PSA doubling- <.02 March , <.04 July, < .1 October - Bicalutamide monotherapy 50 mg, tamoxifen 10 mg

[Coastguy]

I’ve been on Bicalutamide 50 mg monotherapy since August 2019 along with tamoxifen 10 mg and finasteride 1.25 mg. PSA went from 65 in August 2019 to < .02 in March 2020 and remained there until July 2022. I have a small inoperable tumor in the left seminal vesicle next to wall of rectum. I’m very active and in excellent health otherwise. I am meeting with a new medical oncologist Dr. Narendra Tirumali who replaced Dr Julie Graff at OHSU last year.

Does it make sense to start intermittent therapy and check PSA every 3 months ? Depending on the results, reintroduce Biclcutamide again to see if it continues to work. If not what is my next best option. I’m thinking transdermal estradiol might make sense if he or my urologist will prescribe.

Quality of life is very important important to me. Any suggestions will be appreciated. Thanks

[Tall_Allen]

That isn't doubling. All readings with "<" are the same, and undetectable. That symbol means "less than." Doubling time for PSA below 0.1 are not valid anyway.

No one can answer your question because we have no idea what your situation is, and there's nothing in your profile.

[MateoBeach]

Assuming those are actual measured ultrasensitive PSA values (and not all < less than). Then it appears you are progressing now despite the bicalutamide. What often happens (after some time where it has been effective) is that bicalutamide begins to stimulate the androgen receptor rather than blocking it. This can be confirmed by stopping it and rechecking PSA in a few weeks. If PSA goes down when bicalutamide is stopped that is called the bicalutamide withdrawal effect. It proves that it is no longer your friend. This happened to me after 4+ years of it working. It must never be used again is the most cautious view. And time to move on to a different regimen.

[London441]

As TA says, need more information. Especially if those readings are all actually preceded by “<“ or not.

[RCOG2000]

has some form of radiotherapy been considered fir that “inoperable” lesion? Might be worth looking into

[dac500]

PSA reading can vary and may have rather complicated relationship to progression of metastatic cancer. During ADT break when I was expecting a PSA around 1.5, it went up only to 1.1. But the surprise was new lymph node enlargement on CT scan. Perhaps imaging is a better way to watch for disease progression.