Hey guys am I in trouble here? After being on Orgovyx for the last 10 months it appears my PSA is creeping up. How to handle this?

[SViking]

should I be alarmed at such a rise in the last 30 days? My oncologist Dr. Dorf had been suggesting that I take an ATT holiday in two months. I guess things are different now.

[Tall_Allen]

Alarmed?? That is fantastic!

[SViking in reply to Tall_Allen]

I don’t understand. Doesn’t this mean my PSA is rising?

[Tall_Allen in reply to SViking]

Under a microscope.

[SViking in reply to Tall_Allen]

We are very alarmed at the moment. Could you please be more clear than what you see in this test result. It looks to me like my PSA numbers up to read the last 30 days.

[Tall_Allen in reply to SViking]

You are causing your own anxiety over nothing. I don't know how to say it more clearly. Those are good numbers. If your PSA reaches 2.0, it may be time for more systemic therapy.

[wilcoxsaw in reply to Tall_Allen]

TA, given the fact that he has no prostate, and had two previous skeletal recurrences, as well as a recurrence in the seminal vesicles all of which were verified on psma pet ct's, and a history of going from PSAs of undetectable to well above 2.0 in under 6 months you might want to reconsider your answers.

[Tall_Allen in reply to wilcoxsaw]

The PSA he posted is 0.04, not 2.0. He is very far from castration resistance. I should change my response to "If your PSA reaches 2.0, it may be time for more systemic therapy."

[SViking in reply to Tall_Allen]

Given that I don't have a prostate wouldn't I qualify for a PSMA scan if ever reaching .2?

[Tall_Allen in reply to SViking]

Qualifying for a PSMA PET scan doesn't mean that it is useful to have one.

[MateoBeach]

Your full history is not in your profile. I see that you had RARP quite a long time ago with clear margins. then nothing. And now on Orgovyx ADT for 10 months. Did you get salvage RT for BCR? If so did it include pelvic LN fields? Is the ADT adjuvant for the SRT?What was PSA prior to that? That may indicate proper duration for ADT before stopping it and seeing what happens. Scans would likely be useless at this time.

No need for panic.

[SViking in reply to MateoBeach]

A conditioned hardcore athlete, at the age of 59 I had Da Vinci surgery in 2010 with Gleason 4+3=7, PSA 9. Post surgical biopsy showed all margins clear with no seminal vesicle involvement. I had no incontinence and an active sex life for ten years when cancer suddenly went active again with PSA rising from zero to 2.0 in 18 months. PET scan revealed two lesions in my seminal vesicles so I went on Lupron for six months then at four-month mark, hit it with 35 Proton treatments. A few months later when Lupron wore off, and testosterone rose, PSA crept up immediately. A new PSMA scan at UCLA June of 2020 revealed a microscopic lesion in right pelvic bone.

Three treatments of SBRT was used 6/20/2020 without ADT because several doctors said it wouldn’t be needed on such a small matter. But PSA continued to rise monthly from .29 to 4.9 over six months. New PSMA scan 10/18/2021 indicated two small lesions in my lower spine and one in my hip bone.

Started Orgovyx 10/27/2021 with three treatments of SBRT performed at UCLA 18 days later. Bloodwork performed the day before SBRT showed PSA had dropped to .070 along with testosterone in 17 days. Head of RO, Dr. Steinberg, stated that in my case waiting for Orgovyx to work longer was not necessary. (Prior proton therapy RO recommended to wait a few months then go with 35 proton treatments.)

Obviously spinal involvement changes the game with the possibility of micro tumors existing after current treatment that were just too small to see on last PSMA scan. We are hoping that those can be starved with Orgovyx and possibly a secondary agent not yet selected. I agreed to six months of ADT but MO says maybe a year is better. The big question is what caused the recent PSA rise?

[MateoBeach]

That is tough, SViking. Like the story of so many of us here. If there is another rise, even though values are low, must presume there are micromets in many places. ADT certainly slows the growth, perhaps for years, but does not fully kill them. And eventually castrate resistance predominates.Nothing is certain in this except strategies that can slow it even further such as adding AAR drugs.

Requires systemic treatment to go after what cannot yet be seen on scans, in addition to the hormonal treatments. Chemo is one avenue.

I chose Lu-PSMA treatments with a unique ligand called J591. You can read about it in my previous posts this year. No guarantees with an experimental treatment of course. Many promising new therapies in clinical trials. Paul

[SViking in reply to MateoBeach]

At what point am I considered officially castrate resistant? Is there a certain PSA threshold?

[EdBacon in reply to SViking]

There's no exact standard, but you don't even look at it until you reach 2. Then when it's above 2 and you have 2 or 3 doublings, you would generally consider that as castrate resistant.

[cesces]

What is the 3.101 PSA?

Is that some kind of typo?

Just type in what the progression has been please.

Let's ignore the free PSA.

[Hidden]

Why are you causing unnecessary anxiety? Your PSA as I read, is undetectable; ie, less than 0.1. I personally am not an advocate of vacations. I am a believer if your MO says I think you are cured, let’s find out. If PSA rises, then the fix is to simply take a Lupron/Eligard. I am a believer in systemic treatment that reaches the vascular and lymphatic systems to deal with micro-metastasis. Systemic treatment translates to chemotherapy. I wish you the best with a lifetime of undetectables.

Gourd Dancer

[JRPnSD]

If your Dr. Is Tanya Dorff, then consider yourself very lucky.

[SViking in reply to JRPnSD]

You got that right!

[SViking]

This is the result of a retest after only a week. Doesn’t this point to a rapid rise?

Test result