Hello and Happy and Healthy New Year to all. My latest question:
When should our MO be concerned about a rise in PSA? My husband was diagnosed as metastatic in Sept 2021. Many mets to lymph nodes and bones. ( PSA was 7000+) He still has his prostate so I understand getting to undetected PSA is unlikely even though he had chemo and is now on lupron and abiraterone.
PSA was dropping with a few blips until July 2024. Lowest PSA was .5 But it has been creeping up since then to .86 in November and then 'dropped' to .85 in December. Husbands doctor doesn't seem concerned and says he's still doing fine. Had PSMA pet scan last April ( when PSA was also at .85) and then another PSMA pet scan in November showed no change since April. But maybe a scan in July when PSA was at its lowest would have shown smaller mets.
I suggested switching steroid to Dexamethasone or changing prednisone from once a day to twice a day but was met with a lets wait and see. Am I being too impatient?
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Bspouse
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I believe that if your husband trusts your Dr, -then follow their advice
if your husband doesn't trust his Dr - change
I know that I am not the Dr and that I can ask questions but do not have the information or training to tell my Dr what they should do.
I also believe that stressing over fluctuating PSA numbers - at these levels ( my own levels fluctuate similarly ) causes lots of stress and is not good for our condition
Thank you for your thoughtful response. My husband does trust the doctor so I keep a lot of my concerns to myself so as to not add stress to him. Instead, I upload my concerns onto this site. I am glad I did because your and Tall_Allen's responses have relieved my own stress levels. Thank you and God bless you.
you are more than welcome. in my opinion - and experience, THE most helpful thing you might do for your husband - and yourself - is to just be present and to encourage you both to continue doing the things in life that bring you joy - even a little smile in your eyes is pretty good medicine
Hello! If the results for PSA are below 0, this is really excellent result!
My father was diagnosed on January 2023, stage IV, lots of bone mets. His PSA was over 1600. He went through orchidectomy, and is currently on enzalutamide. PSA dropped below 1, and was stable for more than one year. Then it started to rise. In November 2024. PSA was 208. Doctor is checking PSA every 3 month, as well as CT, and bone scintigraphy. There are no new mets even though PSA rises, and bone mets are actualy smaller (shrinked). Therefore, doctors are keeping him on enzalutamide, despite PSA rise. I don't know how long will the therapy be the same. Father is in relatively good shape.
Bspouse said "PSA ... has been creeping up ... now on lupron and abiraterone ... I suggested ... changing prednisone from once a day to twice a day".
So that would be increasing the prednisone from 5 mg to 10 mg? I was not aware that prednisone dose affected PSA; I thought it was just to replace cortisol that was suppressed by abiraterone. And 5 mg is the normal dose, with 10 mg causing undesirable side effects.
Janssen, manufacturer of abiraterone (Zytiga), recommends the following dosage:
Recommended Dose for Metastatic CRPC
The recommended dose of ZYTIGA is 1,000 mg (two 500 mg tablets or four 250 mg tablets) orally once daily with prednisone 5 mg orally twice daily.
Recommended Dose for Metastatic High-risk CSPC
The recommended dose of ZYTIGA is 1,000 mg (two 500 mg tablets or four 250 mg tablets) orally once daily with prednisone 5 mg administered orally once daily.
But the OP's husband is apparently still castrate-sensitive, and she was proposing to increase the prednisone from 5 mg to 10 mg in order to reduce the PSA. I am not familiar with that use of prednisone.
I was under the impression that a rising PSA while on Zytiga would indicate castration-resistance. Is that incorrect? Not sure why, but supposedly increasing or changing the steroid can jumpstart the Zytiga if it is no longer working.
Yes, rising PSA would indicate castrate-resistance to Zytiga (abiraterone), which the Bio says he's been on for 3 years. But I have not read that increasing the prednisone dose would change that.
I have read that changing from prednisone to dexemethazone can gain more time on Zytiga. And that after Zytiga fails, Xtandi (enzalutamide) may work for a few more months. And then using Xtandi together with chemo Taxotere (docetaxel) as in the PRESIDE trial may work. prostatecancer.news/2022/10...
But the Bio says he already had Taxotere in 2022; was that with Zytiga at the same time?
This article about prednisone does say that the dose increases from 5 mg to 10 mg when castration-resistance occurs. The medical reason is not explained; it just says because of "shorter anticipated duration". I.e., not many years left to take it? prostatecancer.news/2019/06...
I think the MOwill probably recommend chemo again since my husband did well on it back in 2022. He still has his port which the use for monthly blood tests which we left in for if/ when he needs additional treatments.
Yes. He was started on chemo and Zytiga in January 2022 as part of triplet therapy which had just been approved as the standard. This past wee, PSA went up a little again to.87. Does that mean it is too late to switch to dexa?
Crazy as this may seem right now I am having the same , my psa has been 0.5 and now test shows 0.93. my MO has switched labs . like you I am stressing out. Go back to MO in a few weeks to review the results. I am taking Orgovyx and Nubeqa since the start, been on it for about 11 months. No SE's hot flashes now and then don't last long . Fan works great for that. From 7000psa to .5 and .85 is very good . Keep us updated
Maybe the change in labs is the reason for the jump on PSA. Also, take a look at the tests. There is a WHO standard (Siemens chemiluminescent). That will be 20% lower than the Equimolar standardization (Beckmann Coulter). So that could show a major difference if the new lab uses the equimolar type test. Prayers for good results for you.
Something to keep in the back of your head: I am having PSA tests almost monthly for the last 5.5years, hence, a rich data set to crunch. Doing this, I have detected a PSA seasonality, ie, during winter months PSADT srinks shorter to the opposite of summer months when it stretches longer.
Interesting. We only have 3 years of data, but there has been a raised PSA each year in Sept or October. Unfortunately, this year, it has continued to rise.
Breath, stay in the moment. Those results are phenomenal. PSA bounces around a bit. Wait until it really takes off or you get 3 or 4 consistent upticks. Otherwise, go for a nice walk and breath.
BSpouse - diagnosed 8/23 Gleason 8. Started Firmagon (lupron) shots 2/24. 5 weeks EBRT IN 2/24, HDR Brachy on 3.15.24. By this time, PSA & testosterone undetectable, where it has remained.
Started Abiraterone 2.1 .24. Primary issue is fatigue and some joint pain. I counter with walking 1-2 miles per day, and gym for weights 2x per week which helps but doesn’t eliminate fatigue & joint pain
Take 750mg Abiraterone sometime after I go to bed, but disciplined for no food 2 hours before & after dose
thank you for all this good info/advice. I think Dr is waiting for PSA to go over 2, but it seems like some Drs don’t wait. I would rather not wait
Husband hasn’t had an CT bone scan since his initial diagnosis in 2021 so I will ask for one. He just had a PSMA pet scan in November.
We were told radiation wouldn’t help him back in 2021 because he had a lot of lymph node mets. But maybe now that many have shrunk, they might be able to zap the larger ones that are left.
Thanks for the support on the dexa, I dont understand why they don’t do that now that it has risen each month for the past 6 months.
Three MO said no reason to radiation then I setup appointments to listen No again from radiation oncology but RO said I should take radiation and call all the three Dr so please visit radiology oncology same as MO I visit every 6 months
Quoting you: When should our MO be concerned about a rise in PSA?
Answer: When your dear Husband (the retired coach) calls time out and threatens to take him out of the game..... And a Happy/Healthy one to both of you.
Thank you. What were your PSA numbers when you switched to dexa? Did it cause you PSA to decline? Or stay static? Looking for more info to give the dr. He seems to think we need to wait until it goes up to 2.
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