Is this pointing to cancer becoming castrate resistant?

[dac500]

This is a followup after my previous posting.

I have been fighting metastatic prostate cancer since November 2018. Before this I had brachytherapy in 2011 for original diagnosis of Gleason 3 + 3 cancer and cyber knife + 9 months ADT for extra-capsular recurrence in 2016/2017.

Since November 2018 I had a nine month ADT break and currently I am at six month point of a second break. Between 3 to 6 months of my first break testosterone rose from < 20 to 114 while PSA increased from 0.07 to 0.135 (1.9 times). During the same period in the current break testosterone rose from < 20 to 28 while PSA increased from 0.104 to 0.188 (1.8 times). If 28 is considered castrate level, then is increase in PSA is a signal towards castrate resistance?

According to my MO's nurse castrate level is <20. She considers the small increase in PSA is due to testosterone rising above castrate level. However, she agreed to a PSA and testosterone test six weeks from now. I personally feel that next three to six months will give a clear picture. Am I right to think that way? Or, should I consider more aggressive treatment soon?

By the way, there happens to be some difference of opinion whether <50 is castrate level or < 20 is castrate level. I understand the standard <50 was established in 1980s when testosterone measurements were less accurate.

[Tall_Allen]

Nurse (as is often the case) is wrong. Castrate level is defined as under 50. But anything under 30 is good, under 20 even better.

[dac500 in reply to Tall_Allen]

I would appreciate your opinion on the following NIH articles:

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

[Tall_Allen in reply to dac500]

Isn't that exactly what I wrote?

[Shooter1]

I would think a small rise like that in both PSA and T would be normal if off ADT. Castrate resistant when PSA rising during ADT with second stage ADT drug in use. Like my increase while T less than 4 and on Xtandi with PSA skyrocketing...

[dac500 in reply to Shooter1]

I had my last 3 month Eligard shot on March 2, 2021. nine months later my testosterone is only 28. So, I consider even a modest rise in my PSA is more significant than a similar rise during my break in 2020 when testosterone was 114.

Metastatic prostate cancer is different in different men. I was initially diagnosed in 2011 with low volume cancer with Gleason 3 + 3. People would say my cancer shouldn't have been treated at all. But guess what in 2018 my cancer became metastatic with about 10 lymph node in pelvic and abdomen detected by PET/CT scan and confirmed by biopsy.

Ironically my prostate has been cancer free all this time. Now, all my cancer is outside the prostate. My goal to keep the metastasis from spreading still further.

[Shooter1 in reply to dac500]

My prostate came out and PSA climbed 20% in the next 6 weeks.. not too good. Gleason 9/10 with mets and extracapsular extension and all neural and venous bundles out of prostate area ++ for aggressive invasive cancer. So I know cancer from mets alone are a concern. My BCR earlier this year confirm this. Mine is now under control, Hope yours will not spread more. I joined the Lupron for life club until an orchi. set me free from that shot in the bum. It's not unusual for T to come back very slowly after prolonged or repeated ADT. Best of luck to you.

[Hidden]

You said "According to my MO's nurse castrate level is <20. She considers the small increase in PSA is due to testosterone rising above castrate level. However, she agreed to a PSA and testosterone test six weeks from now."

Your nurse could be right. I'm in a similar situation. My PSA rose from undetectable to .22 on the last test and my testosterone was 34. I'm also having mine retested after 6 weeks from the last test.

Historically, a serum testosterone below 50 ng/dL was considered to be the castrate level. Current data suggest that the new target for either surgical or chemical castration is a serum testosterone level of lower than 20 ng/dL in an attempt to maximize therapeutic outcomes.

ncbi.nlm.nih.gov/pmc/articl...

Based on my personal experience, I've had an undetectable PSA over the last 3 -1/2 years except 2 times that I know of and both times my testosterone was in the mid-30s. Coincidence? Maybe, but prostate cancer does learn how to be more efficient with male hormones so definitely want to get it down below 20 if possible.

Here's another article

ncbi.nlm.nih.gov/pmc/articl...

[dac500 in reply to Hidden]

Thanks for an appropriate answer.

[dac500 in reply to Hidden]

Did you have any ADT break?

[Hidden in reply to dac500]

No, it's been continuous for me. I had a fairly large tumor burden at diagnosis so intermittent was not recommended.

[MateoBeach]

You may argue that you now meet the strictly defined criteria for being castrate-resistant metastatic PC. That is not something we WANT to happen, but it is USEFUL to be diagnosed as mCRPC. Why? Because it makes you eligible for treatments that are only approved for that. Such as Provenge and others as well as for the majority of promising clinical trials. So ask your MO ( not the nurse) to declare (diagnose) you as now mCR. You should also get referred for Provenge now and review your current treatment regimen. Are you on a bone protective regimen such as denosumab or Zometa, either combined with Celebrex? Good luck.