PSA on the Move

[Hawk56]

Quick synopsis...

Diagnosed in Jan 14, surgery in Mar 14, TCNoMx GS 8, Margins, SV and ECE negative, 10% prostate involved. PSA undetectable until...

BCR in Sep 15 when PSA came in at .2 then .3 in Dec,

SRT in Mar 15, 39 IMRT, 70.2Gya. That failed as PSA was .7 in Jul 15 then 1.0 in Aug.

PSADT and PSAV were indicative of aggressiveness, C11 Choline scan at Mayo in Jan 17 (PSA now at 3.8) showed four PLNs but no bone or organ involvement. Kwon and I agreed to 18 months of ADT, six cycles of taxotere and 25 more IMRT to the PLNs with boosts and wider margins around the four identified in the C11 Choline scan. PSA dropped to undetectable with the first 90 day Lupron and the first two cycles of taxotere. T dropped to <3 and stayed there.

Finished treatment in May 18 with the last 90 day Lupron shot, By Oct 18 T was 135, by Feb 19 it was 482.

PSA over the last 12 months:

2020

3January 2020 USPSA .07

5 May2020 USPSA .07

4 August 2020 USPSA .09

5 November 2020 USPSA .16

2021

5 February 2021 USPSA .29

So, would seem PCa is on the rise again though early for any treatment decision. Given the GS and the previous PSADT and PSAV, I don't expect anything different in terms of progression from when I had first clinical evidence of BCR in Sep 15.

I meet with my urologist on Friday. I plan to discuss waiting for the next PSA test in three months, if that shows a continued rise and is at or above .5, ask that we image with the Aximun scan and use that along with the other clinical data (PSADT and PSAV, prior clinical data to decide whether or not to begin treatment, when, and what are the decision points - at what PSA, combined regimen, monotherapy, what would that treatment be.

Of course, if the imagining comes back negative that throws another variable into the decision.

Sound about right?

[Tall_Allen]

What difference does it make if the imaging is negative? It just means the tumors are too small for imaging to pick up. I would consider ADT+Zytiga, as in this trial:

meetinglibrary.asco.org/rec...

[Hawk56 in reply to Tall_Allen]

Thanx!

[Cooolone]

Sorry to hear of your progression!

So, you've been off hormonal therapy for over 2 years and your PSA has begin to climb. Imaging is important, of course, to try and "see" what's happening. As noted, the lesions may still be too small to see and you'd need to be around .5ng for a decent detection level using G68-PSMA-PET scanning, that's still going to miss some small stuff at those low PSA numbers.

Is crazy, I know, to think "wait" so you can see, but the benefit vs risk rewards need to be considered. And really, would the imaging change anything in regard to possible treatment? You've already had 2 rounds of RT, which is amazing in itself.

Has returning to HT been discussed? If still Hormone Sensitive. Adding Zytiga is a great idea as well. Also, have you any genomic testing done? This may offer some additional doors to be opened if there are some markers identified.

[Hawk56 in reply to Cooolone]

Thanx, when I meet Friday with my urologist I do intent to discuss a combined regimen, I expect that would be ADT and...Zytiga.? TA gave a me a link which can help with that discussion.

Instead of Lupron I may ask about relugolix since it it quicker to castration, less CV SEs and quicker to regain T if you are able to stop.

I do intend to discuss and weigh a decision on imaging. My radiologist who I highly respect recommend I consider doing it as it could provide additional data in the treatment decision making process.

[Cooolone in reply to Hawk56]

Relugolix is approved and out there... Not entirely sure if insurance will cover it and know that it's pretty expensive otherwise. But yes, I too have discussed this pill form of ADT with my MO and as soon as it's available, will be switched over!

Again, don't forget to inquire about genetics, if that appeals to you. Some genetic markers have treatments as well. Some have shown promising results and others not so much. But it's important in my opinion. Some have also been helpful in stratifying what patients might respond to certain treatments better than others.

Best Regards

[Hawk56 in reply to Cooolone]

Thanx for the remainder, will discuss the genetics testing too.