Slow increase in PSA while on xtandi

[Lynsi13]

Good morning!

My daddy had been on Xtandi since April of last year. Since about March of this year his PSA has slowly been rising.. .25 one month, .32 the next and this time (a three month span) it moved from .32 to .44. It's moving very slowly but trending up.

We go to the oncologist on Friday to discuss it but can anyone tell me what your experience has been with incremental increases like this?

Just for backstory, he was diagnosed in June 2015 with stage 4 to a single nearby lymph node. PSA was 257 at diagnosis. Had 6 rounds of chemo initially and started hormone therapy. Went to second round hormone therapy last April with Xtandi.

Thanks so much!

[Magnus1964]

Although his PSA is still low, he may be failing xtandi. It may soon be time to switch to another ADT drug.

[Lynsi13 in reply to Magnus1964]

Thanks for your feedback! We head to the oncologist this morning. I was really hoping that he could get more time from xtandi before moving on to the next treatment. I'm curious to see what his oncologist will say! Can't deny it, I'm as nervous as can be!

[LearnAll]

This is a very slow rise in PSA. It means there are a very small number of cancer cells which are trying to multiply. They are incapable of causing any harm as there are so few. If this happened to me, I will continue with Extandi for now unless any bad sign I see on other biomarkers like ALP or any lesion on PSMA PET or MRI. Let Extandi fail.. but fail very slowly so you can get maximum time benefit on this drug.

[Kaliber in reply to LearnAll]

Great answer 👏👏👏❤️❤️❤️

[Lynsi13 in reply to LearnAll]

Thank you! I appreciate the explanation. It certainly brought me some peace of mind. I was really hoping he could get more time from the xtandi. He had so much success with Lupron and bicalumatide that I suppose I had counted on him having an equally good run on xtandi. We head to the oncologist this morning. I'm very anxious to hear what he has planned for him next. This entire experience has so emotionally taxing!

[LearnAll in reply to Lynsi13]

Please let us know what his Oncologist said.

[Lynsi13 in reply to LearnAll]

I sure will! 💗

[Hidden]

At some point I would want to get imaging to see if there is progression. PSA rise alone doesn't tell you that it's time to change treatments. His PSA is also still very low, so probably should wait until it goes up more before doing conventional imaging (T99 bone scan/CT).

It's been shown that going from second-line ADT agents such as Xtandi to second-line chemotherapy Cabazitaxel is more effective than just switching to another anti-androgen treatment. That's because of cross-resistance with the drugs. Here's more information on a clinical trial proving this:

nejm.org/doi/full/10.1056/N...

If he hasn't already, he could also have genetic sequencing done to see if he has any treatable somatic mutations such as BRCA or ATM.

[Lynsi13 in reply to Hidden]

Thank you for your reply! I expect Imaging is somewhere in his future but am I wrong to think that is PSA needs to be higher before they will do additional imaging? For some reason I was under the impression that there is a minimum threshold.

I had not heard about using additional chemo rather then moving along to the next line of hormonal treatment. I hate to even mention that to my dad! He had such a bad experience with his first go-around with chemotherapy. I'm curious if the side effects of the second line chemo is as difficult as the first? He is 80 years old so that is another thing to take into consideration. Although I will say he is a robust, healthy 80 years old!

And yes, he did have genetic sequencing completed a few years ago and they found that he had no genetic anomalies.

Thanks again for your reply! We head to the oncologist this morning. I'm ready to get it over with. My nerves are frazzled!

[Hidden in reply to Lynsi13]

I did also mention that his PSA will need to be higher to do conventional imaging so I agree.

There's no need to discuss doing chemotherapy until the time comes to make that decision. It's best not to think ahead past the treatment decision that needs to be made at this time. My advice is just take one decision at a time and take it when you need to. That's the best way to keep things less overwhelming.

Wishing you the best.

[EdBar]

I’m in the same boat, dx in 2014, Stage 4, had early chemo and been on Lupron/Xtandi/Avodart for over 6 years, my long time undetectable PSA has begun a slow rise. MO- Dr. Sartor recommended staying the course until PSA hits a scannable level of 0.5 or higher then SBRT may come into play. I am also starting Provenge treatment next week since it is most effective in those with low PSA who are asymptomatic. It seems there’s a pocket of cancer somewhere that has figured a workaround, that’s my non medical assumption. So looks like I’m starting a new leg of the journey after a long remission or dormancy.

Ed

[TonyGS]

Psa slowly being rising and that xtandi was your second hormone therapy, may I know what was the first hormone therapy please

Thank you