PSA rising to 0.4 after 2.5 years Zytiga

[dasyluo]

I have been taking Zytiga and Lipton since May 2020, today blood test shows 0.4 PSA for first time since then, have not talked to Doctor yet, can I please get some advices here.

[EdBacon]

I wouldn't be concerned unless/until the PSA rises above 2. I've known and heard of people who've had PSAs hover around 1-2 for years on Xtandi or Zytiga.

It's unlikely your doctor would suggest changing treatments before that point anyway, but of course it's best to discuss with him/her.

[dasyluo in reply to EdBacon]

hi EdBacon, I Elio have CT scan next week, I will wait for the scan results to discuss with my doctor

[EdBacon in reply to dasyluo]

I didn't know you had small cell when I wrote my response. Obviously you know that PSA is of no use with small cell. Do you have any tumor markers established such Chromogranin or NSE? You're probably also aware that androgen-based treatments don't work for the small cell component of your PCa, but platinum-based chemotherapy does work.

When Zytiga becomes ineffective, it usually makes more sense to go to chemotherapy anyway, rather than switching to another similar drug like Xtandi.

This is based on my knowledge and since I'm not a doctor, you can run this by your doctor.

What chemotherapy did they put you on?

[Tall_Allen]

If you have a combination of small cell PCa and normal PCa, only the normal PCa is affected by the Zytiga. Have you tried docetaxel+carboplatin?

[dasyluo in reply to Tall_Allen]

I did chemo for small cell, but not for normal PCa

[Tall_Allen in reply to dasyluo]

If your chemo did not include docetaxel, you can do it when your PSA reaches 2.0 or increases rapidly.

[dasyluo in reply to Tall_Allen]

I did chemo in 2020 for small cell, I did not have docetaxel + carboplatin yet

[dasyluo in reply to Tall_Allen]

Except chemo, what would be my next line of treatment

[Tall_Allen in reply to dasyluo]

A clinical trial.

[dasyluo in reply to Tall_Allen]

would switching to Xtandi work?

[Tall_Allen in reply to dasyluo]

No.

Docetaxel +carboplatin or a clinical trial only.

[Muffin2019 in reply to dasyluo]

I tried that and did not work at all, PSA rise to almost 50, lesions on the liver and mass in my bladder so into the next treatment which is slowly dropping the PSA, now last blood work is at 26.4.

[Shams_Vjean]

Agree with EdBacon regarding likely response from your MO. An upward trend above 2.0 over several months would probably be more likely to bring forward a new strategy.

Have also heard that some had good results extending the effectiveness of Zytiga by switching from daily Prednisone to Dexamethazone, but not sure if there’s any data suggesting when would be the best time to make that switch.

Hopefully this was within the laboratory’s margin of error or an acute rather than chronic change for you! Best of luck!

[dasyluo in reply to Shams_Vjean]

Thanks, let’s wait for PSA rising to 2

[RMontana]

Dasylou, dont wait a moment further; get a PSMA PET...then if it finds a spec, a dot or an area of growth treat it now...dont wait any longer...see attached...TNX

healthunlocked.com/active-s...

[ctflatlander]

I've been on Zytiga for 5 yrs and had orchy 1 1/2 yrs ago. PSA is .5 and in a holding pattern.

[dasyluo in reply to ctflatlander]

Hi, thanks for the reply,

I saw you switched prednisone to Dexamethasone with Zytiga, does it make any difference?

[ctflatlander in reply to dasyluo]

My PSA started to rise slowly from undetectable to .3 PSA in April 2020 when I switched. It slowly ramped up to 1.1 one year later. I then had Orchiectomy April 2021 and then slowly declined to .5 now. My MO can't explain why. No changes in diet or medication. Will stay on this path until it rises and consider chemo. I had a tough time convincing. MO to make Dexa change. Bob

[slpdvmmd]

I was faced with a similar situation twice. In the first instance I was changed to from zytiga with prednisone to zytiga with dexamethasone. This resulted in restoration of low psa values for about a year. When it started to rise again I paid for a PSMA/PET at the first place it was available outside of protocol at in the US (in Florida). The study was positive for oligometastatic disease. My personal approach was then to go overseas and get LU177 and AC225 followed by external beam radiation. Good response to this approach with two negative C-11 Choline PET scans since. I guess my view is you can start out looking for a worst case scenario i.e. neuroendocrince or other essentially unresponsive mutations or start out at least looking for something you can try to do something about. I would add that I regrettably agreed to the old standard of CT with contrast and bone scan when the decision was made to image. These now and then archaic studies showed nothing and merely exposed me to unnecessary radiation (as if I haven't had enough) and more importantly contrast Realize you may have to leave the USA to get what you want in terms of aggressive therapy. My PSA when my PSMA scan was positive with high suv at oligometastatic sites was 0.75. I view my situation as a ticking time bomb but also feel you should try to delay the explosion as long as possible just as long as quality of life remains good by my definition. I wish you the best in your decision making process.

[dasyluo]

Hi thanks for telling your story.

It looks to me after reading thru your story that PSMA is right and more accurate way to find any progress of disease in the body. And get new treatment according.

My plan is to have doctor switch Zytiga/Prednisone to Zytiga/Dexamethasone, and see it works or not.

[lowT163]

I had one 2 months ago that went from .04 to .12 after 2.5 years of .04. Thought here we go. One month later .04. My guess not every test gets done right. Doing it again in a month just to be sure. Hope yours does the same.

[dasyluo in reply to lowT163]

thanks for the advice, yes, I will try another test before making any decisions.