Rising PSA what to do next?

[Two-oceans]

It is the first time I post here. Been diagnosed in 2018 PSA 31 and Gleason score 9 - 10. RP in may 2018 followed by 36 radiations in September. Been on Lupron 3 monthly since then. PSA undetectable till January this year. Reading in January was 0.17 and yesterday did another test, now rising till 0.93. Seeing my doctor next week, but would appreciate very much all advice from all this people on here that are much more knowledgeable then me.

[Tall_Allen]

It sounds like you are becoming castration resistant. You should have an Axumin PET scan to check for metastases. If there are none, there are 3 medications approved for that situation: Nubeqa, Erleada, and Xtandi.

[Justfor_]

I understand that you are still under Lupron. If so, the first thing I would do is a confirmatory PSA, because a 550% rise in ~2 months is way out of the ordinary. Along with the PSA I would check hormones and the rest in Learnall's list, like general serum analysis, Alkaline Phosphatase, LDH, CRP, etc. According to what I have read a PSA of 0.4 after salvage RT correlates highly with distant metastases. If the confirmatory PSA (use another lab for it) broadly agrees (+/- 20%) with the former than a PSMA PET CT may be in order for the detection of the PSA origin.

[LearnAll in reply to Justfor_]

I agree with what justfor is saying. Before subjecting our bodies to heavy duty treatments, we need to verify by various biomarkers which give us better idea about present state of PCa. Its a fact that in someone without a prostate, PSA rise above 0.1 is considered a matter of concern. Because all PSA after prostatectomy comes from Cancer cells.

Re checking PSA is first step. Then, taking a look at Bone ALP, Hemoglobin, Albumin, C reactive protein, LDH and performance status can give a clearer picture of level of urgency.

Yes, the ultimate confirmation can only come by PSMA PET-CT.

Once you have all Data, you can decide next line of action and kill the cancer cells which are raising their ugly head again.

[JRPnSD in reply to LearnAll]

I thought a PSMA PET-CT scan wasn't usually very productive below a PSA of 2?

[Justfor_ in reply to JRPnSD]

The toughest opponents will settle for PSA > 0.5, but this is only half of the story. PSADT is equally, if not more, important to the absolute PSA value.

[LearnAll in reply to JRPnSD]

Below PSA 0.2 , PSMA PET CT is not useful.

[RonnyBaby in reply to JRPnSD]

Below 0.2, NOT - useful when +> 2.0 (actually lower - but) - move the decimal point ....

[JRPnSD in reply to RonnyBaby]

Like you said...UCLA says 2...not .2 is when they will do PSMA and find it productive.

[Magnus1964]

Your urologist could add casodex to the Lupron.

[winkoliu]

Casodex is a good suggestion.

[Boywonder56]

Erleada...if u have ins. Otherwise 12k a mo....im a reciepient of almost 4yrs...and psa is just starting death marc forward.....b.w

[GeorgeGlass in reply to Boywonder56]

You said that erleada side effects were pretty strong. What specifically were your side effects and how bad were they?

[Boywonder56]

Bone bone pain Amplified by that already on Lupron since since early data is supposed to pretty much zero out your testosterone whichever the Lupron doesnt. The brain fog also I experience headaches but I able to reduce those by splitting up the dosage during the day it is an absolute of mine and I don't know what the other stuff is that you're taking may already be that all I know I've been on it since diagnosis and I think it's what's kept me alive. I also forgot to mention the fatigue I said I'm alive but I feel dead half the time

[Joecarver in reply to Boywonder56]

Me to been on erleada and lupron 2yrs still periodically have same side effects. Joe

[teacherdude70]

My Gleason was 9 but just had radiation. Early 2016.On lupron for 24 months. Lowest psa while on lupron was 0.24. In March 18 psa was 0.19 but 7 months later was 1.00. Started Casodex dropped to 0.46 but then rose to 2.08 6 month after that.

Now on Eligard since May 2020.

Given I didn't have an RP my numbers will be less reflective of castrate resistance than yours but my point is - calm down, see what the doc says but ask questions, lots of questions and make sure youunderstand the answers.

However from my perspective your numbers are not scarey. Look up psa nadir for your situation.

Always have a positive attitude and be your own advocate. Remember we are all unique in our Cancer treatments and progression.

ps; I was 67 at diagnosis. how old were you?

[Two-oceans in reply to teacherdude70]

Thanks for your advice. Was 62 at diagnosis. Physically feeling good, no pain, do long walks every day and some mild weight lifting. Getting lots of support from my wife and my family, helps me allot to keep fighting the beast.

[j-o-h-n]

Greetings Ignace,Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/19/2021 6:46 PM DST