Psa rising

[Altamontt]

Diagnosed December 2018. Biopsy showed cancer in 11 of 12 cores. Gleason 8/9. Psa 14. 5 bone Mets. Started firmagon then Lupron every 4 months since. Chemo with docetaxel finished July 2019. Psa 0.085 after chemo. Started zytiga but lfts increased almost 10 fold. Changed to 250 mg with food and all labs good. Psa 0.08 8/10/20. Scan showed original Mets gone but uptake to left lesser trochanter, left shoulder and left posterior scapula. Subsequent scan showed no change. Psa October 20 0.07. Psa February 2021 0.24. That’s increase x 3. Next psa test March 25. Any insight to offer? I’m doing well except for side effects of lupron. Oh. Also getting xgeva injections monthly.

[Tall_Allen]

I assume you had a DEXA scan and showed signs of osteoporosis before starting on Xgeva.

It appears you have a low PSA type, so the scans are more important than the PSA. Suggest you have a bone biopsy with histology, IHC (for AR, PSA, PSMA, CD56, CGA, NSE & SYNAPTO) and genomics.

[Altamontt in reply to Tall_Allen]

Thank you TA. Not sure what you mean by a low psa type. I will discuss your suggestions with my MO. Again, thank you.

[Tall_Allen in reply to Altamontt]

It means your PSA was never very high, considering the high volume of cancer and the bone metastases originally. Then you had clinical progression without having PSA progression. That suggests your type of prostate cancer doesn't express much PSA.

[HopingForTheBest1]

Talk to your doc about getting genetic testing. If you have any mutations, then appropriate therapy would be offered to you.

[Jb12873]

Double check with dr about zytgia shoudl be taken 2 hours prior to food or 1 hour after according to bottle never take with food and should you be taking 4 250mg tablets versus 1.

[Altamontt in reply to Jb12873]

Thanks. I started on that but liver functions went too high. Am now taking 250mg with food.

[Hidden in reply to Jb12873]

Have it turned around...Zytiga must be taken on an empty stomach, at least one hour before or at least two hours after a meal

[Altamontt in reply to Hidden]

Studies have indicated that 250mg with food absorbs like amount as 1000mg without food.

[Hidden in reply to Altamontt]

And that is a major mistake.

[Altamontt in reply to Hidden]

That very well could be. But I couldn’t take full dose. I will be evaluating other options.

[Hidden in reply to Altamontt]

Best of luck to you.

[Jb12873 in reply to Altamontt]

Try taking it without food see if that helps

[strummer in reply to Hidden]

Why? Our Onc feels it is a good plan.