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?
Do you exercise -- resistance, cardio? If not, start. The more the better.
"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?
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!
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.
Will do, Tall_Allen! Thanks!!
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.
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?
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?
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.
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
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.
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
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 !
Do PET CT PSMA with 18Fluor and chase it with SBRT is what I would try
Don't let them worry you about low numbers.
PSA Undetectable
PSA still undetectable
Undetectable PSA?
Latest PSA! Undetectable 
Recurrence with undetectable PSA?
