Seeking advice for rising PSA in 77 yo husband

[Lyubov]

Grateful for advice for my 78 yo husband. Any specific questions to ask hubs’ medical oncologist at tomorrow’s appt regarding rising PSA since Aug 2019:

0.05—8/9/19

0.08—2/11/20

0.18—8/19/20

0.21—1/6/21

0.24—4/8/21

0.47—7/15/21

0.38—10/14/21

Note: Axumen Pet/CT (9/4/20) & bone scan showed no metastases.

[Hubs background: at 70 yo, dx Dec 2013; RALP 4/2014 – biopsy post RALP Gleason 4+3=7, with tertiary 5; sem ves clear; perineural invasion +; PSA post surgery <0.1

PSA doubles after18 months 0.2, 12/15; ADT Casodex & 1 pill? 1/2016; 39 IMRT 2/3-2016; PSA remained <0.1 until 8/2019.] [Recently, he’s had 2 bouts of radiation/cystitis/urethretitis.]

Thanks in advance for any thoughts you might have to share.

[Magnus1964]

May be time to move on to zytiga.

[Lyubov in reply to Magnus1964]

Will bring up with oncologist. Side effects are big concern; he had great difficulty with Casodex side effects in 2016. I bore the brunt of his moods, anger, etc.

😪

[Hidden]

If he is still on ADT and his PSA continues to rise, he will be considered to be Non-metastatic Castrate Resistant.

There are several drugs he could take that are approved for this condition including Apalutamide, Darolutamide and Enzalutamide.

Here's an article on the subject:

nature.com/articles/s41391-...

[Lyubov in reply to Hidden]

Not on anything now. Onc did say Casodex a possibility -- but hubs had bad reactions to it in 2016. Caused me a lot of heartache as he took a good bit of anger, frustration, moods out on me

😪Maybe he'd do better now. Wiser, older.... Thanks for your suggestions.

[Hidden in reply to Lyubov]

A doubling from .2 to .4 is not anything to be concerned about. His PSA is still really low. When my PSA was in that range my doctor said "Yes, it doubled, but that's not the doubling we are concerned about"

If his PSA is doubling every 18 months, he can just watch it and decide later if he wants to go on ADT and just do the minimum needed to manage the disease. That's what I would do in his situation.

[Lyubov in reply to Hidden]

Thanks, Gregg. Although the doubling occurred in just 3 months, his most recent did go down to .38 from .47; that's a good sign, I think. Yea, would really like not to have to start ADT right now. . .