New Mets, PSA 0.4

[godhelpus]

Hi everyone, I’m so worry for my dad, he has been dealing with this disease since 2019, he was put on vacation 2 years ago and for the last 2 years off medication his PSA was around 0.01, life was good and we were happy for him until his last two psa tests which jumped to 0.4 ! He had a scan and one spot detected on his rib so he was recommended to try radiotherapy !

Please let me know your thoughts, what do you think it’s happening to my dad based on you experience, is his cancer morphing to small cell? Is it becoming Castration-resistant prostate cancer? What should we expect to happen?

[Still_in_shock]

If he hasn't been on his ADT for 2 years, you can't come to the conclusion he's resistant until you put him back on ADT, and see where his PSA goes.

Ask your MO and RO, whether he should go back on ADT WITH radiation.

Small cell? Doubt it's most likely prostate cancer that has metastasized.

Your post 2 years ago mentioned he had metastatic to bones. Was it wise for the MO to put him on vacation?

[godhelpus in reply to Still_in_shock]

Thanks, but I’m thinking that when Psa is that low and T remains castrate level and there is still progression is might be an indication of becoming castrate resistant. Don’t you think so ?

[Still_in_shock in reply to godhelpus]

You said last 2 years of his meds. On vacation. T comes back and feeds those cancer cells that were asleep.

[treedown in reply to godhelpus]

If he isn't on any drugs (on vacation) he can't be Castrate Resistant. That only happens when on drugs.

[SocoCrew in reply to treedown]

If his testosterone levels remains at castrate levels, does it matter whether he is on meds?

[treedown in reply to SocoCrew]

He doesn't mention testosterone level in his post but if he is not on meds and is his T is at castrate level and there's progression I am not sure if that is clinical CR. It might be though, surely somebody smarter than me can answer that

[godhelpus in reply to Still_in_shock]

You asked if it was wise to take a vacation, I don’t have an asnwer for that, but let’s say it was a wrong decision made by his MO, what gonna be a worst case scenario here? What’s happening? I just wanna comprehend his situation better, please?

[treedown in reply to godhelpus]

Sound to me like a recurrence and IMO is nothing out of the ordinary for what little I know about your dad's disease. 3 years is a good rum. Mine was considerably shorter.

[godhelpus in reply to treedown]

Thanks, If it’s a recurrence as you said, what would be the next step ? What should I expect? Any idea?????

[Still_in_shock in reply to godhelpus]

Im not a Doctor, nor do I play one on TV, but I would presume return on ADT with radiation, if your RO thinks its reachable.

0.4 is low, hit it hard and fast.

[treedown in reply to godhelpus]

I agree with Still in Shock. That's what they were going to do for me. RT didn't work out at that time so just Lupron and Zytiga. Scans every 3 to 6 months and wait for Castrate Resistance. Then chemo and down the road we go.

[RoseDoc in reply to Still_in_shock]

If possible, irradiate the met. Go back on ADT.

The “vacation “ is over. Re eval after 3 months of ADT, post radiation.

[Tall_Allen]

It's just what he would normally expect. IMO, it's a mistake to irradiate the met without systemic therapy. It will reduce PSA, but treating cancer is his goal, not treating PSA.

[godhelpus in reply to Tall_Allen]

Thanks Allen, what would be the best next step to manage his cancer? I’d like to know your opinion so in 2 weeks when we have an appointment with his oncologist, I can ask him wiser questions.

[Tall_Allen in reply to godhelpus]

Systemic therapy is required. Met radiation can be done too, if is safe.

[godhelpus in reply to Tall_Allen]

Does it mean that he must go back to ADT /Xtandi as 2 years ago? Or chemo? What do you think patients should get at this situation? Is his cancer coming back more aggressive? Is this the last stage of this disease?

[Tall_Allen in reply to godhelpus]

Probably some kind of hormone therapy will be next. His oncologist should present options.

" Is his cancer coming back more aggressive? " No reason to believe that.

"Is this the last stage of this disease?" It's a very early stage. It is only the end of his first vacation.

You are catastrophizing, which is understandable, but completely unwarranted and unhelpful.

[godhelpus in reply to Tall_Allen]

I appreciate your generous presence on this website; it's very informative and helpful.🙏

[Don_1213 in reply to Tall_Allen]

TA- I want to thank you for the word "catastrophizing" - it's one that often is needed and I had no real substitute for it that was suitable. It applies to more than PCa..

[Tall_Allen in reply to Don_1213]

It's used in cognitive behavior therapy. When we imagine catastrophic outcomes in the future, we cause our own distress

[corvid54]

Treatment protocols are changing very rapidly. Last September usual would be rad to lesion. Then came the October publication of enzalutamide monotherspy success, i read an opinion piece by a RADIATION oncologist stating that recurrence in high risk should skip looking for met to radiate and go strsight to enzalutamide. Enzalutamide was formeely only w castrate resistsnt and or combined w lupron. If his wasn’t high risk not sure but for sure get cutting edge expert opinion.

[Kevinski65 in reply to corvid54]

Xtandi needs to be taken with lupron or other similar drug.

[NecessarilySo]

Having been on four vacations from Lupron, over 12 years, your fears seem overreactive to me. It is to be expected that without ADT, the PSA will rise. I would worry and return to ADT when PSA reaches 4. Track the doubling time. You might also treat the rib lesion with heat or magnets as I describe on my bio.

[Radars in reply to NecessarilySo]

I was dx in 2014 t3b no mo ,finished treatment 2016,rt/ht my testosterone has never recovered, I'm on 6 monthly psa checks, won't give me any trt in case of sleeping cancer cells.

[RodofGod]

My diagnosis: prostate cancer, ductal variant, stage IV, no cure.

I was advised treatment vigilance is the only way to minimize spread. Toying with it openens the door to cancer evening the score...

Temporarily eliminating the need for treatment may have given it room to breathe...it's like rust, it never truly "sleeps!". It still creeps...

It has a life of its own... All we can do is attempt to disown it... It's the bad penny that keeps coming back. You may find you got your time but the piper is back...

This is not intended to set you back... It is not an attack...it is a fact that I must accept too... We never get back the life we had before we became under attack... So... Fight back!

[j-o-h-n]

If possible please fill in your Dad's bio.... all info is voluntary but it helps him and helps us too. Thank you and God Speed.............

Good Luck, Good Health and Good Humor.

j-o-h-n

[AlmostnoHope]

Make sure that "Met" is what they say it is. I very known guys that have agreed to have Mets biopsies and Pirads lesions biopsies only to find they were misread in the scans.