See profile, but in brief. Diagnosed Nov 2021. Psa 600 mets to ribs chest pelvis and lymph nodes. On monthly Firmagon. Had 6 docetaxel and 3 Cabazitaxel on diagnosis. Psa dropped to lowest of 1.42 mid chemo. ALP 70. After 9 chemo’s psa 150, alp 171.
After 1 month on Ztandi psa 115, alp 223.
We are in hospital waiting for an operation on his spine, no spinal cord compression as yet, but drs want to make sure it doesn’t happen. He is going to have radiotherapy on a problem painful metnear his spine in 2 weeks. We both hoped that the psa would drop by more than 23% in a month.
With such a small drop in the psa and an increase in the alp does it mean that the Ztandi is not working?
It is probably working. If he did not have a biopsy of the cancer, discuss doing a liquid biopsy. With his PSA and bone mets most probable they will obtain enough material to do genetic, histological and IHC studies.
It is possible the cancer has mutations which could indicate treatment with olaparib, rucaparib, keytruda or chemo with platinum compounds. It could also help to search for clinical trials.
Discuss having Provenge, a vaccine which has shown in RCT to offer a survival advantage.
Just started Docetaxel treatments myself for the next few months with 6 session, 3 weeks apart. My PSA got up to 227 before they dropped the Zytiga and moved on to chemo. Nothing else seems to be working so I guess I'll consider myself lucky if the Docetaxel does.
There is something called ALP "bounce" where, after starting a new med, PSA goes down but ALP goes up. This does not mean the med is not working... the higher ALP is temporary, from changes in the bone mets, and if the med is working future readings of ALP should show a decline along with PSA. Give it more time.
My husband's ALP never goes up along with PSA. It rises at a different rate and time. Keep measuring LDH too. That has shown correlation with PSA rises for my husband.
Hi Ginny My PSA is stable at 62 and ALP around 210. The latest scans however show no cancer progression. I think the probable conclusion is the these are tumour markers and only the scans can indicate the real position. Firmagon continues to be my most succesful drug at relieving pain. Best wishes to your husband.
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SIGNIFICANT METS PROGRESSION DESPITE LOW PSA, LOW ALP, LOW CALCIUM WITH LUPRON/ZYTIGA TREATMENT
Rising ALP and declining PSA
PSA Fluctuation and Zytiga
Falling ALP
Rising PSA on docataxel 
