History of my cancer becoming castrate resistant

[dac500]

Thinking that some people might be interested to know how my metastatic cancer became castrate resistant I posting a brief history.

When on Lupron break, my PSA reached 1.1 on June 1, 2022. I had a CT scan which found a new lymph node enlargement [Retrocaval lymph node measures 0.5 x 1.1 cm (series 4, image 175), new.]. I was put on 1 month of Casodex which reduced my PSA to 0.342 when I started Lupron shot again and have been on it continuously since then. In a CT scan on January 23, the above lymph node reduced in size [ retrocaval node measuring 7 x 5 mm (series 4 image 177), previously 11 x 5 mm. ] My PSA history since 6/1/22 is shown below:

Between July 22 and July 23 my PSA hovered around 0.3 indicating that Lupron was not effective. Between 7/31/23 and 11/1/23 my PSA jumped from 0.34 to 0.80 [doubling time 2.5 months]. A PSMA PET/CT scan discovered new PSMA avid nodes and the retrocaval node increased in size [Retrocaval node (CT image 202), measuring 1.8 x 1.1 cm with SUV max of 38.4, previously PSMA-avid, and previously measuring 1.0 x 0.6 on prior CT Abdomen and Pelvis.].

My oncologist confirmed that my metastatisc cancer is now castrate resistant. He has added Zytiga to Lupron.

[KocoPr]

Thanks for posting. So are you saying you became castrate resistant because of the vacation you took?

Also have you done a new genetics test on your new tumor?

[dac500 in reply to KocoPr]

I am not saying I became castrate resistant because of the vacation. I don't think the vacation from ADT has anything to do with becoming castrate resistant.

[KocoPr in reply to dac500]

ok, good to know the castrate resistant wasn’t caused by vacation.

Any genetic testing done? It is important to know what mutations your resistant cancer created.

[j-o-h-n]

You thought correctly: Interesting....Thank you!

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/05/2023 7:24 PM EST

[Justfor_]

Using Casodex only for mitigating the initial PSA rise of Lupron, doesn't sound as a good practice to me. What if you had continued taking it? We will never know.

[dac500 in reply to Justfor_]

There was no question of taking it longer than one month. Why worry about a hypothetical situation?

[Mgtd in reply to dac500]

When I read you were on Casodex for a month my first thought was that seems reasonable to to prevent the normal flare from Lupron.

[safari123]

Many thanks for this info. I have had this future question on my mind. All the best

[jackwfrench]

Is your onc saying you are only resistant to Lupron so he’s adding Zytiga? Not clear on the strategy.

[dac500 in reply to jackwfrench]

No he said castrate resistant.

[dhccpa in reply to jackwfrench]

Some still use CR as when initial ADT fails, IF one only used Lupron, Eligard, Firmagan, etc. I think I'm right about that.

[lowT163]

morning.

This is the question on the mind of everyone here?

Do you mind sharing the length of time from the end of treatment to being castrate resistant? Everyone is different I know but as I head into the 4th year off drugs and treatment it’s on your mind a little or a lot more? Mine was out of the prostate so no thoughts of never returning.

Thanks

[dhccpa in reply to lowT163]

I've been on Lupron only since the beginning five years ago. There is no end.

[dhccpa]

You say between July 22 and 23? Is that correct?

And why is 0.3 on Lupron castrate resistant? I've never gone below 0.5 in 5 years on Lupron.

Am I missing something?

[dac500 in reply to dhccpa]

What was your PSA when you started Lupron? On Lupron my PSA reached the low of 0.06. More important is the PSMA scan, which shows new avid positive nodes indicating cancer was progressing when Testosterone was <20. My oncologist said I am castrate resistant and I go by his definition.

[dhccpa in reply to dac500]

Gotcha. I wasn't arguing.

My PSA was 200 when I started Casodex 11/6/2018. I started Lupron 11/29/2018 and discontinued Casodex around 12/20/2018. Next blood test in Feb 2019 PSA was 0.7. over the years since, my PSA has bounced up and down from 0.5 to 1.4. Sept 2023 was .97.

I still have my prostate. Did you have RP or radiation?

[Vegasman]

Zytiga works well. I used it but had to stop because my heart rate was already low and it went too low with Zytiga. Now that I have a pacemaker that keeps ny heart rate above 60, I am going back on this medicine. I am 85. I also get monthly injections of Firmagon.

[dac500 in reply to Vegasman]

Thanks for letting me know Zytiga works well. I am 83

[Ztlf]

My husband had the same problem with Zytiga for a couple of weeks. They raised the amount of predisone he was taking from 5 to 10 mg. Then his BP started to go, and he was hypertensive, so now he is on 5 mg. of prednisone again with hypertensive medication. he has a pacemaker as well, but this issue is not related to heartbeat.

[gsun in reply to Ztlf]

When you say his BP started to go, do you mean up?

[Ztlf in reply to gsun]

Yes. Ooops! It is stable now, but it did go as low as 75/50. Not good.

[Big_Mcc]

Thku for sharing how castration resistance developed in your case. I somehow thought it would take longer but I guess 18 months is about right. Not looking forward to that challenge being on my horizon. Good luck and best wishes

[ImDD]

I thought the current thinking is to start Zytiga concurrently with Lupron right away.

[dac500 in reply to ImDD]

Yes I am getting Zytiga with Lupron.

[ImDD in reply to dac500]

I meant the recommendation now is to start Zytiga immediately...not after CR. Perhaps that was not the case when you started out?

[Graham49]

I presume there's too many tumors for SBRT. Has PSMA Lu177 been considered?