My PSA is now at 47 after a high of 160 and a low of 5 after starting ADT with Firmagon, Abiraterone and Prednisone about 9 months ago

[diamondrn]

I was put on Firmagon in January and my testosterone responded almost immediately to less than 7, but the PSA kept rising, so I was put on Abiraterone and Prednisone in March.

The PSA went from 160 down to 5 within about 3 months.

Now my PSA is back to 74 and the testosterone is still negligible at < 7.

Apparently that is the definition of Castration-Resistant Prostate Cancer CRPC.

My latest bone scan on November 3 is not much different from the one in February, but there are a couple of spots, of 5 or so on my ribs, that seem a little hotter.

I am going to meet with my VA Medical Oncologist on December 30, to decide what our next step might be.

According to Dr. Wong with Mayo Clinic's algorithm, the next step should be Chemo + Platinum, etc.

Has anyone on this bulletin board been in my shoes and had good results with some sort of therapy change?

Thanks and Blessings.

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[Hidden]

The general thought is that short times (less than 6 months) from initial treatment to castrate resistance favors going to chemotherapy over second-line antiandrogens. Sounds like Dr. Kwon is following that. Additionally, if possible I would get a biospy of the mets and look at the IHC and genetics to see if you can get more direction in terms of future treatment plan.

Wishing you the best.

[Javelin18]

I have an aggressive cancer which responded only momentarily to Degerelix. I started docetaxel after it was recommended by my MO and confirmed as the best approach by Dr Dorff. It, combined with SBRT to the prostate, reduced my PSA to 49 from a high of 151.

It began to climb right after ending chemotherapy so MO added abiraterone and I supplemented with liposomal Quercitin. PSA stabilized at 100, and I began early access treatment with Lu-PSMA. Getting my second dose tomorrow, feeling much less pain and inflammation following first treatment indicated cancer cell death.

I have Aggressive Variant Prostate Cancer (AVPC) so my case may be different than yours.

[Javelin18]

To answer your question, it does appear to be castration resistant

[Tall_Allen]

Kwon is foolish making blanket statements like that. The question you have to answer is- How would a PET scan change your therapy decision? If you would do the same treatment with or without a PET scan, there is no point in doing a PET scan.

[diamondrn in reply to Tall_Allen]

Got it. Thanks, Tall_Allen.

I definitely will not push for a PET Scan based on that.

[MateoBeach]

. . . Unless the PET scan was a PSMA PET scan such as Pylarify. If Mets are PSMA avid then you could benefit from 177 Lu-PSMA treatments (abroad or hopefully soon in the USA). Not “useless”.

[j-o-h-n]

Thanks and Blessings to a U.S. Veteran,

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 12/17/2021 10:18 PM EST