Please advice

[old64horn]

My latest PSA on 6/11/24 was 1.06 up from 0.65 on 4/2/24. I have a meeting with my MO on 4/26 to discuss the next step. I was taking Opdivo immunotherapy from 2/2023 to 2/2024 for bladder cancer. so far my bladder cancer is in check so now I can focus on my PCA. Should I get a PSMA pet? is it time to start ADT + Abi and prednisone? other than surgery in2009 and IMRT in 2021 i have had no other treatment so far. thanks

[Tall_Allen]

If you get confirmation that your PSA doubling time is ≤ 9 months, you may want to discuss the EMBARK or PRESTO protocol with your MO.

prostatecancer.news/2023/05...

prostatecancer.news/2022/09...

You may get more time out of a vacation from ADT if you are able to get SBRT to any bone mets revealed on a PSMA PET scan. This was found on the EXTEND trial for bone scan/Axumin-detected metastases, and confirmed (possibly) by the SATURN trial for PSMA-detected metastases.

jamanetwork.com/journals/ja...

ascopubs.org/doi/10.1200/JC...

[old64horn in reply to Tall_Allen]

Thank you TA. I was hoping to hear from you. My PSA 0n 4/18/23 was 0.59 and on 8/16/23 was 0.57 so it didn't quite double froma year ago.

[vintage42]

It appears that you have not had ADT, and your bio says "Due to my age (82), my MO doesn't want to do a PSMA Pet scan nor start ADT. "

Scans are important for locating the cancer to decide treatment. And ADT can extend life.

I did not start ADT until scans found cancer remaining in the prostate and spread to nodes. That might not have happened if I had started ADT from the beginning.

At age 81, I felt nothing from two PSMA PET scans last year, almost nothing from 6 months of Orgovyx with Abiraterone.

[old64horn in reply to vintage42]

Thanks. I had a PSMA when PSA was at .12 that showed nothing. The reason for delaying ADT was mainly due to the bladder cancer surgery and follow up treatment with immunotherapy that ended o 02/2024.

[NecessarilySo]

I'm having a bit of trouble with your numbers, e.g. you have an appointment with MO 4/26, in April 2026? Anyway, your PSA is creeping up but possibly accelerating. ADT would slow PC growth and lower PSA, essentially extending your life for years. It is important to locate your PC. Knowing where it is can give you an idea of how to treat it. Be super aware of any location of pain that persists. You might try self-treatment with diet, heat, etc. You might get another opinion from a different MO. I'd say you have time to explore alternatives.

[old64horn in reply to NecessarilySo]

thanks for your reply. My appointment is for 6/26, sorry for the typo.

[j-o-h-n in reply to old64horn]

NP we expect typos from old64horns.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[ron_bucher]

Not sure I’d like to have an MO with that approach. PSA trend indicates a good chance PSMA show may show tumors to radiate. I’d take radiation over ADT every day of the week.

I was an IBM competitor - worked at Amdahl with lots of former IBMers. Both great companies.

[old64horn in reply to ron_bucher]

Thanks Ron. My MO is not against having a second PSMA since the PSA is much higher now than when I had it at .12. I’ve been battling too many issues for the past two years (bladder cancer surgery and sciatica surgery). I think my visit on 6/26 I’ll know what the plan is. My bladder cancer is in the rear view mirror and my sciatica is fixed.