PSA raised rapidly after 2 months finishing chemo

My dad just took the PSA test and it increased from 0.29 to 1.16 and ALP of 134.2 U/L (40 - 129) after 2 months finishing chemo. He did this test for himself since his doctor askes him take the test after 3 months from chemo. With the above result, we think he need a treatment.

-My dad had taken Casodex and achieved PSA nadir of 0.162 after 10 months of 1st line ADT. He stopped using Casodex when the PSA increased to 0.3. Could he recharge Casodex?

-Based on our understanding from Healthunlocked, the next treatment can be Zytiga. My dad’s doctor said he only took next treatment when imagines showed that there’s progress in his status. I read somewhere imagines are only clear when PSA is greater than a certain value (e.g. 2). Is it correct? Moreover, PSMA scanner is not available in my country (Vietnam), PET/CT is also quite limited. Should my dad wait for few more tests to take next treatment or he should take the next treatment immediately? If his doctor still has no advice on next treatment (i.e. wait for imagines of status progress), should he take Zytiga without a doctor’s prescription?

Looking forward to receiving your advice and experience sharing.

Thank you in advance,

Dawn

[LearnAll]

ALP of 134 is cause for concern. It should be lower. But because ALP includes three sources ,Bones, Liver and Intestines..It is not a very accurate test to assess bone mets.I believe ..in Vietnam...Bone Specific Alkaline Phosphatase is available... So its a good idea to do this test as it is much more accurate .

As for Re starting Bicalutamide, it worked again for me after a gap of 6 months. So my view of re use of Bicalutamide may be different from other men. I will use Bicalutamide again but monitor PSA every 2 to 3 weeks.

[Hidden in reply to LearnAll]

Thank LearnAll. We asked but there's no Bone Specific Alkaline Phosphatase in the hospital doing blood test for my dad. Will check if it is availalbe in other places. Regarding re-starting Bicalutamide, may I ask the 1st time you used Bicalutamide was to reduce PSA level or flare PSA when having ADT1. In addition to that, do you have any information whether Casodex impacts the effectiveness period of Zytiga as next treament?

[LearnAll in reply to Hidden]

My first medicine was only Casodex which dropped my PSA by 88% in 25 days. Then, Lupron and Zytiga was added. PSA dropped by 99.98% in next 10 months.I wanted to do Intermittent (off and on) treatment so I stopped Lupron and Zytiga.

After 5 months PSA started rising so I wanted to experiment with restarting Casodex to see if it will work again. To my utmost surprise, casodex alone dropped my PSA again by

90% so now, after 6 months on Casodex alone, My PSA is at 0.4, ALP is at 44. I want to stay on Casodex as long as PSA stays below 2.0. ( I still have Prostate Gland) I check labs every 2 weeks. Testosterone came up from 5 to 480...and energy skyrocketed and tiredness is almost gone. Zytiga raised my blood pressure to very high level bt thank God.. After Casodex it came to normal level again.

This type of response seems uncommon . This is just one man's clinical trial. But also, I am on 100% plant based diet(except Yogurt) and a dozen dietary supplements and a daily 5 mile walk. My results may or may not happen in others. Casodex may or may not work long term.. but so far so good. Once again, I would say that this is just my personal experience and may not apply to others.

[Hidden in reply to LearnAll]

Did you take Casodex with Dutasteride/Proscar/Avodart or Casodex alone?

[LearnAll in reply to Hidden]

Yes. With Dutasteride.

[Tall_Allen]

He should have a bone scan/CT to check for radiographic progression or if there are symptoms. If his PSA is increasing rapidly, it may show up.

[Hidden in reply to Tall_Allen]

Thanks Allen, we will ask the doctor for a bone scan.

[Hidden]

Yes, I read the information as you shared but still want to know more about Casodex option since it has less side effects in comparision to others, especially my dad has high blood pressure. Thank you for your response.

[kaptank]

If he stopped casodex at PSA 0.3 then it most likely had not failed at that point. It should be safe to restart casodex. Monitor PSA closely (perhaps every month). Casodex has no effect on future use of zytiga or Xtandi. When casodex does fail, it changes it's mode of action and feeds the cancer so it is important to keep an eye on it. Failure might be indicated by 3 sequential rising PSAs with the last one in the region of 4-6. At that point stop. PSA will probably go down for a while, it's a well established effect but it is then time to move to another treatment. Probably Zytiga. He should not use Zytiga without close medical supervision.

[Hidden]

Thanks Kaptank for your feedback. May I ask if you have taken Zytiga or what medicine you are taking?

[MateoBeach]

Standard care if progressing increase of PSA is confirmed in another test would be either enzalutamide or Zytiga, especially if bone scan and CAT show rapid progression. The typical view is that if bicalutamide fails then it should not be started again. However LearnAll shows that for some its potency can be restored. So if things are generally stable on scans (no painful or new mets) then my opinion would be that restarting it to test response, and carefully checking what PSA does, would be reasonable to try. A recent analysis did clearly show that for most enzalutamide is superior to bicalutamide when added to ADT.

sciencedirect.com/science/a...

[Hidden in reply to MateoBeach]

Great Thank You

[RVALuna]

Dawn, I am germline TMPRSS2-ERG Mutated which is the best target for Casodex to work and I am 27 year PCa survivor after mets 2015 to Dec 2017 when I then started Casodex. It drop my PSA with mets from 12 .2 to ) .015 in 2 1/4years The last 6 months it has increased to 0.056 with a Doubling every 12 months. I am going to ride this horse as long as it runs with no mets then I may try to add Niclosamide to bring it back to running as this may eliminate Androgen Receptor V7 which makes the receptor active all the time even without testosterone. It is important to use Avodart /Proscar( I use both) to block Dihydrotestosterone from the high testosterone that forms on Casodex. Also It is important to use aromatase supplements as Estrogen blockers to to keep the from activating tie alpha estrogen receptor from growing the prostate cancer ( such as Dostinex & Femara(Prescriptions) also Chrysin, & Ca Glutarate Supplements. Lycopene from tomatoes also works on the germline TMPRSS2-ERG Mutate.