PSA rise negative PSMA

[kreg001]

Bicalutamide mono therapy worked great for nearly three years. PSA <0.1, T~300-400. Starting Dec. 2023 PSA began rising. Tried Lupron Depot in July. PSA has continued to rise. Now at 2.7. Ga PSMA PET last week reveals only a “mild to moderate uptake in prostate region near residual brachytherapy seeds”. No evidence of metastases. What else can cause PSA rise? Diet, illness (I had a colonectomy), infection (I was septic last spring), new knee, exercise (lot of rehab), …? Thanks, as always.

[ragnar2020]

Hi kreg001,

Have you done genetic and CTC (circulating tumor cell testing) or somatic testing yet? Essentially a liquid biopsy? Some forms of PCa do not show uptake during a PSMA PET scan, so its important to try and find out exactly what is the type of gene make-up of your PCa cells if possible.

[kreg001 in reply to ragnar2020]

I did the PROMISE trial. No markers. As a chemist I assume my PCA is environmental. I’ll ask about CTC. Thank you.

[Tall_Allen]

It's called, non-metastatic castration-resistant PCa. There are 3 drugs approved for it: Xtandi, Erleada, or Nubeqa.

Your PSA is from metastases that are too small to see with a PET/CT.

[kreg001 in reply to Tall_Allen]

Thanks. Again.

[kreg001 in reply to Tall_Allen]

ARi darolutamide?

[Tall_Allen in reply to kreg001]

Nubeqa is the brand name of darolutamide.

[VictoryPC]

If you use Bicalutamide with PCSPES it will work for 10 years like it has for me. All I'm saying.