PSA rising on Triplet Therapy after <18m

[nyc_son]

Hi all. Hope you are keeping your spirits high. This is a follow up to a post I made in 2022 about my father. I haven't posted since, which reflects the period of relative normalcy that followed the commencement of ADT (triplet therapy) at MSK. I want to pause to appreciate that since I know most of us (or at least me) are inclined to only post when there is an alarming development. I still read posts from time to time and am very appreciative of this community.

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Here's the update:

After my initial post and replies, my father had a biopsy, which confirmed the cancer. His Gleason score was 8 (4+4). It had spread to lymph nodes and PET scan showed bone mets. Mostly in pelvic area, though it appears there was at least one example that references the scapular spine, which I take to mean higher on his back but could be mistaken.

In June of 2022 his PSA was measured at close to 9. I believe that was the highest it has ever been measured. He began triplet therapy (initially degarelix, then leuprolide + abiraterone and prednisone) soon after. By September it had fallen to under 0.1 and then under 0.05 by the summer of 2023.

Subsequent PET scans showed some bone mets had shrunk, others were unchanged. Combination therapies were discussed but not pursued at the time. I see reference to darolutamide + docetaxal and abi/pred + docetaxal based on ARASENS and PEACE1 trials — however, all genetic testing was negative so I believe that may rule out certain options mentioned there. (I do not accompany him to appointments but with consent have looked over the notes, results etc.)

Last fall his PSA began to rise, first to 0.08 and this week it was measured at a little above .5. As I understand this would be indicative of castration resistance. We’d hoped to avoid reaching this point for longer, but it was a blessing to have a period of relative normalcy during this stage of the treatment. He has handled it very well; after the first uptick last fall he began exercising regularly again, and now does various cardio six days a week. He’s also eating better and has lost a fair amount of weight.

He will speak to the doctor soon and I think next step is to be rescanned. His quality of life has been good while on ADT. I am trying to get a better sense of what QoL will be going forward, assuming he will require different treatments, either in addition to or alongside ADT.

Besides the cancer, his health is very good. His latest testosterone readings have not come in yet. If any more information would be of use I will try to provide.

All the best to everyone here.

[Tall_Allen]

I'm confused by your post. In the first paragraph you said he has used triplet therapy, but later on you write that he was ruled out to get triplet therapy, which is what PEACE1 and ARASENS involved (genetic testing had nothing to do with them). So I surmise that he has not yet had docetaxel, but he has had doublet therapy with Lubron + abi. His PSA is still too low to change therapy. He can talk to his doctor about switching from prednisone to dexamethasone.

[nyc_son in reply to Tall_Allen]

thank you for pointing this out. I think I may have mixed docetaxel up with degarelix, which he is taking/took in addition to lupron. That would not in fact be triplet therapy.

The side effects with docetaxel I imagine would be more noticeable. That was probably why it wasn’t given at the time but will confirm.

The only thing I know was “ruled out” was medicines catered to those with genetic predispositions.

I will mention dexamethasone, thank you.

[meteghan in reply to Tall_Allen]

Just a quick question. I take 1000mg abi with 5mg prednisone and my psa is slowly creeping up. Doctor changed prednisone to 0.5mg dexamethasone. Is dexamethasone better than prednisone and why?

[Tall_Allen in reply to meteghan]

The change can prolong abi effectiveness.

[meteghan in reply to Tall_Allen]

Thank you very much and have a great day.

[nyc_son in reply to meteghan]

I will see if this can be asked about in our case as well. Thank you both.

[j-o-h-n]

Who's your Dad's doc(s) at MSK? Greetings to your Dad and to you (a great son)...

Good Luck, Good Health and Good Humor.

j-o-h-n