Rapid rise in PSA

[Ian996]

On December 20 my PSA was 830 up from 609 on Dec 2

Yesterday Dec 23 my PSA was 950

I see the MO today any speculation on what he might tell me?

BTW I have had 4 rounds of chemo next infusion is Dec 27 Should I bother with this?

[God_Loves_Me]

Please also schedule CT SCAN immediate as well.

[Tall_Allen]

Consider switching to cabazitaxel + carboplatin.

[MWPesaPharmD]

Since you are already chemo-exposed (and not getting the efficacy you would want) -- you can ask your doctor for a PSMA PET/CT scan, >80% chance it would qualify you for Pluvicto (if you have had an ARPI (abi, xtandi, etc)

[Ian996 in reply to MWPesaPharmD]

I can get a Ga68 PSMA PET scan from a private lab only $3200, I have had a few already and the plan is to have another in January I was on Xtandi for 20 months Didnt work PSA was doubling every 10 weeks, I stopped xtandi when I started a clinical trial for Lu177 That didnt work either It was after the Lu177 debacle that they put me on Chemo

The result of this mornings conversation with the MO is " Stop all drug treatment give my body a chance to recover as my neutrophils, WBC and RBC are very low.

[Conlig1940 in reply to Ian996]

Where in Canada did you have your SBRT Treatment ? ALSO At what clinic did you have your Ga68 PSMA PET Scan ?

I live near Toronto and am currently considering both .

Thanks for your reply & keep a positive ( healing ) outlook as you move forward .

[Ian996 in reply to Conlig1940]

I had SBRT done at UCLA BC Cancer refused the treatment the oncologist thought it was too risky

I get the Ga68 PSMA PET scan done at Initio Labs in Burnaby

[Conlig1940 in reply to Ian996]

Thanks . I am looking at Monotherapy SBRT at Sunnybrook in Toronto using an MRI Cyberknife . The PSMA also in Toronto .

[spencoid2]

PSMA pect scan is more sensitive ect but in your case I do not see an reason to pay a lot more f it is not covered. the Ga68 should give you a good idea of the location and extent of your disease.

[dhccpa in reply to spencoid2]

Isn't the Ga68 a PSMA scan? Or did I misinterpret what you said?

[Seasid in reply to dhccpa]

Of course it is a PSMA pet scan

[spencoid2 in reply to dhccpa]

yes but it uses an older ligand.this is from chatgpt You said:

what is the currently used ligand for psma pet scans it used to be galeum now what do they use

ChatGPT said:

ChatGPT

Prostate-specific membrane antigen (PSMA) PET scans are pivotal in detecting prostate cancer. Historically, gallium-68-labeled PSMA ligands, such as ^68Ga-PSMA-11, were commonly used. In recent years, fluorine-18-labeled ligands have gained prominence due to their favorable imaging characteristics.

Two notable fluorine-18-labeled PSMA ligands currently in use are:

Piflufolastat F-18 (Pylarify): Approved by the U.S. Food and Drug Administration (FDA) in May 2021, Pylarify is utilized for PET imaging in men with prostate cancer.

Wikipedia

Flotufolastat F-18 (Posluma): This agent received FDA approval in May 2023 and serves a similar diagnostic purpose in prostate cancer imaging.

Wikipedia

The adoption of these fluorine-18-labeled ligands is attributed to their longer half-life compared to gallium-68, facilitating broader distribution and accessibility for PET imaging procedures.

UroToday

It's important to note that the choice of PSMA ligand can vary based on regional availability, clinical guidelines, and specific patient considerations. Consulting with a healthcare provider will provide the most accurate information tailored to individual circumstances.

[dhccpa in reply to spencoid2]

Thanks. I was aware that Pylarify was thought by some to be superior. Therefore, I was surprised to find from the report that the one I got here in July was Ga68, since the Pylarify arrived 40 miles away at least a year earlier.

[spencoid2 in reply to dhccpa]

however in the case of major disease like mine or yours? it hardly makes any difference? if you get one paid for and have to go broke paying for the other i think the choice is clear.

[dhccpa in reply to spencoid2]

True, and apparently there's never been a large head-to-head trial, admittedly hard to do on the same patients. Both supposedly far superior to previous PETs (except for non PSMA-avid cells).

The third tracer you mentioned is new to me.

[Seasid in reply to dhccpa]

Bought have a same specificity and accuracy. And bought are PSMA pet scans. Gallium have a shorter half life and it requires better organisation of the nuclear medicine department therefore they don't like it but for the patient shorter half life is better resulting in less radiation.

[Seasid in reply to Seasid]

You are absolutely correct that both gallium-68 (^68Ga) and fluorine-18 (^18F) PSMA PET scans have similar specificity and accuracy in detecting prostate cancer. Both are excellent tools for imaging prostate-specific membrane antigen (PSMA), but there are key differences that influence their use:

Gallium-68 PSMA Tracers

Shorter Half-Life (~68 minutes):

Results in lower overall radiation exposure to the patient, which is a clear advantage.

Requires efficient coordination in nuclear medicine departments due to its rapid decay, limiting flexibility in scheduling.

Production:

Typically requires an on-site or nearby ^68Ga generator, making it less convenient in facilities without this infrastructure.

Lower production yield compared to fluorine-18 tracers, limiting the number of patients who can be imaged per production batch.

Imaging Considerations:

Slightly lower resolution compared to ^18F due to higher positron energy, though this is not clinically significant in most cases.

Fluorine-18 PSMA Tracers (e.g., Pylarify)

Longer Half-Life (~110 minutes):

Facilitates centralized production and distribution, making it more logistically convenient for nuclear medicine departments.

Slightly higher radiation exposure to the patient compared to ^68Ga tracers, though the difference is modest and within safe limits.

Imaging Advantages:

Better spatial resolution and image clarity due to lower positron energy, which can aid in detecting small lesions, especially in challenging cases.

Wider Availability:

More practical for larger centers and facilities without on-site cyclotrons or ^68Ga generators.

Patient vs. Operational Considerations

For patients, the shorter half-life of ^68Ga tracers can indeed be a benefit due to reduced radiation dose, though the difference in exposure between ^68Ga and ^18F is small and unlikely to have a major clinical impact.

For nuclear medicine departments, the logistical ease and scalability of ^18F tracers like Pylarify often make them the preferred choice.

Conclusion

Both ^68Ga and ^18F PSMA PET scans offer high accuracy and specificity, and the choice often comes down to logistical and operational factors rather than clinical efficacy. While ^68Ga tracers are slightly better for minimizing patient radiation exposure, ^18F tracers may provide marginally clearer images and greater scheduling flexibility. Ultimately, patient care should prioritize accessibility and timely imaging over minor differences in radiation exposure.

[PcaFix]

I am not an expert but have you had your Vitamin D levels checked? There is anecdotal evidence that chemo is far more effective when your Vitamin D levels are normal. See this very short youtube: youtube.com/watch?v=qZdm2K3...(Not working as expected?) There are longer, more detailed videos out there.

[woldpack25]

950 not 9.50?

[speranza10]

Have you done genetic tests to see if you have any mutations like brca? These could open the doors for other treatments like olaparib (lymparza) and it is important to do tests of both the blood (germinal) and of the tumor tissue itself via biopsy (somatic). So in case of positivity both parp inhibitors and platinum-based chemotherapy could work

[NecessarilySo]

See my bio re spine mets.

[SillyUserName2]

If you aren’t on Lupron plus an antiandrogen such as abiraterone, then get on them ASAP.

[Ian996 in reply to SillyUserName2]

I am still taking Zoladex and have been for over 5 years

But in my uninformed opinion the Zoladex isnt working My pSA is rising and my testosterone levels are at an all time low

I was taking xtandi for nearly 2 years until I started a trial for Lu177 also prior to the trial the xtandi proved to be ineffective as my PSA was doubling every 10 weeks

[SillyUserName2 in reply to Ian996]

Your only hope might be to get onto the Fenbendazole.org Facebook group. This is an active group and many of thier members have used both Fenbendazole and ivermectin to treat their cancers.

[speranza10]

cabazitaxel?

[Ian996 in reply to speranza10]

I think Cabazitaxel is next Already discussed this with my MO

[speranza10]

Cabazitaxel?

[dmt1121]

I have gone through docetaxel treatment after my RP but my PSA was much lower and earlier in my disease. I personally do not believe chemo is an effective treatment for PCa. but is used as a form of generic "carpet bombing" that may have some value when combined with other treatments.

It's a very personal decision based on your remaining options and the side effects. For me, I have told my oncologist that chemo is not something I will go through again, given it's less than remarkable performance. When my disease progresses and I am closer to the end of the line, I either want a treatment that really adds to my OS with few side effects or I will live life without treatments as long as I can. Of course that may change when I am facing the reality of my situation. Lol.

Good luck.

[Seasid in reply to dmt1121]

Good point.

[Seasid in reply to dmt1121]

I tried to find out what was your treatment until now. ADT, early docetaxel chemotherapy plus Abiraterone. What is your PSA now?

[dmt1121 in reply to Seasid]

My PSA has been rising from an "undetectable level" of .05 now to .12 It is rising, as the effectiveness of the abiraterone wears off. I expect it will accelerate but have begun Hot Extract White Button Mushroom Extract supplements which may help slow it down before taking more drastic measures.

[Seasid in reply to dmt1121]

I read some case report 5 years ago which argued that the PSA could stabilise around 10 but the PSA value loses the correlation between the cancer and PSA. It means that the case report argued that the PSA alone is not indicative of the spread of your cancer.

I am not a doctor just remembered that case study. You probably need imaging like CT, MRI and nuclear medicine bone, FDG pet scan etc.

My understanding is that at some point even the PSMA pet scan results may not be indicative of the spread and the location of the cancer as we go into a castration resistant phase. I believe that TA had something about the PSMA avidity in a CRPC setting.

Unfortunately you decided to keep empty your profile and I can't really understand your situation. I just know by reading this site that usually people switch from prednisolone to dexamethasone when Abiraterone start to lose its effectiveness. The other option is to change to Enzalutamide. It will probably not last long but you could do imaging and if the cancer is localised you could maybe consider SBRT it if it is safe.

I hope you have some good doctors and if not find some. Maybe even a team. I don't know where are you located but I always believed that Dana Farber cancer institute or memorial Sloan Kettering cancer centre is a good place to ask for a second opinion. Don't rely on the opinion of one doctor.

If you could feel out your profile it would be great.

Marry Christmas to you and your family from István Hoffmann.

[speranza10 in reply to dmt1121]

There was a study (I don't remember the name) that showed that after the failure of abiraterone it is better to do cabazitaxel rather than enzalutamide. It is likely that Allen knows the name of this study and other details of it. I can tell you from experience, not mine but from my father that cabazitaxel is better tolerated than docetaxel and more effective. In my father's case docetaxel did not work at all instead cabazitaxel worked well he did 14 infusions, which allowed to keep the disease stable for more than 1 year. If I were you I would give it a try if abiraterone were to fail. Start if you see that the side effects are too many you stop

[dmt1121 in reply to speranza10]

Thank you for your insight. I will do some further checking on its efficacy.

[Seasid in reply to dmt1121]

I just read very recently that one of our member wrote (I can't recall the name) that at the start he was taking abiraterone on empty stomach and when abiraterone started to fail they said to him to take it with food.

I am not suggesting myself for you to do it, but maybe you could ask your medical oncologist if it is a viable option? The absorption of the drug would go up and you may have more side effects and even toxicity. You will maybe end up with high blood pressure and you may need to adjust the accompanying prednisolone up a little bit in order to compensate for the missing steroids. ( I am not a doctor but I thought you could ask your medical oncologist about that possibility?)

[Seasid in reply to Seasid]

Your message raises an interesting point about medication adjustments, especially concerning abiraterone. It’s true that taking abiraterone with food can significantly increase its absorption, which may enhance its efficacy but also potentially increase the risk of side effects or toxicity. However, any changes to how the medication is taken should always be guided by a medical professional.

If someone is considering this option, it’s essential to discuss it with their oncologist. The oncologist can assess the potential risks and benefits, monitor for side effects like elevated blood pressure, and adjust other medications like prednisolone if necessary. Self-adjusting medications or how they’re taken can be risky without medical guidance.

Your suggestion to approach the topic carefully with a doctor shows a good balance of curiosity and caution. Would you like more information on this topic or about abiraterone in general?

ChatGPT said

[speranza10 in reply to Seasid]

I have also heard that taking it with food can increase the effectiveness of Zytiga. Usually people who take it with food only take 250mg of Zytiga. I imagine that this person took it with the full dose, do you happen to know what results he got?

[Seasid in reply to speranza10]

As I said I can't remember his name but he started with full daily dose of 1000 mg of abiraterone morning on empty stomach. When abiraterone started to fail they advised him to take the full daily dose with food in order to have a higher absorption. To be honest that is how I remember but it was recently. I believe (my impression was that it was effective but I can't recall for how long.) next time I have to be more aware when I find something like that interesting and wright it down not just rely on my memory.

[Seasid in reply to Seasid]

It sounds like the person you’re referencing made an interesting adjustment to their abiraterone regimen. Taking the full dose of 1000 mg with food to enhance absorption could potentially provide a temporary boost in effectiveness when the drug begins to lose its impact. However, this approach would increase the risk of side effects due to the higher absorption rate.

Unfortunately, without specific details or follow-up on that person's outcomes, it’s hard to say how effective this strategy was or for how long it worked. It’s a reminder of how personalized cancer treatments can be and why it’s so important to keep track of useful insights like this.

Your idea to note these cases down for future reference is a great one! If you'd like, I could help you find more recent studies or patient stories about similar approaches with abiraterone. Would that be helpful?

ChatGPT said

[speranza10 in reply to Seasid]

Thank you, very interesting. This reasoning has a logic, we all know that food increases the absorption by the human body of Zytiga, so I imagine that more absorption more effectiveness. Of course it must be done under strict medical supervision because an overdose of Zytiga could cause big problems.

[Seasid in reply to speranza10]

Until a normal dosage works I would not increase, I would rather decrease or even drop abiraterone for some time if it is possible by only staying on degarelix or orgovix.

[Seasid in reply to Seasid]

I am seriously considering bilateral full orchiectomy.

[speranza10 in reply to Seasid]

Of course, as long as the normal dosage works it is best to stay on that.

[Ian996]

On Jan 2 my PSA was up to 2400 and as of yesterday is 2730

All my blood work numbers are trending down over an 8 week period

I no longer qualify for trials or any more chemo so we stopped all treatment