PSA doubled 3 months after chemo - normal or a concern?

[Gl448]

I don’t see Dr Dorff until next week, but had labs drawn today. I’m prepping any questions I might have for the appointment.

My PSA has more than doubled in 3 months from 0.014 to 0.039. Testosterone at time of both tests was <7.

At these low levels, is that doubling in 3 months a concern?

I’m currently on Lupron and NUBEQA, and completed 6 rounds of taxotere at the end of April (Triplet Therapy).

PSA cut in half every three weeks while on the chemo going from 0.944 in January to 0.013 in April.

Last chemo date 04/25 = 0.013

05/18 follow up = 0.014

08/30 follow up= 0.039

I had ductal type mHSPC with distant mets, but post chemo PET showed no activity except in the seminal vesicles. Bone met that was biopsied prior to chemo was PSA-negative, and my PSA had always been low despite the aggressive cancer

Would appreciate your thoughts especially    Tall_Allen , but all input welcome.

[Tall_Allen]

Your PSA is negligible, but is a poor biomarker for your type of PCa. Bone ALP? Any FDG PET scans?

[Gl448 in reply to Tall_Allen]

Yeah, I know PSA isn't a good marker for my cancer, I have to always remind the doctors that it never got over 1.1 except after a Turp (trauma to tissue), but the docs seem to be very pleased that it dropped with chemo last time I was there.

I've only had two PET scans, both were Axumin. Dorff chose to use Axumin after I finished chemo since the original PET was Axumin and she wanted to compare apples to apples so to speak. She said back in May that we'd do a re-staging PET in 3-6 months using a different agent.

I'd forgotten about ALP! Thanks for the reminder. I'm not sure it's bone specific, but I've had 20 comprehensive metabolic panels that include it in the last couple of years.

To me, there's been a very clear correlation between the cancer and ALP levels. I always hovered under 50 before I started having serious BPH problems, and then the ALP started climbing significantly after the second TURP and cancer diagnosis.

It dropped throughout chemo treatments, but has jumped significantly since chemo stopped, going from 43 to 73 in 2 months, and then 73 to 102 in the last month.

Here's a chart of the numbers, I hope they format right:

3/21/2021 52 35 - 144 U/L

4/27/2021 46 35 - 144 U/L

9/16/2021 38 35 - 144 U/L

12/8/2021 43 35 - 144 U/L

1/31/2022 53 53 - 128 U/L Urinary Retention (supposedly ordinary BPH)

2/22/2022 47 35 - 144 U/L

8/17/2022 88 35 - 144 U/L mPCA diagnosed 2nd TURP & Lupron started

9/23/2022 128 35 - 144 U/L

10/17/2022 145. 35 - 144 U/L

11/14/2022 105 35 - 144 U/L

01/6/2023 105 38 - 126 U/L 1st chemo infusion

1/31/2023 92 38 - 126 U/L 2nd chemo infusion

2/21/2023 64 38 - 126 U/L 3rd chemo infusion

3/14/2023 54 38 - 126 U/L 4th chemo infusion

4/4/2023 59 38 - 126 U/L 5th chemo infusion

4/25/2023 55 38 - 126 U/L 6th chemo infusion

5/16/2023 43 38 - 126 U/L Post chemo

7/26/2023 73 35 - 144 U/L

8/30/2023 102 38 - 126 U/L

Calcium levels in the blood have gone high the last two tests (July and August), my nephrologist pointed it out as a concern for him, and said to mention it to the MO as well.

Eosinophils have also been weird. I have hay fever allergies, so that may be the reason they're high, but I've read there is some relationship between PCA and eosinophils. Sometimes, good, sometimes bad...confusing to me.

I've always been out of range (high) a little on eosinophils, but you can see a clear spike in August 2022 when the cancer got real, and then they dropped to zero during chemo, and are back above normal this last test. A little too coincidental given the similar behavior ini ALP, but chemo can damage WBC, so maybe that's all there is to the dip and peaks there.

[Tall_Allen in reply to Gl448]

It may be worth tracking LDH too.

[Gl448 in reply to Tall_Allen]

I had bone pain in my pelvis before chemo started.

Dr Dorff was skeptical that I could feel bone pain from that tumor, but when they biopsied that tumor, the radiologist described where he'd be taking the sample from and pointed to the exact spot I felt the pain. I kind of woke up from the twilight during the biopsy procedure and felt the drilling into the bone at the same spot, so I'm 100% sure I felt the pain from the tumor.

After a couple of chemo sessions, that bone pain disappeared.

A few nights during the last couple of weeks I've felt pain in the same place again.

Makes me nervous, but not panicked. Definitely going to mention that to her next week.

[j-o-h-n]

Come on people....... MaleCare Great site.......... needs support.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 08/31/2023 2:22 PM DST

[Mrtroxely]

Best clear advise I was not given.

BREATH, GET THROUGH CHEMO THEN CHECK MONTH OR 2 AFTER CHEMO.....

you chose to take chemo for the right reasons for you.

head down n soldier through...

Then pop head up and check back.

I had 6 sessions of chemo, PSA test before each chemo had risen....

All 6 results had been a slight increase

And doubled twice but still bellow 2!

After all it went back down to what it was pre chemo.

I don't think it did much if anything!

But I did it!

Ps, get to the other side, like swimming lengths in the deep end! Don't stop, you'll sink!

[RMontana]

See if this helps...I sent this earlier to another Brother with the same question...Rick

You also need to consider doubling time not just PSA level. Take a look at this podcast.

healthunlocked.com/active-s...

…and then you cannot use PSA measurements that are taken with testosterone is either going up or going down. Those values don’t count. So it’s important to know which PSA points to take what time frame. Then see what your doubling time is. Less than 15 months is a concern but I don’t know what yours is. See this podcast at Min 15;45 may also help you manage your case with the three examples given. They go through a complete lifecycle of the disease. I found it very helpful.

“Min 15:45; PSA doubling time – how, when and under what conditions should PSA measurements be used to calculate PSADT…key to knowing the rate your PCa is progressing (affects PCSM mortality).”

healthunlocked.com/active-s...

[racoonwar]

My chemo was Jan/Feb 2005 after prostatectomy. Not a good experience. Hair fell out including eye brows and all body hair and never came back . Fingernails and toenails fell off. My PSA has been a rollercoaster. When it went up from less than zero, I had 40 radiation treatments. The next time it went up, I started hormone therapy. I was referred to an oncologist in August 2022. I’m still on hormone therapy along with chemo meds. Bicalutamide then Xtandi now Litiga. PSA is rising, up to 10.8; the only discomfort I’ve experienced has been from the meds. Almost 19 years since diagnosis with no pain; I wonder what would be different without all of the medications. I’ll be 86 next month and still feel healthy.

[fast_eddie]

Those PSA readings would register as undetectable at the lab I use.

[Gl448 in reply to fast_eddie]

City of Hope Main Campus lab.

I believe undetectable at their lab <0.008.