Rising PSA after 1st Chemo Infusion?

[Cew0303]

Hello everyone! I have posted a couple of times before and appreciate how comforting and informative everyone is. I have an update on my dad's treatment progress and a question about rising PSA.

Brief history: My 60 year old father was diagnosed with stage 4 prostate cancer that has spread to his bones. He is undergoing triplet therapy with Lupron injections, Darolutamide, and 6 sessions of chemo. His initial PSA at diagnosis was 4800. After starting Firmagon (later switched to Lupron) and Darolutamide, his PSA dropped to 27! Unfortunately, the Darolutamide was causing elevated liver enzymes, so that was discontinued temporarily. His PSA was up to 37 on 10/8, which was 2 weeks after stopping Darolutamide. He had his first chemo infusion on 10/8 and got through it very well!

He just had his second chemo session yesterday. The doctor advised him to start Darolutamide again at a half dose and we can keep an eye on the liver tests and eventually titrate up to full dose. His PSA result yesterday was at 88, more than double his last result from 3 weeks ago. I have read about possible PSA "surges" after initiation of chemo, but could not get a clear answer from researching. Is this a common occurrence? Or could it have been that the Darolutamide was really helping to lower his PSA and it will start lowering again now that he's back on it? I know no one can tell me for sure and I have messaged the doctor and am awaiting a response, but hoped that maybe someone with experience has seen this happen before? I have read that the doctor will usually wait until 4 chemo sessions before deciding whether it is working well or not, so it's probably too early to tell and I'm just worried for no reason.

[SouthFrance]

I had PSA increase with docetaxel, oncologist said the scan is more important. I went from 52 to 82 but remain on chemo. Waiting for next tests now.

[Cew0303 in reply to SouthFrance]

Great to know, thanks for the response!

[Concerneddaughter123]

My dads psa has increased on chemo. We got his latest Psma scan results today, and after five chemo sessions there is slight improvement in his bone Mets. At his last appt his MO said he doesn’t worry too much about psa levels during treatment as they can fluctuate. While PSA levels can be a roller coaster, they don’t give us the whole picture.

[Cew0303 in reply to Concerneddaughter123]

Thank you for the response, I appreciate it!

[normanbyrott]

I didn't have chemo in the UK just the RT at St Thomas's in London, I was 60 then but it was caught earlier PSA was about 12.The chemo I have recently had was only 4 times and was for throat cancer, I also had 33 RT. I was never given any brand names so unfortunately cannot help.

I wish you both all the best.

[Bodysculpture]

It's not uncommon to have PSA bounce after first or second infusions I was told Hope he can get many more years with the right combo

[Cew0303 in reply to Bodysculpture]

Thank you, very good to hear!

[CAMPSOUPS]

My PSA rose after first or 2nd chemo infusion in early 2020 as is the case for many. My Dr. and a lot of the Dr.'s of brothers here describe the phenomnom as dead PC cells getting into the blood stream and being picked up on the PSA test.

You do have a unusual or harder to decipher situation. The stoppage of darolutamide or die off from first chemo infusions ?

I think he is going to fare well. Just will have to continue treatment and see what happens.

Hopin for the best for him. And you.

❤️❤️