Psa slow increase

[Ilya]

Hi all. My father is 2,5 years with stage 4, bone mets (some in pelvis zone, around 7 in ribs, spine, shoulders). After docetaxel in the very beginning psa dropped from 900 to 1,5. In 2,5 years there is a slight growth - 1,5-1,7, now 2,1. Scans are stable. Is this a dangerous trend and time to switch to arbiraterone? Or it is still stable? He is going to scans in 2 weeks

[Shooter1]

He's had docetaxel, what else is he on.... you say switch to arbiraterone from what??? His scans clear is a good sign. PSA slowly rising does mean darned old aPca is still hiding in there somewhere...

[Ilya in reply to Shooter1]

Actually he is not clear. Still mets in the bones. After docetaxel, he is only on hormon therapy. Lupron. My question was is such growth in psa means he is now not hormone sensitive

[Tall_Allen]

Great response to docetaxel! If scans show progression, try abiraterone, perhaps with Xofigo.

[Ilya in reply to Tall_Allen]

Thanks TA. And if scans are stable, do you think it is not a critical psa growth to switch to something else?

[Tall_Allen in reply to Ilya]

No

[tango65]

His PSA is stable around 2 if you round numbers. If there is radiological progression of the cancer abiraterone or other of the new anti androgen, plus Provenge may be some of the options to consider

[Ilya]

Means he can still be hormone sensitive?

[tango65 in reply to Ilya]

I believe he still has his prostate. It has to be a clear upward trend in the PSA and/or radiographic progression of the cancer to consider the cancer castration resistant.

[Ilya]

Sure he does. I mean what is the upward trend like to know if he is resistant? Plus 10?

[tango65 in reply to Ilya]

I think radiographic progression is the best indicator the cancer has advanced and become castration resistant. If there are 3 or more sequential increases of the PSA they should do the scans and see if there is progression fo the cancer. The PSADT is also important if there is a short PSADT < 10 months they should do the scans.

[Shooter1]

Usually the upward trend would be 3 consecutive rises while on second ADT drug such as Abiraterone or xtandi before hormone resistant. He has lots of treatment options available.. and yes, probably still hormone sensitive.

[Magnus1964]

There are lots of ADT drugs he could move on to.