Started an ADT holiday last January. PSA had been undetectable for a couple of years. (I had a prostatectomy at MD Anderson in July of 2018. Chemo and radiation back in 2015.)
When I started the “holiday”, she told me that if my PSA reached 0.2 again, she would want me to immediately go to UCLA medical center for a PSMA PET SCAN to see if they detect any mets. The reason for UCLA was cost - she said the scan would cost about $2500 - much less expensive than anywhere else.
Prior to my prostatectomy I was becoming castrate resistant. Dr. E added Zytiga to my Lupron treatment and I went back to PSA undetectable in the first month and stayed that way until my prostatectomy.
Hope this helps. I’m sure others will have excellent suggestions.
Best wishes on your journey! You have done very well!
James
James, glad to hear your great results. Was the purpose of your prostatectomy to de-bulk the cancer?
Thanks a lot! Where is Dr Eleni posted now?
I have no idea. Certainly wish her well!
I mean to ask which hospital she is working in after she had left MD Anderson
Those are still very good PSA numbers. I would not worry about small changes like that. If his PSA rises Three times in a row to a significant point of 2.0. then you may need to look at another ADT drug.
Well Magnus...He had prostatectomy so any PSA which is coming out is only coming from cancer cells. Therefore 2.0 is not the right number. It could have been a right number if he had fully intact prostate gland.For people who do not have prostate gland, any PSA above 0.2 needs to be treated by adding Bicalutamide, Enzalutamide or Abiraterone.
His current PSA is still only 0.02 ...far below 0.2...so no change is needed...Only monitor till it touches 0.2.
In clinical trials, e.g. for Apalutamide, the following definition was used to define a PSA progression: "PSA increase that is ≥ 25% and ≥ 2 ng/mL above the nadir"
ncbi.nlm.nih.gov/pmc/articl...
So there is no PSA progression while the PSA value is below 2 ng/ml. You do not have to add anything below that value.
I think the right numbers are ....0.2 or above in men who do not have a prostate anymore...AND..2.0 or more .in men who still have prostate gland.
Without Prostate present in body...2.0 is a risky number as all of the PSA is coming from cancer cells (Because there is no prostate anymore)
The value of 0.2 ng/ml is used to decide if you should get a salvage radiation. It is not used to define castration resistance. You can read the article I refered to.
I have my prostate and my PSA is 0.01µg/L.
I was G(4+3=7) Grade 3 with multiple tumors.
I was put on Lupron Depot 22.5mg/12weeks X 2
and VMAT-RT 3Gy X 20 Fx.
So my PSA went from 22.4µg/L to 0.01µg/L.
My next PSA will be March 1st.
Where I live they do not do PSA monthly except during Rxs.
They do it every 3 months for 6 months then every 6 months fro 2 years then every year. Naturaly if a rise show up then they check it more often.
His PSA has not been above .09. my thoughts were small changes of less than .1 could be due to other causes, and not a serious problem.
Thank you
Absolutely great information by Nalakrats about Germ Line Mutation testing. In my opinion, before starting any treatment for PCa, the first thing Doctor should check is if the man has any germline mutation such as BRCA 1, BRCA2, ATM, PTEN etc.I just got my results back from COLOR.COM..."No mutations identified" What a relief to know as I was worried about my sons and Grand Sons' risks.
Its easy and pain less ,inexpensive testing. They send a test tube in which the man spits some saliva and mails the tube back to Color Genomics. The result comes back in 2 to 3 weeks. Everyone should get this test to know any inherited mutation as treatment may vary according to what mutation is seen.
We are all different in our reactions to treatments and how psa number is involved. The biggest concern is doubling time.I started out 5 yrs ago, at psa 20, gleason 9. Had radiation IGMRT 25 sessions and then 2 HDR Brachytherapy all while on 24 months of ADT. Psa never got below 0.19, March 2018. In July 2018 hit 0.84 and back on Casodex. That failed and in May 2020 started again on Eligard. Psa hit a low of 0.55. I had a PET scan that found 2 lymph node of concern but biopsy showed no cancer. Knocked them down with radiation anyway.
Psa has risen since to 0.74 but still have my prostate so oncology team not concerned, yet.
Doubling time is the marker. Will most likely have another PET Scan this year.
From day one I was told my Cancer is not curable and that I would have Palliative treatment & care as needed. Also my radiation oncologist emphatically, several times, has told me I would die with it not of it.
My point is trust your doctors but question often, have them explain, and above all else stay positive. Attitude, positive attitude, very positive attitude makes life better!
May all readers have a wonderful 2021!
You are on a long trajectory of good results. Indolent cancer. The one bone met was irradiated. All good. Agree that 0.20 is the correct threshold for PSMA PET scan. Your doc is a good one.
Thank you
No he wasn’t tested for genetics
In India,,, Genetic testing for Mutations is widely available in all major cities.There are over half dozen hospitals in Delhi alone which routinely do LU177 treatment. Some Common names of popular private hospitals include Max Medanta City, Fortis, Apollo, GangaRam, Armedis and others.
Third rise in PSA, Doctor says come back in a year.
What is considered Castrate resistant?
Becoming castration resistance or not?
The paradigm has shifted - castrate resistance. 
