PSA update

[wolverine11]

DX Nov 2020. PSA 960 high volume metastatic. Lowest PSA nadir 0.1 Aug 2022. Slowly rising Nov. 2023 was 0.21, Feb 2024 0.41....Doubling time 3.1 months . On Lupron and 1000 mg Abiraterone with 0.5 Dexamethasone . Darn.

[JohnInTheMiddle]

Darn! As you say, Wolverine. I read your bio and its details and I came across the term "hypermetabolic uptake", related to bone mets. This sounds really important. Can you tell us more about this?

I share some aspects of your PCa situation and I'm concerned about amy own very low level of PSA - however might have started climbing. My next test will tell.

Your PSA is now 0.41. Many people will naively say this is not bad at all, despite the fact that you now have a defined doubling time. My understanding is that a doctor oncologist typically won't do anything or raise an alarm until PSA hits 2.0. Which is sort of like closing the barn door after the horse is gone. Can you share any thoughts about what might be done now?

As was once said a long time ago "Keep on truckin'"!

[wolverine11 in reply to JohnInTheMiddle]

Thank you for responding John. As to no focal hypermetabolic in visceral organs. As it says NO to the latter. Have not questioned it. Maybe someone here can enlighten. Yes, you nailed it, oncologist PSA of 2 or I start experiencing pain PSMA scan would be in order. Yes, my PSA doubling time of 3.1 months sucks. Options?Will ask about low dose Taxotere in combo with radium 223 ask oncologist other options. John, or anybody please feel free opinions or suggestions. Thank you

[JohnInTheMiddle in reply to wolverine11]

Hi Wolverine. So I think when you say "hypermetabolic update" that you're referring to something to do with PSMA scanning?

[wolverine11 in reply to JohnInTheMiddle]

At the time the oncologist I no longer see had me a take FDG scan, of which I understand measures glucose being assimilated. Later I found out at my stage of cancer not very good scan. Change Docs in the future will be getting PSMA scans.

[Tall_Allen]

In a similar situation, my friend had a PSMA PET/CT and found that only one acetabular met was active. He had SBRT to it, and his PSA has fallen back down.

[wolverine11 in reply to Tall_Allen]

Thanks TA for your input. My oncologist suggested that possibility. Will ask my onco more about SBRT. That scenario of your friend has boosted my morale. Thanks TA

[God_Loves_Me in reply to Tall_Allen]

Thank you. I do have 5 active lesions on bones and RO suggest to kill them in 5 session. Next week I have my first session. thank you TA.

[JohnInTheMiddle in reply to Tall_Allen]

This is a really interesting comment you have made TA. It's an argument for doing a PSMA PET scan in the course of regular on-going metastatic prostate cancer management. In Canada I don't think I can get a PSMA PET scan unless I pay for it, which I can't do. And the rule is, we don't do scanning or testing if there's no decision afterwards that can be based on more knowledge.

Another reason why I wasn't even bothering to look into PSMA is that while there may be a very large number of metastases to bones, there is no situation where you could irradiate all of them. Prostate cancer has metastasized beyond the prostate one has to think holistically and system wide. Whack-a-mole doesn't really work.

But you have highlighted the possibility here that maybe even in a situation with widespread lesions, that only one lesion of them may be active! (Maybe we can speculate that this is where resistance starts, in one particular lesion?)

And so one can in fact, after a PSMA PET scan, find one or two active lesions and irradiate them successfully. And with a very beneficial result. (This calculation seems a little bit like why intervention with oligometastatic prostate cancer works.)

Am I reading too much into your comment?

[Tall_Allen in reply to JohnInTheMiddle]

My friend had a Super Scan originally. After 2 years on abi+prednisone, his PSA started rising. He switched to dexamethasone, but it doubled every month up to 0.4. On PSMA, only the one site lit up. After SBRT, his PSA was falling down to 0.1 last month. IDK if there is a net survival benefit, but he certainly feels better about it.

[God_Loves_Me in reply to Tall_Allen]

What’s medical name of super scan ? Any links ?

[Tall_Allen in reply to God_Loves_Me]

That is the medical term.

[JohnInTheMiddle in reply to Tall_Allen]

Thanks Allen.