PSA creeping up to 2.8 over the course eight months, next step?

[Kcski]

Hi,

My Dad is 74. He was diagnosed with prostate cancer about two years ago with a PSA of 10,000 and Gleason of 4/5 for a total of 9.

He did six rounds of chemotherapy (Doctaxel). He takes ADT. He eats home cooked meals and works out hard. His result was fantastic with tons of cancer kill! His PSA went to .2 and stayed there for a year.

It has been creeping slowly up for about a year. From .2 to .2 to .3 to .6 to .8 and then to 2.8.

When the PSA rose from .6 to .8, he had a CT/Bone Scan. The scans came back clear with nothing shown.

Is a PSA between 0 - 4 considered acceptable range?

His oncologist suggested Nubeqa coupled with his ADT. What do you guys think of that suggestion?

What does the community think the next best step is?

I think Doctaxel again since it was proven so successful.

I appreciate your valuable insights!

Love and health,

Karyn

[Bkraus1]

Request a PSMA/Pet scan to see if you can localize one area such as a lymph node or bone metastasis. May be a candidate for focal radiation treatment.

[Kcski in reply to Bkraus1]

Good suggestion! I forgot to mention he had a CT/Bone Scan when the PSA went to .6. The scans were clear! Initially there were “things” in the abdominal and leg lymph. Never in bones. Can those “things” be destroyed? Can you go from Mets to no Mets?

[Tall_Allen]

That's a phenomenal response to chemo and is prognostic for good results in the future. It may be a good idea to alternate chemo with advanced hormonal therapies. I assume they found many metastases on a bone scan/CT. Nubeqa sounds good if he can get it - it is usually only available if one is non-metastatic. Otherwise, Erleada, Xtandi, or Zytiga..

[Kcski in reply to Tall_Allen]

I like the suggestion of alternating chemo with advanced hormonal treatments!

Initially they found lymph blockages (are they called Mets?) in the abdomen and leg. The abdominal lymph blockages were threatening his uterine function via his right kidney. The chemo destroyed all that!

He had a CT/bone scan about three months ago (when PSA went from .2 to .6). Nothing was found and the scans were clear.

Can you go from lymph Mets to no lymph Mets? That might be the reason for the Nubeqa suggestion.

Would you advise starting the Nubeqa now or waiting for the PSA to go to 4?

Thanks again and again!

Karyn

[Tall_Allen in reply to Kcski]

The chemo shrinks metastases, so they are undetectable.

I would certainly begin Nubeqa now. There is no point to waiting.

[LearnAll]

By its behavior and excellent response to ADT and Docetaxyl chemo...it is obvious that your Dad,s cancer is not aggressive and his cancer cells release a lot of PSA. Cancer cells which release a lot of PSA are generally non aggressive.In this particular situation, my view will be to wait until PSA rises above 4.0. He might live many years and we need to balance how much treatment is used and at what point.

[Kcski]

Thank you for your advice! I think it is smart to wait until the PSA gets to 4, but I also worry about bone Mets forming. I think avoiding bone Mets is key to prolonging life. It seems exercise really helps with avoiding bone Mets.

What you said about high PSA and less aggressive cancer is very interesting and encouraging. His Gleason score was 4/5, for a 9, which is considered high. His cancer might be weird, though, and your theory could hold. Who knows. It makes sense.

Thank you!

[LearnAll in reply to Kcski]

Its understandable to have worry about more bone met formation. Fortunately, we do have blood test to monitor whether bone mets are growing or they are healing. The simple blood test which is inexpensive ...to monitor bone mets is called Serum Alkaline Phosphatase level (ALP) This enzyme ALP comes out of two sources,,from . bone healing activity and from .liver. Approx. Half comes from Liver and half of it comes from bone. If ALP is falling (in absence of liver disease)..it means bone mets are healing and becoming scar tissues.

Two simple but essential blood tests to monitor monthly are (1) PSA and (2) ALP.

Kcski, when our loved ones are suffering from a serious illness and the medical industrial complex is only interested in making huge profits out of our helplessness..the right course of action is empower ourselves with accurate, reliable information and makes best choices for our loved ones. Knowledge is a nuclear weapon to defend ourselves from this pathologically greedy and heartless medical system. This forum which all its flaws is still a place where we can exchange ideas, learn and make good decisions.

[Shooter1 in reply to Kcski]

With G-9 and rising PSA, 0.8 to 2.8, I would jump on it now... With that fast a climb, it must be growing somewhere. When mine jumped like that a Na-F18 scan showed mets even though regular scans were clear.. Darned stuff was just flying under the radar..

[CAMPSOUPS]

You are right. No reason to wait for PSA to rise to a theoretical point of 4.Scans show nothing as you said but activity is occuring.

Glad you will begin treatment.

Dr.'s are your allies.