PSA rising (but relatively low). Is PSMA scan advised at this point? Or is it too early to be helpful?

[Jabbs4]

Need advice. My husband was diagnosed with Metastastatic Prostrate cancer (de novo) in September, 2021. Treatment: Lupron and Erleada. I had researched and saw that triplet therapy was the way to go. BUT decided against Docetaxal as he had a tube put in each kidney and still recovering (stage IV chronic kidney disease - later downgraded to IIIb). Felt he was too weak to tolerate. (Plus he was very against it.)

Fast forward: has been tolerating Lupron & Erleada very well, all things considered. Weight gain most concerning as he is already on 4 different medications to manage his blood pressure.

January visit found PSA rising and March it rose again. But the rule I thought I recalled/held in my head from what I’ve read is to wait for PSA to reach 1 before doing another scan. (We paid out of pocket fir PSMA scan up front. I wanted best data possible to help determine treatment.). From everything I’ve read the question to ask the Dr was: what will you do differently.? The Dr had several answers. ….which I’ve included in his profile.

I like that he’s being proactive, but I worry that he’s maybe jumping the gun to go for a scan now. …as his PSA is still “relatively” low. But then I think I read PSA alone isn’t best indicator if cancer is actively advancing. Honestly, I can’t keep everything I’ve read in my head and so much going on now (mother died and Im executor so lots going on with that…plus helping care for 91 year old mother-in-law still living at home) I am trying to read up and it seems like I just can’t absorb and apply.

Need advice: is a scan advised at this point? This is a new MO for us and I don’t have a read on how well he keeps up in the field. (Btw, no Gleason or staging as he was diagnosed from biopsy of lymph node in his neck. Also found mets in bones.)

Sorry this is so long. Thanks for listening. Advance appreciation for your insights.

[Tall_Allen]

For someone who has far too much to deal with, I'm impressed by how well you are dealing with everything.

It seems that Erleada is still working well, even if not perfectly, so there is little reason I can see to get a scan or change medications. PSA is a good indicator- if it gets to 2.0 or the doubling time is < 6 months, you can decide to move onto the next medication then. For now, you get a well-deserved break.

[Jabbs4 in reply to Tall_Allen]

Thank you. I had totally forgotten about the doubling time. My husband’s PSA was 0.12 last October, then 0.14 in January and then .23 in March. So not quite double in 3 months, but he’s scheduled another PSA test end of this month.

[Tall_Allen in reply to Jabbs4]

It can be erratic, so best to get a few readings.

[Jabbs4 in reply to Tall_Allen]

Thank yo! . That’s what I was wondering about. Reading up on things that can affect PSA next on the agenda.

[Hidden]

welcome Jabbs4! I had the k tubes for a yr . I wish him well . I know how that is . 🙏🏼❤️

[Jabbs4 in reply to Hidden]

Those tubes were taking the joy out of his life. Thankfully,, he did get them removed.

[Hidden in reply to Jabbs4]

Hallelujah, and thank God for that .. 😎✌️

[tango65]

Treatmentd are changed if there is evidence of radiographic progression of the cancer. Consider to do the PSMA PET/CT when the PSA is around 0.5 to 1.

[Jabbs4 in reply to tango65]

Thank you. That helps explain why he wants the scan. My husband’s PSA was 0.12 in October, then 0.14 in January and then .23 in March. So not quite double in 3 months, but he’s scheduled another PSA test end of this month. .

Appreciate your time in responding. I just wanted to make sure the scan was indicated by data.

[tango65 in reply to Jabbs4]

His PSADT is fast, consider to request measuring PSA every month and if it gets to 0.5 or higher then consider to make an appointment for the PSMA PET/CT.

[Jabbs4 in reply to tango65]

Thank you. I had completely forgotten about that doubling time. Now I see what the MO is reacting to. And it seems you agree that he might be requesting the PSMA too soon. That was my concern. Not sure how often they can do that test. My concern is then twofold: 1)how hard it is on my husband; I hear radioactive tracer and it sets off an alarm in me. Podcast I listened to seemed to minimize it. 2) will it get covered by insurance … if it gets requested too often. So when he really needs it, can he get it?

Again, thank you for your advice and time. Very helpful.

[tango65 in reply to Jabbs4]

The test is not hard. The dose of radiation is low and the tracer is eliminated rapidly. Basically is not different than doing a whole body CT.

[Jabbs4 in reply to tango65]

Another worry put to bed. Thank-you.

[tango65 in reply to Jabbs4]

Wish you the best of luck.

[Benkaymel]

How would the treatment change by having another PSMA-PET scan at this stage for your husband is a good question - especially if you have to pay for it directly. I had one with my PSA at 0.2 and still dropping which was interesting but didn't change my treatment however I'm under the UK NHS so no direct cost to me. It did show that my extensive bone mets were very PSMA avid so perhaps Pluvicto would be a next step when the Xtandi fails. However, depending how long that will be, I'll probably need another scan at that time to check anyway.

[Jabbs4 in reply to Benkaymel]

When I asked about how treatment might change, he said:

Consider germline genetic testing: 

Would be a candidate for HRD testing on tumor: Will plan to check upon disease progression -

Also had ideas about next treatments. I need to check my notes again. I need to do more research….

Best wishes on your journey