Dx T3b m0 n0 Dec 2014, G9. Details on profile. On Zoladex from Aug/21, and Zytiga + Prednisolone from Jan/22.
Current status is:
Mets present in pelvis (3) and ribs (2). Bone scans 4 months apart (Jan-May/22) show no change in size or number of mets. But PSA continues to rise (7.6 to 10 over same period). Testosterone is suppressed, little change.
Seems unusual. Can anyone explain what might be happening? I am feeling fine apart from some fatigue if not active.
Written by
Ian99
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Do you mean that PSA is rising before you have evidence on bone scans of progression? If so, PSA (and bone ALP) are early indicators. Consider switching from prednisolone to dexamethasone.
PSA began rising in May 2021. The rate of increase levelled off after I began Zytiga in Jan 2022 but it continued to rise. What I don’t understand is there is no evidence of the cancer growing according to the 2 scans 4 months apart, but the PSA continues to rise during that same period. What could be pushing the PSA upwards ?Re changing to dexamethasone I did ask but the oncologist was reluctant to change at this point because the cancer seems to be under control. So am continuing on current medication.
Does this mean they do not pick up all cancer activity in the bones ? And I imagine they would also miss mets in lymph nodes. So either of those would continue to drive the PSA. In this case, what type of scan would be best ?
No scan picks up all metastatic activity. There are thousands of microscopic metastases in bone, blood, lymph,around nerves, and in tissue reservoirs everywhere. What is important for tracking purposes is that you stick with the same one.
Hi lan99, my initials are lan, too! And I share the same experience with a bone scan that shows little activity but a steadily rising PSA. Also Dx 2014, G9 (T2c N0 M1b)
I've done Xtandi +Lupron, which worked for years then slowly stopped working. I got castrated to do away with Lupron, then I did Provenge immunotherapy without my expectation of it lowering my PSA, but rather as something that will prolong my active life. I am now approaching my second docetaxel (Taxotere) infusion and my MO expects my PSA to drop around the time of my third (~6 weeks after start of chemo). PSA currently around 11.
Seems we're on parallel paths, but I may be a little further along.
Hi Miccoman. Thanks for the reply, it’s encouraging to read about someone with a similar medical circumstance and a philosophical outlook! I am likely heading toward Docetaxel or similar although am concerned about side effects. Are you tolerating it ok ? What scan are they using to check overall status ?
Just standard CTs, MRIs and bone scans for assessing disease. First infusion I had the tongue thing, so I'm adding ice as I go. I'm bald already so I'm not concerned about hair loss and since I'm by myself bringing in special socks and gloves is just too much for me.
Nothing to with PCa I needed to have chemo (cisplatin). Back in 2013. One of the lasting side effects is a tingling sensation on the soles of my feet. I’m used to it now but could do without it. Is this what the special socks are for ?
I see nothing unexpected in my opinion. Research micro-metastasis and then discuss with your medical oncologist. I wish you the best.
In my case PSA is now 170 with no increase in Mets in 6 years. My PSA had been less than 10 for 21 years since my RP in 1999. I have been on Lupron and Casodex for this time together with radiation. When PSA went up to 15 in 2020 I started on Xytiga. My PSA went up to 126 within 90 days. Started Taxotere infusions in late 2020 and although PSA went down to 26 ,when the 6 month Chemo infusion was over PSA went up to 126. Started on Lynparza in fall 2021 and PSA went up to 180.I just started trial with Lu-177 and after one treatment my PSA went down to 170.
The question I have is the same. Why is PSA rising without any change in Mets.
I have had numerous Axumin scans as well as a scan with Pylarify.
Thanks, nice to have company. I checked my notes from an earlier clinic last year and following a psma pet there was mention of activity in the lymph nodes. But given the bone mets were so visible, the focus has been there. Have you had a psma pet scan to check overall status?
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