My father has been on ADT since two years (Zytiga and Lupron). His PSA fell from 500 at diagnosis to 0.41 last September. Since then it has slowly been creeping up. In 5 months it has risen to 0.74. I have got his PSA tested every month so this is not a random jump but a slow increase. All values in ng/ml.
So I think it will double from lowest value next month indicating a doubling time of 6 months. Our doctor doesn't want to do anything unless PSA increases to 3-4. What do you people think? Should we wait and watch to see if PSA stablises or goes down again, giving Zytiga more time, or should I consult a different doctor and explore changing prednisolone to dexamethasone or alternatively Xtandi.
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Rodeoz15
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Well 11 years ago my urologist thought maybe I should do that but when I looked at the cost back then it was $80,000 compared to what I read that the Life gain was I didn't think it was worth it. Still what I see is only a matter of months gained but I also saw where they talked about four to seven years on another site. Well at 81 years old and good health except for this cancer and the side effects of extendi then maybe I'm foolish for not doing it. I suppose I'm asking for your thoughts on this life extension.
ALL medicines given to men who are metastatic and castration-resistant and usually have already used most other medicines provide "only a matter of months gained." For example:
docetaxel +2.4 months
Pluvicto +4.0 months
Xofigo +3.6 months
Jevtana (after docetaxel) +2.6 months
abiraterone (after chemo) +3.9 months
abiraterone (before chemo) +5.2 months
enzalutamide (after chemo) +4.8 months
enzalutamide (before chemo) +4.0 months
olaparib among BRCA+,ATM+ +3.4 months
Provenge +4.1 months.
These are median survival increases; half do better, some, a lot better. Some are so far gone by the time they use the drugs, that there is little opportunity to increase survival. The real opportunity is in using them earlier, and in combinations.
Thank you very much this is what I had thought so I don't plan to do anything since a few months aren't that important at my age. Thank you very much for the reply and for affirming what I had thought.🙂
I don't claim any special knowledge of the aforementioned options but I have been where your father is now--4 1/2 years of Zytiga success and then having to choose my next steps. My general approach to prostate cancer has been to squeeze all the success out of each treatment used. We'll never be cancer-free but we can "stall out" the march to the inevitable. Hence, in your father's shoes, I would be hesitant to give up Zytiga so quickly. The research that I read indicated that switching from Zytiga to X-Tandi (once it's necessary) has a 1 in 6 chance of succeeding so I made that switch and, after 3 months, realized that I was not one of the lucky ones (but I feel it was worth a try). Once my PSA hit 16.5 and a PET scan found 7 cancer lesions in my mid-riff area I switched to the SOC--Taxotere chemotherapy. Seven treatments of chemo has worked well for me. My PSA is now below 5; my tumors have shrunk; and the side effects have not taken me out of my usual activities. Every body is different but I thought my little case study might be of some use to you. Best of luck to you and your father.
Meowlicious99--I couldn't find the study that promised just 1 of 6 chances when switching from Zytiga to X-Tandi but I did find this Canadian study that found a 36% chance of success. Switching from X-Tandi to Zytiga is not so promising. I hope this helps.
Absolutely not! We waited until mine got over 4, then over the next few months it jumped to 10 because it had spread to near by lymph nodes. Long story, shorten even though I’ve had a radial prostatectomy it now has spread to my bones. I’m screwed but you have time to take the appropriate precautions. I would definitely get a second opinion.
I'm 79 and was diagnosed stage IV prostate cancer in 2011 (robotic prostatectomy) . My first oncologist said wait until PSA doubling time reached 3 months. It took 5 years (2016) to reach that point and then started Lupron, then Zitiga and Xtandi which did not work. PSA rose to 180. Then started Doxetaxel in 2018 for 7 cycles and that worked until last year when PSA hit .1 but rose again to 3.5 and had 4 more cycles of doxetaxel which worked a little and the PSA lowered to .1. Since then PSA rose again to 1.3, but PSMA PET scan last year (2022) showed the prostate cancer spread to my rectum ( rare occurrence). Now completed first Pluvicto treatment (February 2023). Will see what happens on next scan. PSA value does not always correspond to the spreading of the always mutating cancer.
Rodeoz15. Not sure you have read all the responses here yet?
So, this rising PSA is likely real, and telling you to take action. It is unlikely to reverse on its own. Pylarify, the PSMA PET scan will probably show where there is SUV MAX uptake. This is sensitive but relies only where there is PSMA. Some PCa does not give off PSMA, but Pylarify is now SOC in U.S..
2nd. A recent meeting, for me, at Duke Univ Oncology stressed, that when PSA rises, get Provenge. Dont hesitate. Most insurance will pay as it is expensive. The Duke Oncologist told me has many patients who received Provenge early (PSA rising, but under 3.0), who are doing well at 5 years+.
If, the PSMA PET shows mets, learn how many. If they are few in numbers, investigate SABR/SBRT to zap them. I had SABR of Prostate, and T5 in January 2022, painless, and 5 days + 3 days of 20 min treatments. Waited 3 mos., then had PSA. It has come down every 3 mos since. Now, 15 months later, hit my all time low, last Thursday of .008 ! Confirmation it was effective. I am playing Pickleball 5x per week for 2-4 hrs each session. I feel I am blessed. Awaiting the next hurdle, but researched and ready. This is a Marathon. We maybe cannot win the War…..YET ! But we can win many battles along the way, and maintain a high quality of LIFE. Out best to you and yours, Mike
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