Next Step?

[jfoesq]

I have been treated for more than 10 years (except for 3 vacations during the first 5 years) and for the most part have been on Lupron and Zytiga. Starting 2 years ago my PSA starting rising from below .05 (MSKCC doesn't measure anything lower than that) up to about .32 over the course of a year. At that time, I though the next step would be chemo. But- after reviewing scans, my MO thought the reason for the rising PSA might be due exclusively to the largest tumor, which is in my left hip (acetabulum). So- we radiated that tumor and my PSA dropped to <.05 again shortly thereafter in June 2022. It's now about 9 months later and my most recent PSA is now .05 (NO LONGER LESS THAN ).

I will have my PSA tested again next month. My question is- assuming my April PSA is higher than .05, I imagine I will get scanned again. If the scans suggest that the smaller tumor in my right hip is the culprit (which might be the case as I am feeling pain there for the very first time, I am guessing my MO will want to radiate it. But- if that's not the case, or, even if radiated and my PSA continues to rise, what are my options? Chemo? Anything else?

Also- I now every case is unique and I have responded very well to hormone therapy, what are the average life expectancies and common SE's of Chemo and other therapies that might be available to me?

Thanks to everyone!

[Tall_Allen]

Get it radiated, for the pain if no other reason. But your PSA and met profile is still too low to give up on Zytiga+ADT. If you get more mets and your PSA increases rapidly, the new data from the PRESIDE trial shows the effectiveness of the triplet - enzalutamide +docetaxel + ADT in men who are castration resistant:

prostatecancer.news/2022/10...

Another option will be to go with Xofigo in some combination.

prostatecancer.news/2021/02...

[StayingOptimistic]

i keep thinking about the same things. I am in very similar situation and been treated at MSK with a very prominent MO. he said , we will wait until psa goes to .2 and then do a psma scan. Hard to wait though without being worried all the time and not knowing what lies ahead.

[j-o-h-n in reply to StayingOptimistic]

Who's your M.O. at MSK?

(Beware the ides of March).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/15/ 2023 10:47 PM DST

[StayingOptimistic in reply to j-o-h-n]

the same as you

[j-o-h-n in reply to StayingOptimistic]

Lucky us.........

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/16/ 2023 1:38 PM DST

[StayingOptimistic in reply to j-o-h-n]

yes, we are

[NecessarilySo]

You ask for options. There is a surgical option but I guess that it less desirable than RT. I found this about surgery to the hip joint for metastases:

josr-online.biomedcentral.c...

Imo, you shouldn't worry about "if's" and you should just wait for things to develop, then act. "If's" can worry you too much.

Interestingly I have some pain in my acetabulums but only when walking, so I assume it is just joint pain. I'm 11 years from DX Stage 4. My PSA has been <.1 for past two years, testing quarterly. I take Lupron injections (only) and Prolia, quarterly. Recently my osteoporosis lessened to ostopenia, probably due to Prolia and 5k vit D3 daily.

Acetabulums might be hard to treat with heat but you might try it with hot water showers. I've rid myself of several mets, (lymph nodes, skull lesions, spine,) simply by aiming 110 degree F shower at the area for 30 seconds at a time. Do that several times, it might be worth a try. Also you might try intense lycopene diet, at least that is a possible alternative imo.

[j-o-h-n]

Who's your M.O. at MSK?

(Beware the ides of March).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/15/ 2023 10:46 PM DST

[j-o-h-n]

P.S. Dr. M. Morris at MSK just took me off Casodex, and put me on Nubeqa (started 04/09 - last week now 7 days).

(Beware the ides of March).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/15/ 2023 10:53 PM DST