What is considered Castrate resistant?

[Puppypaws78]

What is considered castrate resistant? My husband's psa began rising again after about a year of being undetectable. Originally his psa was 1400's, did 6 rounds docetaxel, lupron for about a yr. Which brought his psa down .02. Recently they added Xtandi because his psa was rising every month up to almost 4. Does this mean he is castrate resistant?

[GP24]

Yes, but there are so many new drugs available now that he can live for an extended period of time. Starting out with a PSA of 1400 is not a good situation. Maybe he can get Xofigo now against the bone mets.

[dhccpa in reply to GP24]

How long does Xofigo work, on average, after one begins it before it then stops working?

[GP24 in reply to dhccpa]

The ALSYMPCA trial, which was used to get FDA approval for Xofigo, showed an increase in overall survival of three months. (Docetaxel was approved in 2004 because it showed an increase in OS of two months. ) Xofigo is used to mitigate pain caused by bone mets and also to stop these from growing for some time. You can get a second treatment with Xofigo after the first cycle of six infusions. If you live long enough for that.

[dhccpa in reply to GP24]

Thanks! I suspect folks will have differing reactions to that info, but you hit my question head on.

[tango65]

The cancer is castration resistant if the testosterone is 20 or less and the PSA is rising despite of castration levels of testosterone.

Since he had chemo the use of a new anti androgen is part of the SOC. He could request treatment with Provenge a vaccine which offers a survival advantage.

It could be given concomitantly with Xtandi. He could receive Xofigo is there are bone metastases which are causing symptoms and there are not visceral metastases.

accessdata.fda.gov/drugsatf...

fda.gov/vaccines-blood-biol...

[LearnAll in reply to tango65]

Tango65 has given correct definition of castration resistance ...It is " If testosterone is 20 or less and the PSA is rising despite this castrate level of testosterone (20 or less) "

[dhccpa in reply to tango65]

How long of an average period does Provenge extend life after starting it? 3 or more years?

[Boywonder56 in reply to tango65]

You forgot your decimal point.....2.0 considerd chem recirrence/ failure...ibelieve but may e your on metricsystem eh!

[Boywonder56 in reply to Boywonder56]

my bad....t vs psa.....i stand corrected....wack my pp

[tango65 in reply to Boywonder56]

I was refering to testosterone. By the way psa 0.2 and higher is considered BCR.

[Boywonder56 in reply to tango65]

My decimal was wrong....blame it on lupron...by the way.....im .1......i hear the train a comin......

[Tall_Allen]

Yes. If PSA rose to almost 4 while he was taking Lupron, he is certainly castration resistant. That is a fantastic response to chemo!

[GP24]

I agree that you should get the testosterone level below 20 ng/dl. But in the current NCCN guidelines they still refer to 50 ng/ml for the definition of castration-resistant PCa (Page PROS-14).

[dhccpa in reply to GP24]

Quite a difference!

[pjoshea13]

There tends to be a fixation on total testosterone [T] with classic ADT, which works by suppressing gonadal production. However, while free testosterone [fT] would be a better measurement, the purpose of ADT is to deny the cancer dihydrotestosterone [DHT].

As Dr Myers makes clear in his vlog post, some men are overproducers of DHT. So it is all very well to say that castration resistance [CR] is a rising PSA while T remains under 20 ng/dL, but DHT must remain under 5.

askdrmyers.wordpress.com/20...

One path to ADT resistance involves the alternative DHT pathway. A blood test will not measure DHT produced in cancer cells - however, Avodart will block the conversion.

-Patrick

[Puppypaws78]

I'm not sure what his T is. They take blood tests every month with all kinda of different test cbc, psa, etc. But as I look through them, there is no mention of testosterone levels. We go to new Oncologist Friday so I will ask him. Thank you, 🐶

[MateoBeach]

Being “castrate resistant “ opens up the possibility of accessing many promising treatments not available before then. I would get referred immediately for Provenge. Second line chemo with cabazitaxel is worth considering as it plays well with Provenge and can restore responsiveness to enzalutamide in some. Almost all of the most promising clinical trials require castrate resistance. Just the next chapter in the long journey. May it be long and filled with more joy and tranquility than pain.

[Turt713171 in reply to MateoBeach]

Why do you like Provenge?

[MateoBeach in reply to Turt713171]

Provenge is the only immunologic treatment tor PC that prolongs survival. And the earlier you get it in the course of the disease the better it works. And it appears even better if received around the time of chemotherapy or radiation which provides more immunologic material from dying cells.

[Turt713171 in reply to MateoBeach]

Thanks for the information

[elvismlv123]

his DHT,DHEA,TESTOSTERONE and Estradiol should be checked. If his PSA continues to rise then these would be rising as well. If they are below 20n/CL then he would be castrate resistant. He most likely is not.

[elvismlv123]

I was on similar for 18 months and I didnt go CRPC. My T came back and I imagine both DHT and DHEA came back too.Check to see if his cancer cells are diploidal. VERY,VERY important to know. If he is diploidal less chance of CRPC. Ask for his slides to be tested by a lab.They can tell from his biopsy samples. This is my opinion. No one believes in this except me. Its personal strong knowledge.

[elvismlv123]

I know of a doctor author who supports this. I read his book but I dont have his name. My PCa is 16 years ok. My PSA is 4 and was 4.7 at DX in 2004.Its been rising very slowly from undetectable in 2005.