PSA rise

[spencoid2]

On aberaterone and had orchiectomy almost 6 months ago. I thought my PSA would drop to close to 0 but it did drop a lot after starting Firm is Gone (before the orchie) down to about 2.85 at its lowest and is now slowly rising. Over the last three PSA tests the doubling time is about 6 months. So this is a trend, minor or not and not test variation or a bad test.

Is this something to ve concerned about or ust wait to see where it goes?

[Magnus1964]

Are you still on abiratorone? If not you need to go back on it. If so maybe you should switch to xtandi.

[GP24]

Add Abiraterone again. The combination treatment Abi+ADT is what you need.

[spencoid2 in reply to GP24]

i am still on Abi should my PSA be near 0 and not rising? i can ask my MO about switching to xtandi. he thought abi was the best unless it doesn't work.

[GP24 in reply to spencoid2]

You could check your testosterone, if it is about 0.03 ng/ml as Abi does usually achieve. You can switch to Xtandi if you and your doctor feel the PSA value is too high. However, there is a cross-resistance so Xtandi works for about three months only after Abi for the average patient. Magnus is different. When Xtandi does not work any more your doctor will recommend Docetaxel. Then a rechallenge with Abi or Xtandi followed by Cabazitaxel.

You could try to add Olaparib according to this study: urotoday.com/conference-hig...

Or try to get a Lu177 therapy which is about to get FDA approval.

[slpdvmmd]

Have you been Imaged?? Seems like a PSMA PET/CT may be indicated.

[spencoid2 in reply to slpdvmmd]

Had two PSMA PETs one fairly recently. Found distant lymph nodes which were biopsied and found to be PC. Last testosterone was low but not recently. Had balls wacked recently so T should be low. On Abaterone. I wrote to the coordinator of the only LU177 that would be convenient (sort of) for me. Asked if I had to go to So Cal (live in No Cal) if I were on the placebo arm. Do not understand how they can pretend to have a double blind study with radioactive medicine. Does no one have a Geiger counter? I would not continue going to So Cal to get saline shots. Nothing closer.

[slpdvmmd in reply to spencoid2]

I fear that LU177 will be a while longer in the United States. I was skiing last weekend with a Urologist who told me their group has been approached about enrolling patients in continuing LU177 tiral. His impression is the FDA is requesting more info as Vision trial was poorly performed and had poor statistics. FDA could approve and require post approval study but not sure what direction they our going. Hard to believe a treatment available for almost 2 decades (or more) overseas is languishing in the quagmire of the drug approval process in this country while other countries are moving on to other radiation sources than LU 177 as well as other targets in addition to PSMA.

[CAMPSOUPS in reply to slpdvmmd]

The bad news: you wasted time writing that.The good news: Its been approved today lol.

[slpdvmmd in reply to CAMPSOUPS]

Good to hear about approval of LU177. But still the hurdle of CMS approval (usually an automatic), insurance interpretation of eligibility (big hurdle), availability, and pricing of a treatment that has ranged of $5000 to 20000 over seas. Also we still remain behind Germany and Australia in development of new radiation emitters and ligand targets which remains incredibly important to all of us. Saw this regarding Novartis Pricing which begs the question of how much this price will be pushed by hospitals/healthcare systems endpts.com/novartis-radioph...

[ishitasen]

PSA doubling time is an important prognostic marker for evaluating the progression free survival in patients with prostate cancer. PSA doubling time of less than six months requires aggressive treatment. Treatment with Erleada (apalutamide), Orgovyx (darolutamide), or Xtandi (enzalutamide) is preferred. Additional secondary hormone therapy is also recommended. A latest PSMA PET CT to know the current status of the disease is also required so that treatment can be tailored according to your needs. If your disease expresses PSMA receptors, then Lu-177 therapy can prove beneficial to you.