PSA stabilizing to 99.30 (from 3103), should we seek additional treatment or wait?

[Sissel25]

Hello everyone and thank you for this wonderful community for giving me so many resources.

My dad was initially diagnosed at a very high PSA of 3103 and he is doing triplet therapy, he is about to take his fifth docetaxel chemo dose and it seems to have stabilized to 99.30. He has bone metastases since diagnosis (+ one that gives him pain to his right hip)

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PSA Nov.11/22: 3103

Given Firmagon on Dec.2/22 (240mg)

PSA Dec.28/22: 500

PSA Jan.24/23 : 600

Given Zytiga to take the same day after blood test

PSA Feb.02: 356

Started Docetaxel on Feb.02

Before second dose: PSA Feb.27: 121

Before third dose: PSA Mar.20: 99.30

Before fourth dose: PSA Apr.11: 99.70

We are at the third dose of chemo

Before fifth dose: PSA May.2: 99.30

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He is going for six doses as is SOC. I was scared that it was increasing as per my last thread but my oncologist told us to keep the chemo going for now and watch out for any changes, and for now it seems to have stabilized. He has a triplet therapy of Degarelix, Zytiga and Docetaxel, but he can't stand the pain of monthly degarelix injections so he's gonna switch to Tritptorelin every 3 months.

I read that <1 PSA is the optimal point to reach, but also I know I can't ask for the sky when the initial PSA was so high. I know a fall of 97% is great news, but I wonder what this community thinks about it.

Should we seek additional treatment, if available, to make it go even lower, or should we just take a wait and see approach until it starts increasing again? Thank you.

[Magnus1964]

You have to look at the big picture. He has stabilized. Quality of life is important, if a treatment is causing intolerable side effects, then switch. Keep a close watch on his PSA.

[Tall_Allen]

That's a great response so far! Don't stop now. He only gets one chance to get the "triplet effect."

[Nusch]

I started with PSA 2.222 and I’m undetectable now - over five years later. I definitely would continue with triplet therapy as long as possible. I also suffered a lot after chemo 4+5, but I survived and it was worth the effort. Fingers crossed!

[RyderLake2]

Hello,

I too had a very high PSA when I was diagnosed ten years ago. It was not quite as high as your Dad (1700) but certainly up there. My PSA plummeted as soon as I started ADT therapy. In my case, I started with Casodex (bi-calutamide) followed by Zoladex (goserelin). I found out I had PCa on May 30th, 2013. By July 10th it had dropped to 59 and a month later (August 19th) to 0.62. I agree with others that you should give triplet therapy (Chemo, Zytiga and Firmagon or degarelix) a chance to work but 99 is still quite high. If you live in France you are in a good spot. Lutetium has been used in Germany and much of Europe for many years. Far longer than in North America where it was only approved last year. Lutetium is a radioactive therapy that latches onto a protein called PSMA that is found at high levels on the surface of prostate cancer cells. This protein, PSMA, is present in both bone and soft tissue prostate cancer mets in around 80 to 90 percent of men. A PSMA PET scan will tell you whether or not your Dad's cancer expresses PSMA. Another option to pursue is Xofigo (radium-223). Xofigo mimics calcium, and calcium goes to the bones. So Xofigo delivers a radiation punch or treatment to the mets in your Dad's bones. It does not require PSMA but it also does not work with soft tissue mets. I would check out both suggestions. Good luck!

[Hidden]

In my opinion, don’t stop. BTW I had nine infusions of Taxotere alternated in nine infusions of Adrimyacin over a six month period in a clinical trial with Lupron/Elligard additionally with the infusions I have paired with Ketoconazole and Erustamine plus 30 mg of Prednisone daily.

Not todays triplet, but the kitchen sink in 2004. As long as the body is strong, kill the little bastards. What does his MO say?

Best wishes.

GD

[lcfcpolo]

This is a tricky one. Great response so far but as you say, ideally PSA will drop lower. Hopefully the June and July blood tests show the PSA going lower and lower.

I would be asking the Oncologist if switching from Zytiga to Enzalutamide (Xtandi) or Darolutamide (Nubeqa) might help if the PSA does not drop.

Good luck.

[J_Monacello]

Sissel, I took degarelix shots to my abdomen for 15 months and like you, I had painful, swollen injection site reactions which got worse as time went on. You should definitely talk to your oncologist about switching to Orgovyx (relugolix) which is very similar to degarelix but it's an oral medication. Or you could also switch to Lupron or Eligard or Triptorelin, but Orgovyx is most like degarelix (it's an LHRH antagonist).