PSA .04 up from undetectable six weeks ago

[ReMarcAble]

Open till six weeks ago I was on Xtandi for a year with an undetectable PSA. Six weeks ago I stopped taking the Xtandi but continued with my Lupron and my PSA has gone up to .04. My question is should I get back on the Xtandi or possibly try Zytiga and prednisone. My understanding is when I become resistant to the Zytiga that the Xtandi has a good chance of still working where that may not be the case the other way around. Looking for what you guys think. Thank you

[Magnus1964]

Why did you stop xtandi? If something is working, stick with it. You can move on to zytiga or another ADT if xtandi fails,

[ReMarcAble in reply to Magnus1964]

I stopped Xtandi hoping the Lupron would do the trick and I could add back Xtandi or another ADT drug at a later time. I just wanted to be taking as few drugs as possible. It seems that some people feel you should hit it with everything you can for as long as you can while others want to do the least possible that is still keeping them in remission.

[Magnus1964 in reply to ReMarcAble]

"Hitting" Pca with everything at once uses up a lot of weapons in your arsenal. Using them one at a time saves more weapons for later if others should fail. Besides arbitrarily stopping an ADT drug more than likely gives news lines of cancer a chance to find a work around and you will not be able to back on that drug later. I hope I cleared this up for you. My advice is to go back on xtandi now.

[ReMarcAble in reply to Magnus1964]

Thanks! I just gobbled up160mg!

[Tall_Allen]

I don't understand why you would stop taking Xtandi while it was working - of course you PSA will increase. I hope you did not select for resistant cancer by stopping too early.

[TJGuy in reply to Tall_Allen]

Tall-Allen

Please explain further.

First tier ADT is often used intermittently in lieu of continuous ADT for quality of life and potentially better CV health. Perhaps restarting on a arbitrary PSA number like 8 or 10. I don't believe I've ever heard this promotes earlier castrate resistance. The period of effectiveness is about the same maybe ever so slightly less for intermittent. Note I think I've heard a more individualized personalised science approach to when to restart is now something to be considered.

Their are some who promote regular ADT vacations (year on year off for example if your PSA rise rate permits) and ending that vacation well before say reaching a PSA of say 8 or 10. I believe this has been referred to as "adaptive theory" start and end the vacation well before the cancer adaps, again for quality of life.

Once taking second tier ADT like Zytiga or Xtandi are you saying don't stop until those fail or you will be creating castrate resistance to ADT? It seems for most people the period of effectiveness of second tier is rather short to begin with.

Now this is triggering another question I'm seeing recent studies showing and promoting ADT (lupron)+ Xtandi to give far better performance than ADT alone so this appears must be directed at hormone sensitive patients.

I was under the understanding Zytiga should be used before Xtandi and not the other way.

Now early on, second tier ADT was only for castrate resistant PC, but now is approved for hormone sensitive PC as well I believe.?

So which is it, PC becomes castrate resistant while on ADT which I believe many of us thought or does going off ADT give a jump start to becoming castrate resistance while off or later when you resume. I didn't think you would become castrate while off, but is it we don't know until we go back on.

Now how insurance will approve and pay for second line ADT may be a whole another story.

Can you comment what is fact, what is thought or being studied, and what is just wrong?

Thanks

[Tall_Allen in reply to TJGuy]

ReMarcAble had ADT+Xtandi for recurrent mHSPC. This has nothing to do with intermittent ADT, which is Lupron only. There are no vacations for second-line hormonals because vacations will only select for the most resistant AR mutations. Just as you wouldn't start and stop antibiotics because it selects for resistant bacteria.

[tango65]

You should start xtandi again and discuss having Provenge a vaccine which may offer a survival advantage.

[Hidden]

I have no idea what you should take. What does your Medical Oncologist say? However, I do know that 0.04 is considered undetectable..... anything under less than 0.1 is considered undetectable.

GD

[EdBar in reply to Hidden]

.04 is detectable cancer, he is using an ultra sensitive test. I qualified for Provenge with PSA readings that are increasing yet remain less than 0.1. My cancer has become castrate resistant even though it is still at very low levels.

Ed

[Hidden in reply to EdBar]

The term “prostate-specific antigen” isn’t exactly correct, because there are other cells in the body that produce PSA at very low levels. Urethral glands can, and so can salivary glands, normal breast tissue and some cancers besides prostate! Reason why most use less than 0.1 as undetectable; particularly academia and research medical oncologists.

I asked about ultra-sensitive tests once. The answer, it makes no difference in treatment changes for metastatic prostate cancer. Only a select few researchers really know how to interpret and they would have to run several other tests as confirmation. Besides, to most patients ultra-sensitive testing only serves as a source of worry and stress. I could go on, however, I won’t. No sense in getting into a wetting contest over insignificance.

Seventeen years stress free with my <0.1 readings,

Gourd Dancer

[EdBar in reply to Hidden]

That’s what Snuffy Meyers preferred and now Dr. Sartor, the US test gave me an early heads up that things are changing after being undetectable while using a US test for several years.

Ed

[anony2020 in reply to Hidden]

Your reply seems to make sense. How the PSA number is classified should not depend on the sensitivity of the test. Sensitivity only means you can detect smaller amount of PSA.

BTW. I found this. May help the discussion? It seems a study in UK, with limitations, suggest that intermittent Xtandi actually EXTENDS, overall survival (OS). If I understand the jargon correctly, by as much as 100% even?

ascopubs.org/doi/abs/10.120...

Best wishes to everyone. 🙂

[treedown in reply to Hidden]

I suspect he had a RP. To the best of my knowledge undetectable is lower for guys without their prostate.

[Don_1213 in reply to treedown]

Exactly. If treated with radiation/ADT - there is still prostate tissue in the body, and some of it may be capable of producing PSA. If the prostate has been removed (RP) there should be no tissue capable of producing PSA (except a tiny bit from some other gland I forget the name of) and the numbers will be lower, less than 0.1.

0.1 is fine for radiation, below that is "undetectable" on a standard PSA test. One would hope to see less than 0.1 for a radical prostatectomy patient (so a more sensitive PSA test is done.)

[MateoBeach]

I agree with the opinions above about restarting anti since it still works for you. However, Tango65 points out that your interlude with rising PSA while on Lupron documents that you are mCRPC, and that makes you eligible for getting Provenge paid for by insurance or Medicare. You should definitely take advantage of that helpful therapy. It is an upside.