My husband just got his PSA score this morning. After declining scores for over 4 years, it went from .21 to .44 . He was diagnosed in June 2018, and has done very well with Zytiga/prednisone. However, this is worrying us a little. He's not scheduled for another PSA test until November. I'm thinking we should request one in 30 days rather than waiting and see what happens. Any advice or insight would be greatly appreciated.
PSA rising?: My husband just got his... - Advanced Prostate...
PSA rising?
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ForJoel
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PSA went from 0.21 -> 0.44 in how long? Has he tried switching from prednisone to dexamethasone?
pubmed.ncbi.nlm.nih.gov/300...
After abiraterone has run its course (let PSA go up to 2.0 or new metastases), he can try Pluvicto.
Potential change in therapy dictates when to do diagnostic tests.
Thank you!❤️
It went up since the last test about 90 days ago.
So it's doubling roughly every 90 days. As Allen says, you need to look at changing treatment when it reaches 2.0 which should be somewhat after November at that rate but it wouldn't hurt to get an earlier test.
It would help people to help your husband if you could complete the Bio in your profile with a summary history of treatment and results.
Has not tried switching yet, but I thought that might be a good idea.
Wouldn’t he need to be exposed to taxanes first before he could get Pluvicto? At least, with insurance coverage…I’d love to be wrong here.
Normally, yes, but there are several clinical trials that do not require chemo:
Good morning! We just got the results from his Sept. PSA test: .62
February = .20, May = .18, August .44, Sept. .62
The oncologist agreed to try dexamethsone in place of the Prednisone. Additionally, they are going to run some kind of scan this month that is new to us, but they thought was necessary. Do you think only changing the Prednisone is prudent, or should we look at Pluvicto? The P.A. mentioned it, as you did, as a possible next step. We don't want to jump the gun! Thanks in advance for your advice.
Marilee
Changing to dexamethasone is a good idea, but I don't know if it increases survival. Pluvicto does.
ok, thank you. I read that after Pluvicto, you can’t try anything else. Is that accurate?
"I read that after Pluvicto, you can’t try anything else. " Where did you read this? I am interested to see it myself.
Hope you did feel out your profile? Otherwise it is difficult to recommend anything.
I did fill out his bio. I just haven’t added this latest score.
in your bio i only read this:
"Bio
My name is Marilee; I am the wife of the patient. We’ve been married for 39 years and have 5 children. I’m here to help my husband (Joel) make good decisions about his health and to find ways to support him. "
We would like to see your treatments and date of diagnosis listed etc.
We’ve been to Andrew Armstrong at Duke and can go again if necessary.
Would help to have treatment history in the profile. It would be easier for us to help without having to ask a lot of questions.
I would say go monthly tests now to monitor situation
My Onco has told me 90 days for tests but I choose monthly. My medicine plan has $0.00 for blood Tests but that's not my reason....I feel better with tests that often.
He was getting tested every 30 days, but when it kept declining, his Onc switched to 90. They agreed to go back to 30 days now and scheduled him for a test next month. Th👍
The "feel better" part is very important to us all. Doc's sometimes fail to see that.Even though my psa has been undetectable for a year I choose monthly for tests and Onco visits.
I tell the staff that it's like a three legged stool. Leg one is I feel good, leg two is the good test results, and ked three is a positive Onco visit. Most of the time it is a NP I see but 3-4 months see the doc herself.
Good time to get Provenge treatment while PSA is very low, best results come from using it while PSA is less than 5.0.I’m in the same situation, my PSA became detectable again after 6+ years of being undetectable and has been doing a slow rise over the past year.
He might want to get a PSMA scan to see what the source of the PSA rise is. If it is a single lesion or two you may be able to treat with SBRT radiation. This may help extend the time until he needs to go to something like Pluvicto. There aren’t many options available after you play that card. I don’t agree with simply letting it go up to 2.0 and using Pluvicto.
I’ve been getting an ultra sensitive PSA done every two months, If PSA is increasing quickly, I agree with getting one done monthly.
Ed
Thank you! Very helpful. Joel started Provenge treatments in 2019, but he got a bad infection from the port and had to stop. Would they be able to try again?
My psa was 24 last october and it is 40 now . My prostate was removed 2002 and the psa returned five years later and keeps on going up . Not taking any meds so far .
I went to monthly PSA when it started to rise from 0.12. Just kept going up. Last was 24.9 with radiation treatments, xofigo, xtandi, provenge all used. Now starting a BAT to see if it will work.... 5yrs and 4mo into stage 4.
Personally, I like to know my PSA monthly.
A piece of information, that I've been getting myself tested for PSA randomly at Quest Lab (placing my orders at Direct Labs). Current cost is $42. Last one I had with them was like 6 months ago and I remember paying $29 during a monthly special.store.directlabs.com/
My HMO -Kaiser- does not want to test more than twice a year, so I'm testing additional when I feel like.
Best wishes for Joel...
Pluvicto is recommended if your life expectancy is under 8 years. It could have long time side effects. It is better not to rush with it if it is not needed. You are doing fine now. Therefore Pluvicto should not come into immediate consideration.
If your tumor burden and PSA is low volume cancer than Pluvicto can be very toxic to your organs.
This paper argue that:
Maybe Provenge would be beneficial if you could organize it. Provenge extends life by 4 months. I personally would have it but I am in Australia and here it is not approved.
Provenge is most effective in extending life when your PSA is under 5.
My oncologist here in Australia is not recommending it but it extends life therefore I would gladly organize it if i could.
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