Climbing PSA

[Muffin2019]

Started abaritone in November of 2020, psa has gone from 12.3 down to below 1 for quite to 10/12/21 now has climbed to 4.4 as of 3/23/22. I am assuming it only lasted for about 15 months, means on to another treatment plan as it has lost its effectiveness, any thoughts on this and what would be the next logical steps. A cat/bone scan in the beginning of February showed no disease progression or new mets. Pet scan then xtandi ? Chemo again and how many sessions then xtandi or back to arbitrone? Looking for some thoughts on next step to drive down the psa before it gets higher, I have no bone pain at all.

[Tall_Allen]

Why not try switching to dexamethasone?

[Muffin2019 in reply to Tall_Allen]

I have been on it 1 MG since last February of 21, is the dosahpge high enough ?

[Tall_Allen in reply to Muffin2019]

Yes.

[Muffin2019 in reply to Tall_Allen]

I have one bottle of abritone that is paid for, PSA is going to be checked on April 19 before I see the oncologist to see if I am accepted in a study of xtandi and something else. Since I paid for it I am thinking of taking it with a high fat of low fat meal, could not find the toxin amout when it becomes dangerous or overdose. Thinking of 1- 250 or two 250 tabs with a low fat meal and 1 or 2 with a high fat meal to see if it has any effect on the PSA. It has gone from 1.8 to 4.4, no idea what happened, the PA said he might want another scan but did one on Jan 31st of this year, why would another scan be needed so soon and does the insurance pay for that again so soon. Is he treating the cancer or the PSA (scans came out good, no progression of disease in both the CT and bone scan) ? You are very knowledgeable on this stuff and if anybody had luck with adding food to abritone I would like their input. Thank you.

[Tall_Allen in reply to Muffin2019]

Maybe he wants to see if you qualify for Pluvicto.

[Muffin2019 in reply to Tall_Allen]

He is trying to get me in a study that is opening the end of this month, the PA thought it was the arrow but that is not for prostate, looked it up and for lung and thyroid cancer so could be that study, he was excited about it last month when I saw him. Then I should forget taking it with food as it could screw up my being accepted in the study ? Is the LU177 tolerated well or major issues that you have heard about ? Not heard of taxane chemo before this, what is it and how effective is it ? I know I ask alot of questions but the knowledge on here is terrific.

[Tall_Allen in reply to Muffin2019]

"Then I should forget taking it with food as it could screw up my being accepted in the study ?" I don't know what the requirements of the trial are, but I doubt that would make a difference. If taking it with fat increases the absorbed dose, it may increase side effects. Let your oncologist know so he will watch you more closely.

"Is the LU177 tolerated well or major issues that you have heard about ?" There are some major side effects that occurs in a small number of patients.

"Not heard of taxane chemo before this, what is it and how effective is it ?" If you've had chemo for prostate cancer (Taxotere or Jevtana), you've already had a taxane.

[Muffin2019 in reply to Tall_Allen]

I had dox in 2018 with lupron before going to eligard when lupron was hard to get. Would you recommend that I do not screw with the dosage as prescribed an hour before eating untill the next PSA blood work ? I now take the xgeva every 3 months, this one had to be delayed due to the tooth issue and that need authorization now from the insurance company this year, they will need authorization for the scans if he does them so close to the last one. Never had those two for chemo.

[Tall_Allen in reply to Muffin2019]

Get your MO's approval before experimenting on yourself.

[Muffin2019 in reply to Tall_Allen]

I sent a message as to what I plan on doing with both low fat and high fat breakfast and the dosage of the meds, also asked if the PSA number does effect the study they are trying to get me into. I will wait for their reply before doing something that gets me in hot water. You are a wealth of information that is reliable. I guess I still have the PSA anxiety after all these years. Have a good night and God bless.

[spencoid2 in reply to Tall_Allen]

My MO said that he has to go along with the drug companies recommendation of 4 without food but that if I had problems he could change it to 1 with food and is confident in the Indian (and other) studies and using food to increase absorption. I don't think the people running the study would have any way of knowing how and when you took the abiraterone unless you told them. Probably would have been best to not mention it. Are you having to pay for the abieaterone yourself?

[Muffin2019 in reply to spencoid2]

No, the insurance pays for most of it.

[spencoid2 in reply to Muffin2019]

I wanted to take a lower dose just on principle but MO talked me out of it

[MateoBeach]

Now you have a new choice to consider: Since Lu-177-PSMA-617 was finally approved yesterday by the FDA for metastatic CRPC after prior treatment with Taxane chemo and an Androgen Receptor drug, you now qualify to get it and should seek out this as a possible next best option. Treatment centers will be coming online within weeks so now is a good time to get it arranged.

[Muffin2019 in reply to MateoBeach]

Do you take that with adt drug like xtandi ?

[MateoBeach]

Metastatic CRPC has a 100% chance of killing one. Pluvicto is the name of the Lu-PSMA treatment as Novartis has named it. I would go for it (and am).

[Muffin2019 in reply to MateoBeach]

Wil, look, it up., thanks

[nextphase]

Have you had your prostate removed?

[Muffin2019 in reply to nextphase]

No due to spreading in three places in the bone in 2018

[nextphase]

Have they talked about Lupron for you?

[Muffin2019 in reply to nextphase]

Have been taking since 2018, switched to eligard when lupron shortage.

[nextphase in reply to Muffin2019]

My journey is kind of like yours.I had robotic surgery in 2008 coming up on 14 years. Last year my PSA started rising so my OC put me on lupron. My PSA so far is holding at 0.02. Just thought I would share good luck to you fighting this.

[Bowmaster]

i have the same problem with my PSA . It is going up steady and i had my prostate removed 2002 . Can you please tell me what did you use to bring it down ? Here is my e-mail [e-mail] Tahnk you .

[diamondrn]

Abiraterone failed after about 6 months. My PSA is back up to 190 and I have a bunch of painful metastases on my ribs, spine and pelvis, Muffin2019.

This is the link to an article that I wrote about it >>> healthunlocked.com/advanced...

[slpdvmmd]

My impression is that bone scan and standard CT is having less if any role in your situation. PSMA PET/CT would seem to be in order and was the right step when my situation was similar to yours and I had negative standard imaging.

[Muffin2019 in reply to slpdvmmd]

You are probably right , I think that is the next step.

[Muffin2019 in reply to slpdvmmd]

Very impressive background, sounds like my case is similar to yours so will be doing the pet scan, hopefully the insurance will cover it. I think that is what he had in mind then maybe continue with arbitrone/dex for a few more years since the cost of the arbitrone has dropped through insurance. Thank you for your help, I will be following your journey.

[slpdvmmd in reply to Muffin2019]

Wish you well. Sad, given the evidence, that we have to wonder what our insurance companies will allow.

[j-o-h-n]

A Muffin a day will lower your Psa......

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/25/2022 7:37 PM DST - Greek Independence Day.

[ishitasen]

Since there is a gradual rise in your PSA level, the abaritone is no more effective for your prostate cancer and you might have to switch over the treatment. The various options left for you includes chemotherapy, Xtandi, enzatulamide followed by rechallenge with abiraterone and targeted therapy etc. You can discuss these options with your treating physician and decide subsequently.

[Muffin2019 in reply to ishitasen]

Thank you, I see him on the 19th of this month, I am on the last refill of arbitrone so I have enough till may while he gets approvals and where to go from here, he will tell me more about the study I may qualify for. Getting blood work done in a week or so, I expect the PSA number to be higher, have to check the calcium and potassium due to the bone shot.