PSA not dropping: I started on... - Advanced Prostate...

Advanced Prostate Cancer

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PSA not dropping

Muffin2019 profile image

I started on arbitrone at the end of December so realistically it has been 7 months, it was 15.5 in December, dropped to .7, then .8 and last one this month .9. I know the oncologist says it us undectabke to him if below 1. My scans showed no progression of the disease in June, is it normal to jump around with arbitrone. Had anybody encountered this or is it just me being weird, taking the arbitrone one hour or more before my breakfast 1000, My scans showed no new Mets, on xgeva and tamulsin for BHP, any assessment will be helpful. Will it keep going at .1 a month or is that normal with arbitrone.

27 Replies

I am not an expert here, but it doesn’t seem like a significant increase in PSA to me.

BTW, I like your avatar.

Mandrake248

The abiraterone is still working, but you should consider switching from prednisone to dexamethasone to keep it working longer.

cesanon profile image
cesanon in reply to Tall_Allen

Is that because dexamethasone is better than prednisone?

Or is it just that changing things up will help?

Tall_Allen profile image
Tall_Allen in reply to cesanon

Not sure what "better" means in this context

cesces profile image
cesces in reply to Tall_Allen

Better would mean better at lowering the PSA levels he is complaining about.

Though I thought the function of these steroids was to reduce side effects not PSA levels. So I am confused as to why you are recommending the switch in steroids when the complaint is about PSA levels?

Tall_Allen profile image
Tall_Allen in reply to cesces

Because of this:

bjui-journals.onlinelibrary...

I have a hard copy of that link and will contact him as to the switch, has anyone done this, taken half doses with food to increase the absorption of the arbitrone and in your opinion would it be more effective as long as the liver can tolerlate it ?

No increase in effectiveness over 1000 mg.

Thank you

cesanon profile image
cesanon in reply to Tall_Allen

Wow: "The median time to PSA progression on AA+P was 8.94 months. The median PFS on AA+D and AA+corticosteroids (P then D) was 10.35 and 20.07 months, respectively. "

Thanks for doing such a thorough job of staying current with the most recent research.

And finding the stuff that is most important. You certainly have a lot to sift through in order to find the gems.

Philly13 profile image
Philly13 in reply to Tall_Allen

PSA readings can be very erratic. I believe my results are more erratic than most. In my opinion, paying attention to trends, especially at the low levels is important. Look for other markers that might indicate cancerous growth like ALP and LDH and corroborate results.

When I was on Abariterone (Zytiga generic) I switched to Dexamethasone for a while and i think it slowed down the systemic spread of cancer but did not stop it. Dexamethasone is a long-acting glucocorticoid with a half-life of 36 to 72 hours, and is 6 times more potent than prednisone. Prednisone is shorter acting, with a half-life of 18 to 36 hours. Does more potent make it better? I believe that there are statistics about improved results with Dexamethasone. If memory serves, it helps more than half the people that make the switch.

My participation in a clinical trial for AMG 509 ended early in July after a 50% increase in PSA. (80 to 120). Back pain from pressure developing in my vertebrae caused by increasing intensity of tumors in my skeleton was escalating. Interestingly, the whole body bone scans did not indicate the lesions were progressing or at least did not provide details to suggest it was getting worse.

As we prepare for transitional treatment options, I had another PSA test on July 16 and PSA went down to 88. So June 29 was 123.7. Up 50% from June 1. Mid-July was 30% lower again. For me, it is important to look at readings fairly frequently. I became more concerned during these last several months of erratic but trend-increasing PSA readings because other measurements I watch seemed to corroborate the lack of progress and pointed toward deterioration and increasing inflammation. Plus, my freaking back hurt.

Your question was about an increase in PSA. My bottom line response to your specific question is don't overreact to individual readings.

My oncologists considered below .2 undetectable but were not concerned with volatility above that number as long the trend did not indicate rapid doubling. In my case, each time the increases accelerated it moved quickly.

Good luck!

Philly

Those PSA movements below 1 are insignificant. I have had those while on many ADT drugs.

My inexpert thoughts on your situation are that, at some point, the increases in PSA will accelerate, but it is still possible that it will take some time before it reaches a level where a different treatment becomes desirable.

You might compile a list of treatments to investigate. Some that I can think of include enzalutamide (trade name Xtandi). It's another androgen deprivation drug but it works on an entirely different principle and sometimes works even when abiraterone has failed. Radium-233 (Xofigo) is taken up in bones that are hungry for calcium. It is most useful to men who have bone related cancer. It's a radiation source that has nothing to do with androgen deprivation and should work for men who can use it regardless of androgen deprivation resistance. Lutetium-277 is another radionuclide with nothing to do with androgen therapy and works well for men with lots of PSMA. Chemotherapy can sometimes work well in a second treatment. It can also sometimes restore sensitivity to ADT like drugs.

I don't think you should spend every waking moment learning about these drugs. The reason we are living is, after all, about living, not about cancer treatment. But I listed those to give you some reason for thinking that if and when abiraterone ceases to work for you, you still have multiple treatment options.

When you see you oncologist next I recommend asking him what he thinks are the best options for you if and when abiraterone is no longer helping. He might say "Let's worry about that when it happens" and that's not necessarily a terrible answer, but it's obvious that you're still worried (most men would be) and you can explain that knowing about further options can help you reduce your worries more than being told not to worry.

Best of luck.

Alan

Interesting---the Oncologist says it is undetectable below 1. All my Docs. say it is undetectable below 0.1. But what you are showing, is that Zytiga is controlling the PSA, in an acceptable range of PSA, in my opinion. When Zytiga Fails, PSA jumps in whole numbers---so you are good to go! Switching out of Prednisone, to Dexa. will probably drop your PSA a bit more. That has been the experience of some men, men on this site.

Nalakrats

It could be a trend or it could be just noise.

You should start testing monthly until you are able to discern which it is.

Muffin2019 profile image
Muffin2019 in reply to cesanon

That is what I am doing until January next year, I have to have the blood work done due to the xgeva.

cesanon profile image
cesanon in reply to Muffin2019

If you see it continuing to rise for another few months. Even in small increments.

Then you need to mobilize and get some second opinions. It's probably not noise but is a trend.

Muffin2019 profile image
Muffin2019 in reply to cesanon

What is noise, first time hearing this.

cesces profile image
cesces in reply to Muffin2019

Random variations

Hi. I’ve been on abiraterone since Oct. my PSA was 11, it dropped to 3 and has been slowly rising every month and it’s now 16. I’m having scans every 2 months and my bone Mets have not increased. My oncologist says the main indicator is the status of the Mets so continue on.

jfoesq profile image
jfoesq in reply to davebliz

My story is a bit different from most as I was on 3 "vacations" from Lupron (the first vacation was for 17 months and the following 2 were for shorter and shorter periods) and I wasn't always taking Abi, even when I wasn't on "vacations" until about 2 -3 years ago (lost track). In addition, my onc was VERY aggressive and offered me the opportunity to get my prostate removed , along with more than 30 lymph nodes in my stomach area(I was only his 13th patient he did this to) because I was young(AGE 54) and otherwise healthy. I also had the largest tumor on my left hip receive radiation. So far, so good for 9+ years. Keeping my fingers crossed for many more.

Muffin2019 profile image
Muffin2019 in reply to jfoesq

Good for you, I hope you continue to do well, we need more success stories like yours to keep us always to look forward and fight on. You were young for the cancer but I think we are seeing more younger due to the climate change and all the technologies that were not around years ago.

MateoBeach profile image
MateoBeach in reply to jfoesq

👍🏼👍🏼🤞🙏🏻

I have had my PSA numbers jumpup a bit at some point while on Zytiga but fortunately the last few tests showed it dripping from .09 to .08 to .06 most recently.

Jbooml profile image
Jbooml in reply to jfoesq

That’s interesting…are you complimenting your treatments with anything else. How long have you taken Abi.

Muffin2019 profile image
Muffin2019 in reply to Jbooml

Since December of last year, 7 months, not really complaining just wondering why it is not dropping more. My scans showed no progression on the bone and CT scans in June of this year. Also on predisone and lupron and xgeva.

It is enough of a steady rise to be concerning but not yet calling for a change of therapy. Though that may be coming not too far down the road as resistance progresses. I’m the meantime I would request a PSMA PET scan to see if there is some source or sites that are actionable that did not show on the standard scans.

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