2 years post Taxotere and ADT, PSA increased from .3 to .4 to .8 over the course of six months. Next best step?

[Kcski]

Hi Everyone,

My Dad was diagnosed with advanced prostate cancer at age 72. His PSA was 9,800 (very high). He had an issue with something pushing on his bladder. Lymph nodes were involved, but no bones or organs.

He chose to do 6 rounds of Taxotere with ADT.

The result was tremendous! His PSA went to .3. He had a ton of cancer kill. There is no longer an issue with the bladder. This result has lasted for two years with a three month ADT shot. He PSA remained steady at .3 the entire time.

Over the last six months his PSA has gone up a very small amount. Let’s say from .3, to .4, to .8.

With the overall increase from .3 to .8, his doctor (Dr. Nordquist) wants him to decide if he should:

1). Do nothing (wait and see)

2). Enroll in a trial with Zytiga and Fuzuloparib

3) Zytiga

4) Taxotere for another 6 rounds (my suggestion because we have proof it worked so well)

He just had a PET scan and there are no bones or organs involved

What do you guys think?

Thanks again and again for your insight, knowledge, and help!

Much love and good health to the community❤️,

Karyn

[Tall_Allen]

If he is BRCA2+, #2 sounds good to me. If not, wait. It may take a while for the cancer cells, which are mostly senescent now, to "wake up" and become vulnerable to more therapy. When that occurs, consider combining Taxotere and Zytiga. Among newly diagnosed men with high metastatic burden, the combination significantly improved survival in the PEACE1 trial. I have no reason to believe that it will work, just guessing.

[Kcski in reply to Tall_Allen]

Thanks Tall_Allen! My Dad specifically asked me to post and get your opinion. We are so lucky to have you on this site!I like what you said. I didn’t know that cancer cells took some time to wake up after a successful attack. I am grateful for this important information. I was concerned about the cancer getting a foot hold, but it sounds like it needs to be “awake” to be vulnerable.

He is not BRACA2+, so the wait and see game sounds best. Do you think PSA should be tested sooner than the normal three month span? I also like your Zytiga plus Taxotere combination suggestion, when the time comes. Finally, I wanted to ask you, if an Axial CT scan and a delayed whole body scintigraphy were ok instead of a PET scan? That is actually what my Dad had instead of the PET scan I posted on my original message. Thank you for helping so much ❤️

[Tall_Allen in reply to Kcski]

Maybe get another PSA in a month to see how stable it is. Here's what we know so far from PEACE1 and a similar trial with Taxotere+Nubeqa:

prostatecancer.news/2021/05...

[Hidden]

Zytiga, keep it simple - don't over think this stuff. Zytiga has a well proven track record and works well for many men 3,4, even 5 years or longer.

Of course what do I know?

[Kcski in reply to Hidden]

I understand you don’t want to get overly stressed out over the decision, but my instinct is that it is important to play your hand strategically and correctly for the best outcome. I don’t know nothing either, but I deeply feel it is very important to pick the right drugs first and play the rest in the best order. The Taxotere first was major imho.

[Woodstock82]

I too started out with a very high PSA. Lupron and Taxotere brought it down nicely, but when it started rising again then Zytiga was the next layer of defense.

I enrolled in the CHAARTED2 clinical trial, and was selected for the chemo arm, so when I started the Zytiga I also started a set of cabazitaxel infusions. I have had very good results from that. Nine months after I finished the chemo my PSA is still extremely low. The plan is that someday, when my PSA is rising again, I'll add a third layer of ADT, probably Xtandi. I hope that 177Lu-PSMA becomes an option available to me before that, though.

[Magnus1964]

At your dad's age might consider the Zytiga and Fuzuloparib trial. A second course of Taxotere might be rough. He can always use Taxotere as a fall back position.

[Kcski in reply to Magnus1964]

He is pretty tough! He works out almost everyday and that really helps. He does not mind discomfort, if it will give him more life. His mind set is, take the best life extending option and deal with the manageable discomfort.

[j-o-h-n]

Hello Kcski,

First of all add a few vowels to your userID because when I mentioned your ID to my wife she thought I was having a seizure.

Second Women should never use the abbreviation for "In My Humble Opinion" as "IMHO"...Use IMRO = IN MY Respectful Opinion.

Thirdly I would suggest Watchful Waiting for your Dear Dad (but what do I know?).

Finally IMHO you're a wonderful daughter...If you were my daughter I would marry you.

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 12/14/2021 10:15 AM EST

[Kcski]

LMAO (laughing my ass off)!

It feels good to laugh! That is strong medicine as well

You are a wonderful person!

Thanks and I like the waiting idea, too!

[slpdvmmd]

Surprised he was not on Zytiga since the outset. His story sounds similar to my own. My question is what type of PET scan did he have. If he has not has a PSMA PET then I would certainly consider this.