I'm 87, diagnosed Gleason 9. After a year and a half of Orgovyx and Zytiga my PSA has risen from a low of 0.69 to 6. However, my T level remains below 10. My recent scan, posted here, shows most of the PC gone or smaller. The drugs are very hard on me. My question is should I stop using the ADT drugs given my age and my low T? I have no bone pain, but the drugs are very bad for my QOL. Terry
Rising PSA, but T remains below 10. - Advanced Prostate...
Rising PSA, but T remains below 10.
Written by
Poollover
To view profiles and participate in discussions please or .
Read more about...
31 Replies
•
My best wishes and prayers for you Terry 🤗
This answer is AI generated, therefore should be checked with your oncologist and form a basis for further discussions.:
"At age 87, managing both quality of life (QOL) and prostate cancer progression is particularly important. You’ve been on potent ADT (Orgovyx) and Zytiga for an extended period, which has reduced your testosterone to below 10—a very effective level for suppressing hormone-sensitive prostate cancer. Despite the PSA rise from 0.69 to 6, your recent scan shows a positive response with most cancer shrinking or disappearing. The key issue seems to be balancing cancer control with the burden of side effects.
Here are some points to consider:
1. PSA Rise: The PSA increase could indicate some cancer cells adapting to the treatment, but with testosterone suppressed below 10, it's possible the rise is due to hormone-insensitive cancer. This scenario might require a change in treatment strategy, but stopping ADT could lead to more aggressive cancer growth.
2. Impact of ADT on Quality of Life (QOL): ADT can significantly reduce quality of life, leading to fatigue, muscle loss, and cognitive changes. In older adults, these side effects can be particularly debilitating. However, stopping ADT could allow testosterone to rise again, which may worsen cancer progression.
3. Alternatives or Adjustments:
Intermittent ADT: Some doctors recommend intermittent ADT for patients like yourself, where ADT is paused for a while and resumed when PSA rises to a certain level. This approach can improve quality of life during off-treatment periods.
Switch to a less aggressive therapy: You may want to discuss whether reducing the dose or switching to a less intense therapy is feasible.
4. Monitoring Without ADT: If you were to stop ADT, close monitoring with PSA and scans would be necessary to detect any rapid cancer growth, allowing you to restart therapy if needed.
Given your age and low testosterone, this is a delicate decision. It’s important to have a thorough discussion with your oncologist about your goals—whether prioritizing quality of life or continuing aggressive treatment is more aligned with your personal values. A geriatric oncologist could also provide insight into managing treatment in older adults."
You could yourself download the ChatGPT application to your phone and continue asking questions. Of course you can also post a new post on this forum.
My question to you is did you have a PSMA pet scan? Which scans did you have and do you have a medical oncologist?
Thank you.
Current scan
What is the SUV max in your prostate? I am not a radiologist but my professor of nuclear medicine states all on the psma pet/ct visible Mets. I don't want to drow wrong conclusion therefore your cooperation is welcome if you have the information about the SUV max of the prostate etc.
I wanted to ask you what is a current dose of prednisolone what you are taking now?
What is the current PSA doubling time?
I take Dexamethasone 2.5mg instead of prednisone. For the first time it more than doubled in one month, about 2 to 6. I still have no bone pain. Over a year ago when I was first diagnosed with Gleason 9, stage 4, I first stopped taking Testosterone jell (which I had been taking for 7 years) and only took 20mg of Prednisone which, before administrating ADT, brought my PSA from 72 to 11. I suspect that stopping the Jell starved a lot of the cancer. Just a guess.
We are not doctors here. Just brainstorming. Could you ask for second opinion if you don't communicate well with your current medical oncologist? I believe that one month is very fast. Are you taking your medication properly? Are you taking one gram of Abiraterone on empty stomach? Is your blood pressure regulated properly? You could try to change to enzalutamide or maybe nubeqa? Usually 0.5 mg dexamethasone is used or 5 to 10 mg Prednisone in order to regulate blood pressure. Even if you change to enzalutamide or maybe nubeqa you should continue prednisolone for some time with the reduced dose in order to avoid I believe it is called adrenal insufficiency? Tiredness . You really need good doctors.
Am I correct? On the psma pet ct scan you don't have anything visible but your PSA is rising? What's about SUV max in your prostate? What is it? Maybe your cancer is confined in your prostate? Do you have problem with urination, retention etc? You could ask for the fdg pet scan?
Firstly, I want to thank you for your insights and help in general. You are helping me come to terms with a QOL issue that I have been thinking about for a while.
As you can see from the scans the cancer the cancer was spread all over, but the drugs seem to have cleared most of it. Even the cancer in the gland shrunk. I'm still living a vigorous life, but a couple of hours of exercise or work are triggering more and more fatigue. I'm now seeing a cardiologist to see what effect the drugs are having on my heart.
The specific issue right now for me is what to do about my rising PSA (2 to 6 in one month) and the QOL effect of Orgovyx and Zytiga on my 87 year old body. These drugs are losing their effectiveness. What I'm wrestling with is whether to switch drugs or take a vacation from all cancer drugs and see where that takes me. I might have a few years left of the wonderful life I've lived. How best to live what's left. No one can answer that question for me, so I'm trying to factor in all the variables that I can. Again, thank you for your help.
Could you please say what is your SUV max value of your prostate and do you have any visible metastasis on the psma pet ct scan?
This is the AI reply: (didn't know that some ADT is milder if they all reduce your testosterone?
"You're very welcome, and I'm glad I can provide some clarity as you navigate these complex decisions. It's evident that you've given thoughtful consideration to the balance between continuing aggressive treatment and maintaining your quality of life. Given how much you've already achieved with Orgovyx and Zytiga, it's clear that these treatments have worked well to suppress the cancer, even if their effects may now be waning. The rise in PSA from 2 to 6 within a month suggests some level of progression, but your scans showing most of the cancer gone or smaller are encouraging.
You're facing a deeply personal decision about how to move forward, and it’s completely understandable that you're evaluating your options carefully at this stage of life. Here are a few things to keep in mind as you weigh your options:
1. Cardiac Health and Drug Side Effects:
You're absolutely right to consult with a cardiologist, as both Zytiga (abiraterone) and Orgovyx (relugolix) can affect heart health, especially in older adults. Fatigue from ADT and Zytiga could also be compounded by any cardiovascular impact. If the cardiologist finds a heart-related issue contributing to your fatigue, adjusting the drugs might help improve your overall stamina.
If the drugs are contributing to cardiac strain or other significant issues, it could make the decision to either switch drugs or take a break easier.
2. Intermittent Therapy or Treatment Vacation:
Taking a "treatment vacation" by stopping ADT and Zytiga for a period may offer you improved quality of life without immediately risking rapid disease progression. Intermittent androgen deprivation therapy (ADT) is sometimes used to allow patients periods of recovery from the side effects, and if closely monitored, it may let you enjoy life without the constant drug burden.
Your PSA rise is notable, but if your scans show a mostly stable situation, you may have some time to monitor closely and assess whether taking a break is feasible. A rising PSA doesn't always correlate directly with rapid cancer growth, especially with cancer cells that may now be less sensitive to hormone therapy.
3. Switching to New Treatments:
If the PSA rise is concerning and you prefer not to take a full treatment vacation, you might explore other options like newer hormonal agents or even less aggressive therapies that could help slow the cancer without as many side effects.
A different hormonal drug or a milder form of ADT might allow for a compromise between keeping the cancer under control and maintaining a higher quality of life.
Additionally, other treatments like Lutetium-177-PSMA, if accessible and appropriate for your case, could be a future option, though that would need a thorough discussion with your oncologist.
4. Living Fully:
This decision ultimately comes down to what will allow you to live your life in the way that’s most meaningful to you. You’ve already fought through a lot, and your cancer has responded well to the treatments so far. If taking a break from cancer drugs offers you the chance to live more fully without the fatigue and other burdens, even if only for a period of time, it could be worth considering.
Ultimately, the answer lies in how you want to prioritize the time ahead. You’ve already demonstrated incredible resilience, and it seems clear that you're thinking deeply about how best to enjoy your life as vigorously as possible. Working with your oncologist and cardiologist will help clarify what’s medically feasible, but you're the best judge of what will allow you to live with the highest quality in the years to come.
Take the time you need to evaluate these options, and don’t hesitate to ask more questions as you continue this journey. It's an honor to assist you, and I wish you strength and peace in making the choices that feel right for you."
That is why I wish to know if you had a psma pet ct scan and what are the SUV max values. You could switch to bicalutamide only treatment without ADT or maybe only Enzalutamide or only darolutamide or Apalutamide mono therapy.
I myself probably don't have on the psma pet ct scan visible Mets and my only visible cancer is in my prostate. The radiation oncologist suspects that maybe my pelvic lymph nodes are infected because my PSA was also rising. My RO wanted me to have the fdg pet ct scan but I am already more than 6 years into this fight with only degarelix plus bicalutamide with early chemotherapy.
Maybe you should contact a radiation oncologist for advice. You should not just stop ADT because your cancer could spread locally in your prostate and you could develop retention and could and up with the catheter. The AI has good ideas but we humans decide.
Technique: Noncontrasted CT scan was obtained from the skull vertex to the mid-thighs primarily for attenuation correction and anatomic correlation with the PET scan. PET scan was performed approximately 1 hour and 45 minutes following the intravenous administration of 9.81mCi of F-18 PYLMA.
Musculoskeletal: Multifocal extensive radiotracer uptake throughout the axial skeleton and visualized portions of the appendicular skeleton have markedly decreased in degree of radiotracer uptake in the interval with some areas resolved and sclerotic lesions extensively at this time consistent with partially treated osteoblastic metastasis.
Advanced degenerative changes of the glenohumeral joints are noted and degenerative changes of the spine, SI joints, hips, symphysis pubis and glenohumeral joints.
IMPRESSION:
1. Marked improvement in radiotracer avid osteoblastic metastasis and marked improvement in radiotracer avid nodal metastasis. Radiotracer avid disease in the prostate has also markedly improved.
2. Coronary artery disease and aortic valvular disease. Chronic atelectasis unchanged.
3. Colonic diverticulosis without acute diverticulitis
4. Bladder wall thickening suggesting chronic bladder outlet compromise.
Report Electronically Signed by: Paul Gagnon, DO on 8/28/2024 10:40 AM
Hi Seasid,
This is all the info I have at present. Presently, I'm leaning towards trying a vacation from drugs, but will wait until my cardiologist finishes his analysis. Bottom line it's hard being attached to a dying animal. Just finished a book on AI which has me totally fascinated: microbots injected directly into the human brain to facilitate a partnership of some sort. Again, thank you.
Thank you for sharing the detailed scan report and your thoughts on taking a treatment break. The report shows significant improvement in the radiotracer avid metastases throughout your body, including the prostate, bones, and lymph nodes. While there are still some osteoblastic lesions, the marked reduction in radiotracer uptake is a positive sign that the treatments have worked effectively up until now. This makes your idea of taking a break from the drugs more reasonable to consider, especially if your heart health could improve without the added strain from the medication.
It's clear you're in a place where quality of life is a priority, and waiting for your cardiologist’s assessment before making a final decision is a wise move. If your heart health is stable, and given the improvements noted on the scan, a temporary drug holiday could allow you to regain some energy and enjoy life more fully for however long the break lasts.
Regarding your recent read on AI and microbots, it sounds like you're exploring fascinating ideas at the intersection of health and technology. AI advancements, especially in medicine, are truly transformative. Your interest in the topic shows you're still engaging deeply with new knowledge and concepts, which is an incredible asset in maintaining a vibrant and curious mind.
Ultimately, if you choose to take a break from the cancer drugs, it could be an opportunity to see how your body responds without the burden of side effects. Close monitoring of your PSA and regular follow-ups with your doctors will ensure that any changes in your condition can be addressed promptly. Whatever path you choose, it’s clear you are making thoughtful, well-considered decisions based on both your health and quality of life.
If there's anything else you'd like to explore or discuss, feel free to reach out again. Wishing you the best as you navigate this next chapter.
ChatGPT said.
Here’s a general order of the drugs you mentioned, from lowest to highest toxicity, based on typical adverse effects and their impact on the body:
1. Darolutamide – It has the least toxicity among second-generation anti-androgens. Darolutamide is known for its lower risk of neurological side effects compared to enzalutamide and apalutamide, making it more tolerable for many patients.
2. Bicalutamide – As a first-generation anti-androgen, bicalutamide is generally considered less toxic than the newer agents but can still cause side effects like gynecomastia, liver enzyme elevation, and hot flashes. However, it typically has a lower risk of severe toxicity.
3. Abiraterone – Abiraterone works by inhibiting androgen biosynthesis. Its main toxicities are related to mineralocorticoid excess (e.g., hypertension, hypokalemia) and liver toxicity, but with proper steroid use (like prednisone), these side effects are usually managed well.
4. Enzalutamide – More potent than bicalutamide, enzalutamide has a higher risk of neurological side effects, including fatigue, seizures (rare), and cognitive impairment, which contribute to its higher toxicity.
5. Apalutamide – Similar to enzalutamide but slightly more toxic, particularly in terms of rash, hypothyroidism, and increased risk of falls and fractures.
6. Cabazitaxel – As a chemotherapy drug, cabazitaxel comes with a significant risk of neutropenia (low white blood cells), infection, anemia, gastrointestinal side effects, and other toxicities. It's generally more toxic than the hormonal agents.
7. Xofigo (Radium-223) – This is a radiopharmaceutical with its own unique toxicity profile. While it's used to target bone metastases, it carries risks of bone marrow suppression (leading to low blood counts) and other radiation-related side effects. Its potential long-term effects, including myelosuppression and secondary malignancies, place it at the higher end of toxicity.
Keep in mind that individual tolerance and side effects can vary depending on the patient’s health condition, co-morbidities, and concurrent treatments.
From our friend ChatGPT
The effectiveness of these drugs varies based on the stage of prostate cancer, the type of resistance mechanisms present, and individual patient factors. However, when considering general effectiveness in castration-resistant prostate cancer (CRPC) or advanced disease, here’s an approximate ranking from most effective to least effective:
1. Cabazitaxel – This second-line chemotherapy is highly effective for patients with metastatic CRPC who have progressed after docetaxel. It has a unique mechanism compared to androgen-targeted therapies, which is why it's often effective when hormonal therapies fail.
2. Enzalutamide – A second-generation androgen receptor (AR) inhibitor that has shown strong efficacy in both metastatic hormone-sensitive prostate cancer (mHSPC) and CRPC. It is more potent than first-generation anti-androgens like bicalutamide.
3. Abiraterone – This drug, which inhibits androgen biosynthesis, is highly effective for many patients with mHSPC and CRPC. It is often used in combination with prednisone to mitigate side effects.
4. Apalutamide – Similar to enzalutamide, apalutamide is another potent second-generation AR inhibitor, primarily used in non-metastatic CRPC and mHSPC. Its effectiveness is slightly lower than enzalutamide but still very strong.
5. Darolutamide – Also a second-generation AR inhibitor, darolutamide is effective in non-metastatic CRPC and has a more favorable side-effect profile, particularly regarding neurotoxicity. While very effective, its slightly different structure may make it marginally less potent than enzalutamide in some cases.
6. Xofigo (Radium-223) – This radiopharmaceutical is effective in targeting bone metastases in CRPC, especially in patients with symptomatic bone disease. However, its efficacy is limited to the bones and doesn't treat soft tissue or visceral metastases, making it less versatile than the above hormonal therapies or chemotherapy.
7. Bicalutamide – As a first-generation AR inhibitor, bicalutamide is generally less effective than second-generation AR inhibitors like enzalutamide, apalutamide, and darolutamide. It is still used, but its effectiveness in advanced or resistant prostate cancer is limited.
Summary:
Most effective: Cabazitaxel > Enzalutamide > Abiraterone.
Moderately effective: Apalutamide ≈ Darolutamide.
Less effective: Xofigo.
Least effective: Bicalutamide.
This ranking assumes that the cancer is progressing or has become resistant to standard androgen deprivation therapy (ADT), as these drugs are typically used in later stages of prostate cancer. Effectiveness also depends on specific patient characteristics and prior treatments.
To maximize the benefit and prolong survival in metastatic prostate cancer, particularly castration-resistant prostate cancer (CRPC), the order of drug use is crucial. The optimal sequence of treatments depends on the disease stage, prior treatments, patient health, and cancer aggressiveness. Based on current clinical practice and treatment guidelines, here's a suggested order of use for longest survival:
1. Abiraterone or Enzalutamide (First-line for metastatic hormone-sensitive prostate cancer (mHSPC) or early CRPC)
Rationale: These potent androgen receptor (AR) pathway inhibitors are typically used early in the disease, either in combination with androgen deprivation therapy (ADT) or after resistance to ADT develops. They have shown significant improvements in overall survival when used early in both mHSPC and CRPC.
Order: Abiraterone is often used first in patients without significant liver issues (due to its need for prednisone co-administration). Alternatively, enzalutamide can be used first, particularly in patients with better liver function or those at risk of mineralocorticoid side effects from abiraterone.
2. Darolutamide or Apalutamide (Second-line AR Inhibitors)
Rationale: In cases where enzalutamide or abiraterone stops being effective, darolutamide or apalutamide can be introduced. Cross-resistance may occur, but these drugs have shown efficacy in certain cases, particularly when used before moving to chemotherapy.
Order: Darolutamide is often preferred due to its better side effect profile, particularly in avoiding neurological toxicities that enzalutamide and apalutamide can cause. Apalutamide is similarly potent and can be used based on individual response.
3. Cabazitaxel (Third-line, after AR-targeted therapies)
Rationale: Once AR-targeted therapies lose effectiveness, chemotherapy with cabazitaxel is often the next step. It is effective in patients who have already been treated with docetaxel (or even before docetaxel in certain cases) and provides significant survival benefit. By delaying the introduction of chemotherapy until the hormone pathway is fully exhausted, patients can get the most extended benefit from AR-targeted therapies.
Order: Cabazitaxel is used after exhausting the benefit from hormonal therapies. It should follow enzalutamide/abiraterone and apalutamide/darolutamide to delay the use of chemotherapy and its side effects.
4. Xofigo (Radium-223) (Used for bone-dominant disease, later stages)
Rationale: Xofigo is typically used in patients with CRPC who have symptomatic bone metastases but no visceral metastases. It improves survival and quality of life by targeting bone lesions directly. Xofigo is often used after AR-targeted therapies and possibly after or alongside chemotherapy.
Order: Xofigo is used when the disease is predominantly in the bones, and can be sequenced after or alongside cabazitaxel in patients with significant bone metastases and limited soft tissue disease.
5. Bicalutamide (First-line, but generally avoided in advanced stages)
Rationale: Bicalutamide is a first-generation AR antagonist that is typically used earlier in the disease course, often in combination with ADT. However, in advanced metastatic disease, it is less effective than second-generation AR inhibitors and is rarely used as monotherapy in late stages. It could be considered as an initial therapy or a stopgap in specific cases, but it is largely superseded by newer agents.
Order: If used, bicalutamide is often started early and replaced by more potent therapies like abiraterone or enzalutamide. It would not be prioritized in advanced CRPC due to its lower efficacy.
Suggested Sequence:
1. Enzalutamide or Abiraterone (early CRPC or mHSPC)
2. Darolutamide or Apalutamide (if resistance to first AR inhibitor develops)
3. Cabazitaxel (when hormonal therapies fail)
4. Xofigo (for bone-dominant metastatic disease, later stages)
5. Bicalutamide (only early in the treatment course or as an adjunct in certain cases)
Alternative Sequences:
For patients with heavy bone involvement and no visceral metastases, Xofigo might be used earlier in the sequence, potentially after the first AR inhibitor but before or alongside chemotherapy.
In cases where chemotherapy is needed earlier due to aggressive disease, cabazitaxel might be introduced sooner, followed by continued AR-targeted therapies.
By starting with potent hormonal agents and delaying chemotherapy and radiopharmaceuticals until the hormone pathway is exhausted, this sequence aims to provide the longest benefit and survival.
To help you decide about further treatment:
Renal and Cardiovascular Toxicities by New Systemic Treatments for Prostate Cancer
I am really not a doctor but I believe if you could be placed on darolutamide mono therapy it would be the best for you after excluding that your PSA doubling time is not localised to your prostate only. You may need to contact a radiation oncologist if your only visible cancer is in your prostate. If on the psma pet ct scan you don't have any visible cancer at all than you should discuss your further treatment with medical oncologist and also with the radiation oncologist. In general PSA alone is not treated without radiological progression on the psma pet ct scan. You can add an fdg scan in order to exclude psma negative cancer. Lutetium psma treatment is out of consideration if you don't have high SUV max values or if your cancer is low volume in order to avoid kidney toxicity as a result of the lutetium psma infusion
It sounds like you're receiving some thoughtful advice about your current situation. The suggestion of darolutamide monotherapy is interesting, especially if your PSA doubling time suggests that the rise is not just localized to the prostate. Darolutamide is known for having fewer side effects compared to other androgen receptor inhibitors, so it might offer a better balance between cancer control and maintaining quality of life.
As for the radiation oncologist consultation, it could be helpful to explore whether there's localized progression in your prostate that could benefit from additional targeted treatment, especially if other areas are stable or responding well to your current regimen.
The point about not treating based on PSA alone without radiological progression is crucial, especially with prostate cancer. PSA is just one indicator, and radiological scans like the PSMA PET/CT or FDG scans can give a more precise understanding of cancer’s activity and spread. If no significant cancer is visible on the PSMA PET/CT, then a shift in treatment strategy, such as potentially taking a break or switching therapies, can be discussed more confidently.
Lutetium PSMA therapy is generally reserved for cases where there are high SUV max values, indicating high PSMA expression. As you've already had good response to your treatment, and if your cancer is low volume or not highly PSMA-avid, it makes sense that Lutetium-177 might not be the best option right now due to the potential risk of kidney toxicity.
It seems you're in a good position to consult both a medical oncologist and radiation oncologist to assess these options carefully. You’re clearly weighing the pros and cons of different treatments, and it’s important to ensure that any next steps take into account your overall health, quality of life, and the precise behavior of the cancer.
Keep gathering information and consulting with your healthcare team, and feel free to continue discussing your thoughts and findings here. I’ll be here to help if you need further insights.
ChatGPT said.
Unfortunately, the MC Docs available to me on Cape Cod, MA are so burdened that they have little time to deal with anything outside of the AMA's standard flow-chart. I'll try anyway. Thank you.
Could you find a geriatric oncologist and get a second opinion at least as suggested by chatgpt? I understand that it is very time consuming for them to do everything properly like organise your scans, PSA and testosterone tests, Tepper you properly from your very high dose of dexamethasone etc. I am happy that I am still only on 100mg bicalutamide and degarelix monthly adt injection and my PSA is still only 2.8.
From chatgpt:
I understand how challenging it can be when medical care is constrained by time and standard protocols, especially in busy areas like Cape Cod. It's frustrating when there's a need for more individualized attention, especially when you're dealing with a complex and nuanced case like yours. However, it’s great that you’re still planning to try and engage your medical team in discussions about alternative options.
If possible, you might consider reaching out to specialized cancer centers that may have more flexibility in terms of time and expertise, even if they're outside your immediate area. Telemedicine consultations with oncologists who specialize in prostate cancer or those with experience in therapies like darolutamide or Lutetium-177 PSMA might also be an option to explore.
Additionally, patient advocacy groups or forums related to prostate cancer may have recommendations for doctors who think beyond the typical flowcharts and can offer more personalized guidance. Your proactive approach and detailed understanding of your condition are assets in finding the right care.
Feel free to reach out again if you need further support or ideas as you move forward with this process. Best of luck with your next steps.
It sounds like you're navigating your treatment with careful consideration, and the idea of seeking a second opinion from a geriatric oncologist is a valuable step. Geriatric oncologists specialize in balancing cancer treatments with the overall health and quality of life of older adults, often incorporating strategies that can improve outcomes while minimizing side effects.
To find a geriatric oncologist, you can try a few options:
1. Local Cancer Centers: Large cancer centers, such as Dana-Farber Cancer Institute in Boston, may have specialists in geriatric oncology or advanced prostate cancer. They could offer telemedicine consultations if traveling is difficult.
2. American Society of Clinical Oncology (ASCO): You can search for cancer specialists on the ASCO website or through their "Find an Oncologist" tool. Many oncologists associated with academic institutions or specialized cancer programs are more likely to offer individualized care and second opinions.
3. Prostate Cancer Foundation or Advocacy Groups: Groups like the Prostate Cancer Foundation or ZERO – The End of Prostate Cancer, often have resources for locating oncologists with specific expertise, including geriatric oncology.
4. Telemedicine Services: Some cancer centers offer remote consultations for second opinions, which might help if you're limited to Cape Cod. Memorial Sloan Kettering Cancer Center (MSKCC) and Mayo Clinic are examples of institutions that offer second opinion services through telehealth.
If you'd like, I can help narrow down some options for you based on your location and preferences. It’s great that your PSA is stable on Bicalutamide and Degarelix, and getting a second opinion could give you more clarity on how to manage your treatment going forward.
Let me know how you'd like to proceed!
Chatgpt said.
Would you or could you consider switching to degarelix monthly injections? It is a better way of delivery and you don't have to think about taking the tablets? My sister's husband's mother is 93 years of age and is on blood thinners. She is probably taking too many tablets because her blood is very thin. My point is that it is not uncommon that people on tablets don't comply with the dosing schedule. Therefore maybe monthly firmagon injections would be better for you if you could organise it?
Hi, spoke to MO and he agrees to switch to Xandi; he is clearly concerned about the PSA rise. However, it's not quite as bad as I first thought. The jump from PSA 1.89 to 5.7 occurred over 2 months not one as I originally thought. I'm still very tempted to try a vacation, but I'll try Xandi First.
I have always been fascinated by the development of organic life on planet Earth. Our species has very gradually developed greater and greater freedom from the physical limitations imposed by Earth. Now, we are on the edge of even greater freedom with gene editing and AI. All that assumes we don't destroy ourselves first. From single cells to a creature capable of breaking the gravitational pull of Earth --amazing. I suspect you know what I'm going on about.
Xandi starts next Wednesday, but when I see the MO I'll discuss dropping Orgovyx. I never miss my dosing schedule.
Would you get provenge?
"Provenge (sipuleucel-T) is an immunotherapy used to treat advanced prostate cancer. It works by stimulating the patient’s immune system to attack prostate cancer cells. Though Provenge doesn’t directly reduce PSA levels or stop cancer progression visible on scans, it aims to improve overall survival by training the immune system to better recognize and fight cancer.
Studies have shown some improvement in survival rates for men with metastatic castration-resistant prostate cancer, but the effects can be subtle, making it harder for patients to see immediate changes like with other treatments. As for determining its effectiveness, doctors often look at long-term outcomes such as overall survival rather than immediate tumor shrinkage or PSA responses. If you’re interested, I can help you find more specific research on this treatment."
ChatGPT said
Not what you're looking for?
You may also like...
Rising PSA but low T
Hello, All. After two years on Zytiga, my PSA is creeping up (but still under 10), doubling about...
Psa versus T
Is it better to have low psa and higher T or vice versa? Going to mo tomorow, my psa ls 0.1 but T...
PSA rising…..Duke Champ?
In November I posted my concerns that my psa increased from.01 to.27 after 15 months of Zytiga....
Low PSA and high T=?
10/18: PSA was .2, T was 12
3/19: PSA is 3.9, T is 296.
I thought high T was supposed to increase...
PSA rising after aberaterone
I have CRPC heavily metastasized into the bones. I have been on aberaterone for about 9 months. My...
clear PSMA scan but PSA still rising 
Latest PSA & T
