PSA plateau

[bandgeek]

Diagnosed March 3rd 2021 with Stage 4 advanced metastatic PCa. PSA222

Immediate ADT. 3 month Lupron injection, daily 1000mg Abiraterone and 5 mg prednisone. Dropped to 1.5 in 9 months. Except for the 1st few months of malaise and emotions, I have been lucky enough to not present with any of the side effects. At my one year mark, my PSA has plateaued at 1.5, with no movement down over the last 3 months. Oncologist not concerned, yet, and am staying the course for now. Doesn't feel it is an indicator of resistance. Has this happened to anyone else?

Also, Just heard that Parp inhibitors were just approved. Heard of them?

[Tall_Allen]

PARP inhibitors are only beneficial if you are BRCA+, although there may be a benefit in combination with Zytiga or with radiopharmaceuticals.

[cesces]

If it isn't moving you're good.

It's not the absolute level, it is the trajectory.

Somewhere you have prostate cells generating PSA.

But whatever they are doing they aren't replicating uncontrollably like cancer cells.

[JimJimJimJim]

A number of doctors advise that a man should get as much benefit as he can from each treatment before he moves onto the next.

Zytiga (abiraterone) and Xtandi (enzalutamide), in particular should not be stopped just because PSA is rising again.

Treatment should continue until radiation shows things are getting worse, or clinical symptoms such as greater pain. The only time that PSA should be a signal for ending is if it goes up for more than 50 ng/mL above its lowest point while the drug is being used.

Becker studied whether this advice was being followed by ordinary doctors, not just those in the larger research hospitals in the big cities. In American veterans hospitals, he found the PSA level at the beginning of treatment most men of them matched the PSA at the end of treatment, showing that this group of men was not getting the full benefit of either of these drugs.

Treatment of Metastatic Castration-resistant Prostate Cancer With Abiraterone and Enzalutamide Despite PSA Progression

pubmed.ncbi.nlm.nih.gov/310...

One of the studies which advise not to stop to early:

Abiraterone acetate + prednisolone treatment beyond prostate specific antigen and radiographic progression in metastatic castration-resistant prostate cancer patients

sciencedirect.com/science/a...

[j-o-h-n]

Greetings Mr. Band Geek, (Would you blow a few notes on the request below):

Would you please be kind enough to tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, you might want to copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 03/25/2022 6:16 PM DST - Greek Independence Day.

[Scoofer33]

I might be a fair representation of your cancer situation, just five and a half years ahead of you in the process. The highest my PSA ever got was 17.9 (3 months after RALRP, which was strange since normally it goes to undetectable levels and hopefully stays there for two years). My cancer has never behaved like everybody else's. The PSA continued a long slow advance every quarter until I was considered castrate resistant. I had six successful treatments with Radium 223 (Xofigo)to de-bulk the cancer in my bones. During this time I didn't worry about PSA numbers because I knew they would rise during this treatment. My PSA rose to around 7.9, I think. I then went on Abiraterone acetate (Zytiga) and Prednisone in 2018. I have been notified this treatment is no longer working for me. I'm now wondering if I want to pursue SOC Chemo or a clinical trial of CAR-T cell therapy at City of Hope. Due to the weirdness of my cancer, I have had many treatments swept off the table. My doctors now believe my cancer has morphed into Neuroendocrine Prostate cancer, so they suggest adding Carboplatin to my chemo cocktail to kill the small cell cancer as well. I wish you well, bandgeek. My heart breaks for the knowledge of what you will go through the losses along the way, but rejoice that you are not experiencing the worst of the side effects!