PSA rising after my 4th chemo

[Maxone73]

I am quite mad (not with anyone in particular). I had a steady decrease in PSA during my first 3 round of docetaxel. It was 15 before starting, 3 after the first infusion, 1.5 after the second, 1.01 after the third. Each time it was measure 3 weeks from the infusion (on the day before the next infusion). Now I had the bloodwork done one week after the infusion because I have a checkup next week and it is 1.8.

[KocoPr]

That could be dead cancer cell PSA antigens pieces. We get bumps from treatments that kill cancer cells. I actually got a large bump after 4 days of starting darolutamide

[Maxone73 in reply to KocoPr]

After 4 docetaxel with a 21 days interval? I am not sure.

[dac500 in reply to Maxone73]

That would be my question.

[KocoPr]

you should also look into senolytics. Mateo beach is very knowledgeable about that. It is very important!

[KocoPr]

Let’s hear from some of our very experienced warriors on their input.

[Maxone73]

👍👍👍

[MoonRocket]

Let's review, you have a prostate, no radiation?

If yes, a .3 increase in PSA should not be a concern.

[Maxone73]

too late for radiation, 0.8 raise, the only external cause I can see is that the day prior to my bloodwork I had a very heavy weightlifting session, but I don’t know how much it could influence psa when you are on adt+daro anyway

[OzzieJ in reply to Maxone73]

When I was week 2 of chemo I did two heavy crossfit sessions the week before my bloods. It spiked my ALT and AST liver enzymes (as they can also be produced by muscle) so they delayed the next infusion. No idea if it can impact your PSA or not but just to be aware there can be other impacts from doing weights just before a blood test. Best wishes.

[Maxone73 in reply to OzzieJ]

Yes. It always altered my liver enzima as well. Normally I would have my tests done 48 hours after my last workout. In this case I forgot that I had the test and had two heavy workouts, one 24 hours and another if I remember correctly 48 hours before. I forgot that even if mostly cancerous, I still have a prostate. I hope that’s the reason behind this sudden raise.

[Tall_Allen]

That's still a good response compared to where you started. Maybe switch to cabazitaxel+carboplatin for the next couple of infusions.

[Maxone73 in reply to Tall_Allen]

thanks Allen! I will see the oncologist with my psma pet scan on Thursday. He keeps telling me not to become “psa results dependent” but this result scared me. I know that studies say that a vigorous workout can even double psa tests results but they are not done with people on adt. The closest I could get was a study done with older guys with benign prostate enlargement!

[Benkaymel in reply to Maxone73]

I agree with your oncologist, you should monitor progress via scans not individual PSA results which can be influenced by other factors.

[gsun in reply to Tall_Allen]

Do you have studies about caba+carb vs docetaxel?

[Tall_Allen in reply to gsun]

Cabazitaxel is only indicated after docetaxel fails, so there cannot be any such trials.

[Histbuff in reply to gsun]

I found an research review on caba + carb at this address but I wasn't persuaded by the results comparing cab with the combination. ncbi.nlm.nih.gov/pmc/articl... I especially focused on Figure 2. I went through 4 treatments of caba and all I got from it was lots of nausea and a fast-rising PSA.

[PCaWarrior]

pubmed.ncbi.nlm.nih.gov/183...

It can be a good sign. I would try to keep calm and talk to my oncologist.

In my case I had SBRT and my PSA, which I expected to be around 0.25, was 1.88. A quick rise like this usually doesn't happen after SBRT (sans prostate). However, I used some combination therapies per Sartor and other MOs and ROs. So this chemo-like jump is hopefully the sign that I wiped out the mets. Otherwise, the MOs and ROs were wrong. I was wrong. And I won't be replying much longer...

[MoonRocket in reply to PCaWarrior]

That study was conducted on CRPC patients, this gentleman is HSPC. While the results may apply to HSPC, it's difficult to determine the actual reason since these two forms of PC are very different.

[PCaWarrior in reply to MoonRocket]

So your message is that he should not try to keep calm and talk to his oncologist?

[MoonRocket in reply to PCaWarrior]

Not at all ..in fact, even though I incorrectly stated he had a .3 instead of a .8 ride,I noted he had a prostate and no radiation. I didn't think that rise is a concern.

How would miss application of a study help?

[PCaWarrior in reply to MoonRocket]

Please add something constructive and look for HSPC studies. CRPC and HSPC react similarly to DNA DSB therapies.

[MoonRocket in reply to PCaWarrior]

Sometimes doing nothing is the most constructive. He'll have his appt with the MO and discuss the PSA, along with test results. For those of us who have incurable PCA constantly fretting about PSA is not productive. Neither is searching the Internet for studies aligning to our biases. This is my humble opinion.

[PCaWarrior in reply to MoonRocket]

Agreed. I think that worrying over what a bounce might mean is not productive. Wait until he talks to his MO or RO.

My PSA bounced 500%. I'm HSPC. I worried for a few hours and then let it go.

[robert570]

It fluctuates, too soon to worry. Wait until after the next round. It might go down again, or hang around that number. I have been fighting this disease for 10 years and the lowest I ever had was .18 and I now sit at 19.8 remember that they go by how quick it rises or lowers. If you stay around that number by a few, up or down, you are fine. I stayed between 1 to 3 for almost 10 years until recently. I'm on Jevtana and prednisone and it's starting to fall again.

[Mw921000000]

please update us after the next infusion!! Interested in hearing about your progress 🙏🏻

[Sailameme]

This is from an article I had read quite a few years back. This was written by an oncologist in Chicago. A patient had arrived for his blood work to be completed and the result showed a rise; not what he was expecting. The patient he had discovered had ridden his Harley thirty miles to the clinic. The oncologist discovered this and advised from hence he should drive and stay away from excessive physical work two days prior to blood work being completed. Also, such things as horse riding and manual work. This is just thought 💭 which I am passing along. One never knows.

[Maxone73]

on the other hand, my PET scan said that almost all my metastasis responded to chemo. Some are less than a half of the volume they were before starting. Mixed results drive me crazy!

[Derf4223]

ADT can cause problems with mood -- a known side effect. Do you have access to an ADT-cognizant mental health counselor? All of us on ADT are overall very frustrated with everything about it. I find lots of exercise and focusing on being there for my wife of 33 years help a lot.

[Maxone73 in reply to Derf4223]

Hopefully lots of exercise is what caused the raise! Hardcore exercise can cause a 50 to 90% raise in PSA according to a study. And even if not in shape, I still have a prostate! And on the 20 I will repeat the test as I have another chemo on the 21st. This time I will remember to stop working out 48 before the test. Then we will see.

[Mrtroxely]

Mine went up, my PSA was low.It doubled twice.

It went back down after finishing chemo.

Try not worry.

You've started chemo

Breath

Relax

Soldier through.

You made the right decision for you.

It's going to be bumpy ride but you can get through.

For me, with hindsight I'd have not done chemo.

But.....

We never truly know what the outcomes will be unless we try.

Well done for reaching out.

Well done for questioning

Well done for making brave decisions

Your partners, family and friends are your rocks through this

I salute you sir.

And it looks like chemo is already having a great result killing them little cancers

[Maxone73 in reply to Mrtroxely]

I still have two infusions to go..let's hope for the best with this triplet therapy I am doing!

[Maxone73]

Dr. Kwon says (not to me directly) that when on adt + arpi, imaging matters more than PSA...if he is right I am doing good

[Maxone73]

UPDATE: the oncologist is positive, everything going by the plan in his opinion. He said that PSA reading in this case is not reliable, because it fluctuates on its own, plus I worked out the two days before the reading, plus I had post-chemo constipation, plus the reading was one week after chemo while normally it's 3 weeks after chemo. He would start worrying if the fluctuation had brought it above 3 while on Docetaxel.

He said the PET scan is quite good and that we will have another next June...I thought it would have been in March. Anyway we will monitor PSA because every month or two I will have to go to the hospital anyway (for zoledronic acid infusion).

I don't know...I feel good and I know the pet scan is good, yet I don't feel that relaxed...paranoid maybe?

[MoonRocket in reply to Maxone73]

Have yet to meet an Italian that didn't suffer from anxiety, so I would say all is normal.

[Maxone73 in reply to MoonRocket]

😂😂😂😂 I am a northerner, sorry...those who are super relaxed about everything are from the south!