Recent PSA test result no longer “und... - Advanced Prostate...

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Recent PSA test result no longer “undetectable.” What’s next?

Woodman33 profile image
21 Replies

After 5+ years of measuring “undetectable” with my PSA results I recently measured 0.24 NG/ML which I’m assuming my PCA is becoming active again. I see my oncologist on Monday, 8 Jan for a follow-up appt.

Can anyone share with me what the likely next course of action will be?

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Woodman33
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21 Replies
Derf4223 profile image
Derf4223

Do you exercise -- resistance, cardio? If not, start. The more the better.

Tall_Allen profile image
Tall_Allen

"Stage IV" can be a lot of things - what exactly is it? Multiple bone metastases? Lymph node metastases? Any radiation? Why only orchiectomy -- why not 2nd line hormonals?

Woodman33 profile image
Woodman33 in reply toTall_Allen

When first discovered they found 5 bone mets and possible lymph node mets. Before starting any hormone treatment I had radiation therapy to mets in my lower spine.

Not sure why my oncologist didn’t recommend any 2nd line hormonals! I’ll ask him on Monday!

Tall_Allen profile image
Tall_Allen in reply toWoodman33

Let us know what he says. Orchiectomy+ Zytiga, Xtandi, or Erleada is the standard of care. If diagnosed now, the standard of care would include docetaxel too.

Woodman33 profile image
Woodman33 in reply toTall_Allen

Will do, Tall_Allen! Thanks!!

Woodman33 profile image
Woodman33 in reply toTall_Allen

Saw my MO (Dr Robert Dreicer, UVA Health Cancer Center), today. He reminded me why he didn’t prescribe Zytiga, Xtandi, or Erleada in combination with the Orchiectomy. My initial MO didn’t agree with the standard of care at the time of my PCA diagnosis. He started me on Lupron and Bicalutimide, only. About a year later we moved and I started seeing Dr Dreicer at UVA. He was surprised that my initial MO hadn’t prescribed the “standard of care” which would’ve included Zytiga, or etc. He told me it was too late to add any of these other drugs and have them be effective. I had my Orchiectomy about 2 years ago and he stopped the Lupron/Bicalutimide treatments.

Anyway, his recommendation from today’s appt was, since my PSA is still very low (0.24), to wait three more months and check it again.

Yzinger profile image
Yzinger

See this is where I get confused. I had my 4th round of chemo yesterday and the day before they test my blood - PSA was .53. I thought I had asked in here before about if that is considered good or even undetectable and the answer was yes it is good and within the threshold for really low or undetectable.

But, above we see a post that states being above .20 doesn't sound great. What am I missing or over-analyzing guys?

GP24 profile image
GP24 in reply toYzinger

I assumed he had surgery. But now I understand that this is not the case.

Yzinger profile image
Yzinger in reply toGP24

Thanks for the reply.

TJGuy profile image
TJGuy

So your PSA may not have just awoken and may have shown activity earlier if ultrasenitive PSA tests had been employed.

But at this point you need to confirm if your PSA result was a abnormality. You should switch to ultrasenitive PSA tests at your PSA level. Your insurance should cover them, just as they cover the old less sensitive PSA tests. They typically cost like $50 more.

You've been on ADT suppressing the PC, and you had multiple metastases, some treated with radiation.

So if you've been on ADT since Radiation you don't know how effective the radiation was to the radiated metastases.

You have choices, after confirming PSA rise with a new(s) PSA tests. Arrange monthly ultrasenitive PSA tests at your Jan 8th meeting. You're at a very low PSA and regular old PSA test don't give you the accuracy you need. LabCorp has the most sensitive ultrasenitive PSA tests.

If you determine you indeed have PSA rise while on ADT, you can switch ADT and or add a second level ADT to continue to try to suppress PC growth.

You can let the PSA rise to determine several things, doubling time ( but it takes a long time for ADT to stop affecting the determination of doubling time).

You can let PSA rise for PSMA scanning to be effective. Usually 1.0 or above is effective. To determine what metastases you may have and see if they can be addressed through a number of various treatments to eliminate them.

If your interested in treatment towards eliminating your PC not just suppressing it, make sure your care is being directed by a like minded doctor and hospital.

You can stay on some ADT and perhaps a second level ADT to hopefully continue to suppress the PC for some time.

Are you at a major Cancer center hospital?

Woodman33 profile image
Woodman33 in reply toTJGuy

I’m seeing Dr. Dreicer at Univ of Virginia (UVA) Health Cancer Center.

NecessarilySo profile image
NecessarilySo

I suppose that with orchiectomy you have low testosterone. So your cancer might be castration resistant. I believe Xtandi is for that. But also, it is good to review proper diet. Beyond that, check foods that might suppress prostate cancer, like lycopene.

j-o-h-n profile image
j-o-h-n in reply toNecessarilySo

Note: Based upon today's posts, our distinguished member Kaliber complained (see his post) that Xtandi may no longer be available to us so called paYtients. Check it out, but maybe in your case it may not be necessary.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/04/2024 8:50 PM EST

Kaliber profile image
Kaliber in reply toj-o-h-n

Not available at Kaiser Northern and Southern California regions …. That I know of.

❤️❤️❤️

Shams_Vjean profile image
Shams_Vjean

If you’re just entering the castration resistant phase and aren’t having any symptoms then Provenge might be an option. A personalized immunotherapy treatment which has a somewhat narrow window for eligibility.

5 years is a pretty good run for a de novo metastatic stage 4 Dx! Congrats and best of luck with your future treatments.

j-o-h-n profile image
j-o-h-n

Your age? And as a woodman, be careful about what else you might be chopping off...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 01/04/2024 8:37 PM EST

Woodman33 profile image
Woodman33 in reply toj-o-h-n

73

Kaliber profile image
Kaliber in reply toj-o-h-n

lol oooch ….oooCH …. OOOWL .😂😂😂

Bowmaster profile image
Bowmaster

That is exactly what happened to me . On the fifth year it came back and now it is 119 . As of November I am on hormonal therapy . Good luck . OO don't trust the doctors !

Manilo profile image
Manilo

Do PET CT PSMA with 18Fluor and chase it with SBRT is what I would try

CRPCMan profile image
CRPCMan

Don't let them worry you about low numbers.

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