PSA rate of decline in ADT with ductal type cancer?

[Gl448]

Before commenting/answering, please consider my biopsy showed DUCTAL type cancer. I am Stage 4B with GL4+4=8 throughout the prostate, including the vesicles, neuroblood bundle, bladder neck, bladder, with Mets in pelvis, sacrum, pelvic lymph nodes, and several places in spine.

Does this PSA series of results look normal/okay? I feel like it should be dropping quicker.

PSA Date

0.50 02/11/2020

0.40 08/19/2020

1.17 11/10/2021

9.70 07/28/2022 (foley catheter in place 2 wks)———-biopsy 08/04/2022, Eligard 08/18

3.95 09/06/2022 (19 days after ELIGARD)

3.80 09/23/2022

2.02 10/17/2022

1.92 11/07/2022

From posts here including citations of some research, I understand that ductal cancer does not elevate PSA much at all, and also that it doesn’t respond as well to ADT.

I’m nervous my that my care team is in no hurry to get me into a second line hormone blocker and ultimately triple therapy because the PSA has dropped. They’ve done nothing since Eligard and a PET in September while we continue to wait for bone marrow biopsy that’s been delayed after a six week wait already.

From my point of view, I had cancer that spread extensively throughout the prostate area and went metastatic hiding behind low PSAs under 1.2 for a long time and it’s probably continuing to spread despite the ADT. (I think the 9.7 PSA is a fluke. I had a TURP in March that removed a thumb-sized amount of prostate material, blood and clots for 3-4 months after that, a painful cystoscopy for urine retention which saw cancer growing into the bladder, and a Foley catheter inserted after multiple painful and bloody attempts by both myself and the nurse to use a coudé catheter failed. Seems like a lot of trauma to the prostate that could elevate PSA.)

Am I just being overly paranoid?

[Gl448]

I guess a related question is, could a Gleason 8 ductal type cancer go from nothing to stage four metastatic as described above in less than eight months? Can it be that aggressive and fast growing?

[Boywonder56 in reply to Gl448]

Yes

[Boywonder56 in reply to Boywonder56]

When not treated aggresivly ..its an sggressive cancer...

[tango65]

I would request to start with docetaxel and abiraterone or darolutamide ASAP, since for your description it seems you have a large volume ductal metastatic PC.

[Gl448 in reply to tango65]

That’s the plan. I was just looking for some talking points/data to bring up with the MO to get her to start the process without waiting for a bone marrow biopsy, which seems to be an impossible to accomplish procedure here. Thanks.

[tango65 in reply to Gl448]

I believe you should discuss adding abi or daro and docetaxel to Eligard ASAP, since you have been on Eligard for 4 months already.

[Tall_Allen]

There is a lot of misinformation posted by well-meaning denizens to this site.

While it is true that localized ductal PCa does not present with high PSA, after it has metastasized PSA can climb rapidly. I think you should discuss triplet therapy ASAP (not "eventually"). Eligard is certainly inadequate.

[Gl448 in reply to Tall_Allen]

Oncologist is open to triple therapy, after I pointed her to the appropriate study, as you suggested before, but for some reason insists on bone biopsy first. I was willing to wait on that for a while, until they canceled my ct guided biopsy because the machine is broke. It’s like a bad joke.

Might be time to change docs.

[anony2020 in reply to Gl448]

Why can they give you triple and wait for bone biopsy? Just wondering as layman. 🙂

[Gl448 in reply to anony2020]

No idea. I’m discussing with MO on Friday.

[anony2020 in reply to Gl448]

Good luck.

[Boywonder56]

You should be on erleada or the like i have same ductal type...been <.1 for 5 yrs

[DMohr011]

Have you had any genetic testing done? My ductal cancer came from inherited Lynch syndrome, my msh2 and epcam genes are not fully there. Made me elligable for Keytruda and today, no cancer is found.

Aggressive it was. Had a physical exam fall of 2019. No DRE from the doctor, they only look at psa. Well psa was 1.2 then, and a year later at DX it was the same.

[Serpico13 in reply to DMohr011]

My PSA never went above 4.2 until it dropped to 3.9 and my FP doc was wise enough to always do a DRE sent me to a Urologist. Turned out to be meta intraductal with quarter size spot on pelvic bone. Don’t rely on PSA alone! That was all from Nov. 2021. Saw Kwon at Mayo in April 2022 and had prostate taken out in May. Now on Lupron and Xtandi. Had radiation 3X on pelvic spot in June after healing from surgery. Now it’s a waiting game to see what happens, months, years? So grateful that God has given my wife and me great peace through all of this!

[Gl448]

Genetic testing is on my list of things to discuss with MO.

[Gl448]

Good info. Thanks