Now I'm really confused

[GSDF]

I just came out of a meeting with Daniel Shervin of Northshore hospital in Glenview IL,my new MO....I was concerned in that my PSA that was at 480 a Nov 2021 . Started Firmagon which brought it down to a nadir of 6 and started rising reaching 25 in April 2022. Went on Orgovyx and Xtandi and PSA rapidly went to 4, then 30 days later 2.33 and a month later (now) PSA at 2.03....

Im concerned that the Firmagon failed after just 4 months and now I'm seeing xtandi seemingly stalling and I'm taking steps to plan out my next move.

Shevrin said I shouldn't be worried at all, that my .2.03 PSA down from 2.33 is good news and nothing to worry about saying that wit still having a prostate gland we are not looking for a PSA of zero or below but just a low PSA with no symptoms which is my situation....My layman's thought is with PSA seemingly stalling the Xtandi is failing as the Firmagon just did and that next month PSA will show increase.

I asked about starting docetaxel now and he was very adamant saying there's no need and it would be a mistake at this point.... All I've read on this board has advocated adding docetaxel to the mix... Any input would be welcome ...Thanks!

[tango65]

Adding docetaxel to enza has been done in clinical trials but there is not evidence of a clinical advantage yet and it is associated with significant side effects.

ncbi.nlm.nih.gov/pmc/articl...

ascopubs.org/doi/abs/10.120...

Your PSA is low and it seems stable. If you are concern consider to request a PSMA PET/CT to determine if there is radiographic progression of the cancer which is an indication to change treatment.

[Tall_Allen]

Sounds like a good MO. Docetaxel is a bad idea when there is no sign of activity - no benefit, but lots of side effects.

[GSDF]

Thank you 3, very much 🙂

[tango65 in reply to GSDF]

Best of luck!

[cesces]

Get an second opinion on Bipolar Androgen Therapy.

Mayby not for not for now, but to prepare for your next escalation.

[Brianne07]

Hi Mate i am in Sydney Australia.I have prostate cancer which got out into the blood stream into the lungs neck and a couple of other spots in the bones .I was diagnosed in January with the PSA at 370. I am 73. very good diet walk around the park a few days a week and no other pre existing medical problems.I had a few samples taken from the prostate and knew already what the results would be.Went onto to Firmagon (hormone treatment )then after a few months went onto Docetaxel (chemo) a total of six treatments .Been off the chemo 8 weeks feel 1000%..Saw the professor last Monday23/10 PSA now 0.08%.He says i have had a very good result.Next month will see him again. He mentioned unlikely to go down any further.If it rises then i am eligible for Zytiga which is heavily subsidised by the Government .There are plenty of experts here who have had it longer than you and i and will give pretty sound advise.But do not be afraid to ask question .I would always want to hear the answer from someone highly qualified and who is keeping up with the latest"trends" if you know what i mean.My "team" for the last 8 months consists of me and the professor. I have a first business even when i had chemo i still worked 2/3 days a week Then fell into bed each night and slept for 10 hours or more .I am lucky my wife is very good at massage and that has helped a lot Best wishes if you want to keep in touch drop a line here.

[meowlicious99 in reply to Brianne07]

congrats for awesome response to font line therapies. Hoping for durable remission.

[GSDF in reply to Brianne07]

Thank you Brianne... 🙂👍

[lcfcpolo]

I'm also on Xtandi. My PSA came down similar to yours but then continued to drop by much smaller amounts. Hopefully yours will keep going doing downwards.

[GSDF in reply to lcfcpolo]

Thank you lcfcpolo... Your history is encouraging! 🙂

[cigafred]

I do not understand why you have not done a scan and, if no evidence of metastases, had radiation or a prostatectomy? I have been with Dr. Shevrin for many years--in my opinion and that of many professionals he is one of the best.

[GSDF in reply to cigafred]

Hi Cig - I asked Shevrin about psma scan and he said ins (Medicare) would never cover as long as PSA stable. I asked for other scans or MRI he said it would give no additional information,as long as PSA is decreasing,even tho it just fell 1/4 of a point over past month... I'm nervous that the Orgovyx and Xtandi are slowing just as the Firmagon did after a few months and then PSA began rising aggressively... I'm just trying to be proactive for when/if Xtandi fails.... I was also told that with Firmagon failure after just 4 months, I would likely not get a very long run with Xtandi either,thus my concern and confusion.🙂

[cigafred in reply to GSDF]

Sorry, I do not have the knowledge to add much. A cure might be possible if the cancer is contained in the prostate, so without a scan it seems that possibility has been rejected.