Increase in PSA

[Juju0713]

Hi, my dad (age 62) was diagnosed with Stage 4 prostate cancer with multiple bone metastases in October 2022. He is also BRCA positive. He received 6 doses of docetaxel which he completed on 1/30/2023 and has also been taking apalutamide daily and eligard injections every 3 months. He just received his latest eligard injection 1 month late for when it was due (4 months vs 3 months) due to insurance issues. His PSA on 4/10/2023 was 2.9 and on 6/12/2023 was 4.3 so obviously an increase. Is this reason for concern or could it be due to the late eligard injection which he received also on 6/12? Just looking for some insight here and/or wondering what next steps might be whether it's rechecking PSA or if I am missing anything......Thank you.

[tango65]

Consider discussing with the doctors to treat him with ADT, plus abiraterone and olaparib, based in the Propel trial results.

ascopubs.org/doi/abs/10.120...

[Juju0713 in reply to tango65]

thank you so much, I have read about the PARP inhibitors for BRCA mutation, I just wasn’t sure at what point they decided to add this on

[meowlicious99 in reply to Juju0713]

i believe olaprib is never added early to treatment because of high toxicities and PC patients often live a long time and its impractical to be on PARP for that long.

That said, like all therapies, PARP are also being experimented with early administration. Depends mostly on clinician's judgement.

[Wa40]

Hi Juju,

I am sorry for his Cancer, I would like to share my experience as somebody who I knows was facing the same situation .

LU-177 PSMA therapy, also known as Lutetium-177 PSMA therapy, is a targeted radioligand therapy used in the treatment of prostate cancer. It offers several benefits for patients, including:Targeted treatment: LU-177 PSMA therapy specifically targets prostate-specific membrane antigen (PSMA), a protein that is highly expressed on prostate cancer cells. This targeted approach allows for more precise and effective treatment of prostate cancer, while minimizing damage to healthy tissues.Extended survival: LU-177 PSMA therapy has shown promising results in extending the overall survival of patients with metastatic castration-resistant prostate cancer (mCRPC). It can help control the growth and spread of cancer cells and growing PSA value rapidly, potentially improving long-term outcomes.

I would definitely recommend this treatment for your Father, please try to get some information from his oncologist.

My friend got this treatment in Germany which was unfortunately cheaper then in states and quicker because it was very difficult for him to get this treatment in states as many people are waiting for this treatment already since months and mostly are undergoing to Clinical trials.

If you will need any help or if you will have some question regarding treatment you can write me any time.

Best Regards,

W.Daniel

[Juju0713]

thank you. So does this mean he is already castrate resistant after only a few months?

[CAMPSOUPS in reply to Juju0713]

Maybe. If he can have another PSA in 2 to 3 weeks it will be more of an indicator of a trend or not. After my chemo 3 1/2 years ago it took awhile for my PSA to settle down. It reached a low of 5 or so then climbed to 8-9 where it stayed for a year.

Tango65's response is a good one. Olaparib is chosen for those with the BRCA+.

[meowlicious99 in reply to Juju0713]

It possible but minor bumps happen for no reason also. One bump doesnt indicate CR.

[Ahk1]

I have heard that when giving chemo. The dying cancer cells sheds psa in the bloodstream so, may be the increase in psa due to that? Not sure but just a thought.

[robert570]

I went up and then went back down. Everyone's different. I was told they look at the average score versus a single reading. You should have a better reading at the next one. If it still goes up but not as much as the last one, then he might be heading in the right direction.

[Vasili]

Yes, it could be due to the late eligard injection

[ishitasen]

Since your father psa levels are rising, most likely your father has devolop resistant to the inj. Eligard and Apalutamide and if there is further rise in psa levels your father might need to switch the treatment. Please discuss with your oncologist. There are multiple options available to you for further treatment, one of them is Pluvicto / Lu-177 PSMA therapy