BIOCHEMICAL RECURRENCE -NOW WHAT?

[binati]

I was Gleason 5+4 with PSA of 253 in May 2019. PSMA Pet CT showed tumour in the prostrate, seminal vesicles and MRI showed one ECE. Started ADT in Jun 19 and continued for 30 months. Had RT (IMAT) in Oct to Dec 2019. PSA came down to 0.04 by Jun 2020. Then from Sep 2021 PSA started increasing slowly. I had one PSMA Pet CT in Aug 2022 at PSA of 0.7. Then PSA kept going up so in Dec 2022 had another PSMA Pet CT at PSA of 1.3. Both scans showed no nodes, metastases or lesion in the prostrate. It was all clear.

Hence, it is classified as a biochemical recurrence with a doubling time of around 3 to 4 months. MO is saying that there are two options in India - Enzalutamide and Darolutamide for castrate resistant non-metastatic PCa. His recommendation is to start Darolutamide owing to the higher chance of maintaining a decent QOL and delaying time to metastasis. My general health is good. I have no heart problems, no diabetes or any other morbidity. Recently I have also got an Orchidectomy done in preparation for starting Xtandi or Nubequa.

Is there any point waiting for PSA to hit >2.0 or one should start the medication immediately?

Are there any other options? Is there any chance of a cure at this stage?

[Tall_Allen]

With your rapid doubling time, I don't see any point in waiting for a higher PSA. There are likely many micrometastases, which can be controlled for a long time just with your hormonal therapy.

[GP24]

You could get salvage brachytherapy although you already had IMRT radiation.

[tango65]

Since you are currently on ADT and the PSA is increasing rapidly darolutamide may be a good choice of treatment which can provide years of progression free survival.

[binati]

There is no tumour in the prostrate for brachytherapy to kill off. Basically micro-metastases in the blood - hence biochemical recurrence and nothing shows on the PSMA Pet CT scan.

[Teacherdude72]

Start Nubeqa ASAP! Best results for me personally. I also do Lupron with it. Mono therapy Nubeqa not as effective I am told. My PSA since the third month of 20 so far is <0.02. I was diagnosed in late 2015 with G9, 4+5.

[binati in reply to Teacherdude72]

Yes on my last visit the MO said that no need to wait with the rapid doubling time I should start Nubequa next rweek. He wanted me to get my CBC, Liver and Kidney function tests to set a baseline as well as Echocardiography and DPTA or nuclear renal scan to check kidney capacity. I've got all these done and will be meeting him this week to get started. I have already had my Orchidectomy so no need for any Firmagon or Lupron. WIth almost 3 years of Firmagon it is unlikely that I would have had any resumption of Testosterone anyhow. Keeping my fingers crossed.

[Teacherdude72 in reply to binati]

Wishing you the best. Keep us, me, updated please. Other parts of the body can produce T I think ask your doc.

[binati in reply to Teacherdude72]

I have been taking Nubeqa for the past 10.5 months. I have had no side effect other than insomnia which was already there with ADT. Blood tests show slightly low platelets though this has stabilized for the past 8 months. Liver and Kidney function tests showed normal function.

PSA has ranged from 0.04 to 0.08 (last) and is tested every 3 months.

[binati]

Will keep the forum updated as there may be useful experience and learning for others.

[binati]

I have been on Nubeqa since Feb 23. It is now over a year. I am continuing regular blood tests (CBC and KFT and LFT) and also PSA once every 2 months. As far as side effects are concerned they are from the ADT I think. I have had Orchidectomy so the effects are from low testosterone. Nubeqa has not had any side effects that are obvious or distinct from those of ADT. I do sometimes feel that there is greater weakness at times. Not sure if that is Nubeqa as it comes only occasionally. My biggest worry is Osteoporosis. I have been exercising and taking oral Ibandronic Acid for bone regrowth. I worry about problems in the jaw resulting from necrosis and am flirting with using Estrogen patches for bone health.