Zoladex increase in PSA

[nycrunner]

After being on Bicalutamide since May 2020 I switched to Zoladex as my PSA had increased from 0.9 to 3.8 in April.

I expected my PSA to drop below the 3.8 but my result this week came out at 6.9.

Testosterone over the last month has dropped from 19.3 to 0.7.

My Pet Scan in February reported as follows;

Overall significant improvement in extent of NaF avid sclerotic

osseous metastases with complete resolution or decreased activity.

With the PSA increase I am not sure what to do next.

Would appreciate any advice comments etc.

Thanks

[Tall_Allen]

Why were you taking only bicalutamide when you had known bone metastases? SOC is Zoladex+Zytiga/Xtandi/Erleada/Docetaxel. Well, better late than never.

[nycrunner in reply to Tall_Allen]

Hi TA

You are correct.

I tried the Zytiga Zolodex combo 2 years ago.

It made me very fatigued so I discontinued.

I must admit that the benefit carried through to May 2020 when I went on to Bicalutamide.

This worked well till Jan this year when the PSA started increasing.

This time my Onco agreed with the Zoladex after the good Pet Scan result.

Hence my dilemma as to how long to persevere with solely Zolodex.

Could the sudden flare from 3.8 to 6.9 be a temporary increase?

Thanks

Dave

[Tall_Allen in reply to nycrunner]

Yeah, fatigue is the biggest side effect of all of them. Unfortunately, there is a trade-off with survival. The intensified meds work longer and extend survival. They also put off the pain longer that will start happening. It sucks, but that's the only choice you get.

[MateoBeach]

Your next PSA will confirm the trend (or show it was temporary from cell deaths upon restarting Zoladex?). Then you need to go promptly to the next tier of treatment such as adding Zytiga/pred or chemo. Estradiol patch can make the ADT SEs much better.

[noahware]

The bicalutamide could take nearly a month to wash out. If it had changed from AR antoginist to agonist, and was actually feeding the cancer, then it would seem a possible cause for the PSA rise.

Some men get an "antiandrogen withdrawal" response after stopping bicalutamide, meaning the PSA could rise for a month (or more) and then decline. So it would be a bit premature to assume you simply have a rising PSA with castrate levels of T... it has not been long enough to define the trend.

I would think the scans mean you can afford to be patient, and see where PSA goes with the Zolodex.

[RGD115]

In short my PSA was 6.1 on diagnosed and increased to 13.1 within 2 years cancer contained in the prostate went on Zoladex which brought it down to 1.2 upon this went back to prague for proton treatment returned to uk managed to get my consultant to let me have a follow up of Zoladex for 3years in those 3 years my PSA was 0.1 have now been off Zoladex for 2 years now and my PSA has increased a little to 0.2 am well pleased that I chose to go against my consultant and go to prague for proton treatment hope you can come to a know what is right for you good luck for the future

[j-o-h-n]

Where are you being treated? And who's your Oncologist? Thanks....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/11/2021 5:57 PM DST

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

Hi j-o-h-nI am based in Auckland.

Enjoy your humour.

[j-o-h-n]

To: NYCrunner,

Of course you're in New Zealand...I'm such a jerk thinking nyc runner meant you're a runner in New York City, New York in the United States. You have to forgive me, geography was never my strong point when I was in jail..... I stuck up people regardless of where they were from. "Hands up mate"......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/11/2021 10:32 PM DST

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

Hi j-o-h-n

I should put my hand up for confusing you.

My favourite marathon was New York.

I still cling to the hope of returning one day.

I have a little unfinished business having had two second placings in my age group.

A first place has been a little illusive.

Managed first placings however in Chicago and LA but NYC is the one.

This PCa is a bother but still average 8km per day all be it at a much slower pace.

Best wishes

Dave

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

Holy Sheep...... I can only do that while counting sheep in bed....I bet you're going tp tell me you're also a 4 day a week rugby player. BTW the only thing I know about rugby is that you need leather balls to play....Come back to NYC and run the marathon we need visitors since the Covid hit, the city is dead. Crime and Grime is back....and many people are fleeing the city and moving to Florida (which is called, God's waiting room). Keep running......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/11/2021 11:20 PM DST