is this what CR looks like?

[lokibear0803]

Starting Nov 20 last year, I began a relugolix on-cycle. Here’s the PSA readings from that point:

Nov 20 : 3.10

Jan 8: 0.31

Feb 27: 0.13

Apr 15: 0.08

So up to this point, the PSA is dropping nicely, as it always has with on-cycles; and as I would expect, since I’ve been a strong responder to ADT for a long time by now (since late 2015).

However, suddenly we have this:

May 20: 0.21

Not what we expected.

This does coincide with a highly stressful period of time during which I’ve apparently lost significant levels of hearing in one ear. Therapies have included amoxicillin/klav + prednisone and now a series of intratympanic injections (I believe dexamethasone). My point being, this has been high stress. My world has basically gone off the rails.

So my MO and I consider the sudden jump in PSA not 100% convincing as a possible beginning of castrate resistance, for two reasons: (1) that’s not the kind of change up in PSA trajectory we’d expect for the very earliest weeks of CR, and (2) the high-stress events surrounding me + whatever effect these events may be having on my biology may be a factor, if not the cause.

In particular, I welcome the opinions and experiences of others, esp. those who have become castrate resistant or are familiar with the experience of others who have:

— is that large of a turnaround in PSA, within the space of 5 weeks, unusual for this transition to CR?

— or, is this kind of change up seen often enough that it very well could be a transition to CR?

I will of course be getting followup PSA’s and scans in the coming weeks to confirm things, and my MO and I do have a plan should this turn out to be real. Meanwhile I thought it could be useful to know more about the experiences of others.

Many thanks for taking a moment.

[mrscruffy]

Have had this cancer for 8 years in June, went CR at 7 1/2 year mark. PSA has always fluctuated somewhat. It the went from .70 to 3.1 in the period of 3 months and we decided CR was the culprit and off to next treatment

[EdBar]

I was undetectable for several years, when PS A began to show up again and eventually hit 0.2 my oncologist, Dr. Sartor recommended a PSMA scan which showed a met on a rib. I had 3 sessions of SBRT and PSA fell back to nearly undetectable again. A year later, same thing happened and this time a met on another rib, SBRT again and latest PSA was 0.07. I’ll keep playing whack a mole as long as I can hoping to hold back on other systemic treatments and their SE’s. Personally I don’t think stress is going to cause a rise in PSA, just keep testing though and see if there’s a trend. Good luck!

Ed

[lokibear0803 in reply to EdBar]

do you recall what was your PSA doubling time or velocity as it was rising?

[EdBar in reply to lokibear0803]

6 or 7 months I believe but at those levels it really doesn’t apply, you’d have to hit 2.0 to start using doubling time and I’m not gonna let it keep rising to that point without doing anything. I’m in the hit it hard hit it early camp, that strategy has served me well for 10+ years.

[lokibear0803 in reply to EdBar]

you’re right, DT is not useful at those low levels. Regardless what I’m hearing is it took you 6-7 months to get from undetectable to 0.2, correct? I’m comparing that to my rise from 0.08 to 0.2 in about 4 weeks, which is quite rapid compared to yours.

Thanks EdBar -

[EdBar in reply to lokibear0803]

No doubling time was calculated over 3-4 PSA tests once I became detectable.

[Sisto]

My MOs have always considered two consecutive months of PSA rise to be an indicator of time to move onto another agent. When one runs out of agents that work, the status goes to CR. That’s my understanding, anyway. Good luck!

[j-o-h-n]

CR = castrate resistant for those un-abbreviaters who DNSAA....

Good Luck, Good Health and Good Humor.

j-o-h-n