PSA hovering around 1 even after a year on ADT + Enza, should we insist on Triplet Therapy ?

[dudubaya]

Hi All,

My Father was diagnosed with Advanced PCa with extensive bone mets but no visceral spread last November. His PSA at dx was 325 and Gleason was 4+5 with all cores positive.

His treatment started off with 10 sessions of Palliative RT followed by combination of Degarelix + Enzaluatmide + Denosumab repeating every 28 days. He has been on this regimen till date

His condition has visibly improved over the year but PSA hasn't dropped to undetectable levels as we had hoped initially. His PSA readings since treatment have been :-

12/21 - 4.1

3/22 - 2.29

5/22- 0.99

7/22 - 1.17

8/22 - 1.03

10/22 - 0.94

Apparently his PSA Nadir seems to be settling around 1 . I have gone through a lot of articles that suggest that lower PSA Nadir (preferably undetectable) has better prognostic value. Was wondering if adding Docetaxel to the regimen is desirable here ?

Our Oncologist says that while he would have liked the PSA to drop to undetectable levels he is not overly worried about the PSA trend , he wants to reserve chemo for future use when PSA starts rising with a clear trend, till such time he wants to continue with the existing combination

Is this ok or should we insist on adding Docetaxel as recent articles seem to suggest that Triplet Therapy offers better OS benifits ?

Thanks & Regards

[Tall_Allen]

It is too late or too early to add chemo. It is only beneficial when there are signs of active growth. He seems to be stable, which is good.

[dudubaya in reply to Tall_Allen]

Thanks for the quick response Allen, its very re-assuring coming from you. Just another question for you here since you have seen a lot on this forum- any reason why his PSA might not be coming down further? He was diagnosed with BPH few years beforebeing diagnosed for PCa , could that be a contributor here?

[Tall_Allen in reply to dudubaya]

Some of his cancer cells are ADT-resistant, most are sensitive.

[MateoBeach]

Stable and doing well so let him cruise. If and when it starts progressing significantly, consider Ra223 Xofigo as option to chemo.

[dudubaya in reply to MateoBeach]

Thanks for the insight MateoBeach . Need to check with our Oncologist if that particular mode of treatment (Ra223) is available here in India

[Oldie68]

I don't see a trend in the PSA readings. If anything, it seems to be slowly dropping, although not significantly. I am not an oncologist but chemo might indeed be better later, when there is a clear trend. Tell your father to stop worrying and enjoy life and whatever he likes doing every single day.

[dudubaya]

Thanks for responding.. He is taking it pretty well, it's me who is doing the "worrying', so thanks again for the reassurance

[Seasid in reply to dudubaya]

We can't beat the cancer but should navigate the way to cause less side effects with the treatment and still not shortening our life. It is not always easy to predict the best outcome. That is why we need good oncologists to help us with their experience.