Concerned over psa

[Fight11]

My husband is on Zytiga along with prednisone! His psa has slowly been creeping up. It was. 12.2 then 13.6 now 14.2. It never actually even came all the way down. He has been on this since September . Two Oncologists said he is stable and they want to get the most out of the Zytiga they can. How can he be stable if his psa is slowly creeping up ? Any thoughts?

[Danish-patient]

In my opinion he is not stable. He could switch from prednisone to Dexamethason. I would also work for having a PSMA PET scan taken to see whether PSMA Lutetium might be an option. In my case PSMA Lu has worked really well in combination with Zytiga. However, it doesn’t work well with bone mets. If that’s what is happening, the scan could indicated whether RapidArc radiation therapy could be an option.

I myself wouldn’t just wait for the disease to progress uncontrolled.

[pilot52 in reply to Danish-patient]

do not understand your thinking about Lu-177 not working on bone mets. I had a high tumor load all but one were bone mets. I was chemo naive, after first infusion all bone mets except one were not seen on follow up PSMA scan. I have not yet reached nadir and there are no bone mets visible and psa 0.42 Following my third and final infusion. Your case like everyones is different and to infer that it does not do well on bone mets may mislead..Google Chemo - naive patients and Lu-177. Also about 30 percent post chemo do not respond but 70 percent do.. Blue Skies

[Danish-patient in reply to pilot52]

I totally agree that we all react differently to medications. What I mention is my own experience from nine cycles of PSMA-Lutetium, that it didn´t bring my PSA down as well when I also had a bone met in L3. I have met another patient with the same experience. I have heard the same thought from a professor in oncology.

I am totally in favour of PSMA-LU as a fantastic treatment for us, but since it´s hugely expensive to access (for us in Europe at least) I feel that I have an obligation to mention the issue I have seen,

[j-o-h-n in reply to pilot52]

You forgot the "Woof" (White Shadow?).....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/05/2021 5:43 PM EST

[pilot52 in reply to j-o-h-n]

She has been removed as my co-pilot on long flights....she takes up to much room in the front...flew today and could not wait to put her in the back....It was a hoot....anyway .....Blue Skies and always a tail wind , Sky King and Penny (WOOF)

[j-o-h-n in reply to pilot52]

"doggone it"......

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/05/2021 7:28 PM EST

[Magnus1964]

He is not stable. Those three rises are an indication that he needs to move on to another ADT drug.

[Chugach]

The PSA is rising (not stable), but not rising exponentially. Once when I was on chemo I had a similar slow rise. I did an extra couple cycles just to try to keep the lid on it while figuring out the next plan. It is time to change treatment strategy.

[tom67inMA]

As best as I can remember (which basically means don't take this reply as 100% accurate) My oncologist explained to me that there are three way he tracks cancer, in order of his priority: 1) how the patient feels and appears to him, 2) scans, and 3) blood tests. I personally would put scans at #1 given my past history, but I'm an odd duck having developed neuroendocrine differentiation with undetectable PSA and appearing to be in otherwise excellent health.

How does your husband feel? Does he have any pains that are getting worse with time? Has he had a scan recently? How is the rest of his bloodwork (especially ALP)? Is his weight changing? etc., etc. There is a possibility that his cancer is stable but is merely producing more PSA with time, because cancer can do weird things like that.

BTW, the purpose of PSA is to activate sperm. It's vital to our survival as a species, but of absolutely no use to the human body. Different cancers will produce wildly different amounts of PSA per cell, so it's hard to compare one man's PSA to another's. Small changes in PSA could theoretically be the cancer changing how much PSA it is producing, and not actually represent a change in the total tumor burden. That said, being in the teens and rising is generally not a great sign.

If he hasn't had a scan recently, I'd think it's a good idea. If there's one spot that's growing and causing the PSA rise, it could be zapped with radiation (especially if the spot is causing pain) and maybe the PSA will plummet, and he can stay on Zytiga for a lot longer.

In short, PSA is tested because it's easy, not because it's the best way to track the cancer.

[ctflatlander in reply to tom67inMA]

Tom, You have been through the wringer from reading your posts and your knowledge about this monster will get you through this. My psa is creeping now at 1.1 and expect to treat it differently at some point. I'm not sure I want to wait till my psa is doubling. My thinking is chemo now and not wait.

[Tall_Allen]

Try switching from prednisone to dexamethasone. Then use chemo.

[Fight11 in reply to Tall_Allen]

What type of drug is that? What does it do? Is it different from the prednisone?

[Tall_Allen in reply to Fight11]

It's a different corticosteroid. Sometimes switching extends the usefulness of Zytiga.

[Chask in reply to Tall_Allen]

I had a strange result when switching to Dexa. My PSA jumped from 4 to 10 and I experienced very unpleasant side effects like chronic leg cramps and significant depression. Two months later I went back on to Prednisone and everything returned to normal including my PSA which returned to 4. Onco didn’t think any of that was due to Dexa, but I don’t know.

[Fight11 in reply to Tall_Allen]

The Dr was thinking maybe Lynparza or immunotherapy. Do you know anything about those drugs

[Tall_Allen in reply to Fight11]

Lynparza only works if he has a BRCA mutation. The only approved immunotherapy is Provenge. Keytruda is approved for a rare genetic mutation. Has he been genomically tested?

[Fight11 in reply to Tall_Allen]

He has the cdk12 mutation. Does immunotherapy work well? And is there side effects

[Tall_Allen in reply to Fight11]

I already gave you a list of drugs in clinical trials for that mutation.

[Fight11 in reply to Tall_Allen]

I gave the Dr that list have said maybe immunotherapy

[Fight11 in reply to Fight11]

She also did mention she might try one of the drugs you mention begins with A can’t recall the name

[Nirman]

You need a Psma pet scan alkaline phosphatase levels testestorane total to decide if disease is progressing switching to dexamethesone is also a good idea it’s a steroid which you have to take in place of prednisone but you need to consult your medical oncologist first where are you from?

[hope0505 in reply to Nirman]

Hello Nirman.I appreciate you, Tall Allen and every one else sharing such useful information on this forum. My father is in a similar situation. He responded to Zytiga and Prednisone for some time . Now his PSA is slowly creeping up. We switched to dexamethasone while waiting for the next steps. My father is in Goa. PSMA Pet scan is not available there. Do you mind sharing your contact information so that I can get recommendations on oncologists, locations where PSMA Pet scan is available and other resources. Thank you!

[Mollygrace666]

sounds like the cancer is beginning to become immune to the Zytiga , it worked for me for over a year and then my PSA started to rise as well , from low 3s to over 6,5 , my doctors decided on an alternative treatment

[George71]

Adding Veyonda to Lu-177 is doubling median OS for MSCPC

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