PSA .75 after Doublet Therapy (Firmagon & Nubeqa) started August 2024 (PSA was 383) When Should Schedule PSMA-Pet Scan?

[Rcole727]

After PCa reoccurence, after Proton therapy in 2009, started Doublet therapy.. Firmagon & Nubeqa in August 2024 and PSA just tested January 16th, is .75. Wondering when I should have 2nd PSMA-Pet scan to check on bone & lymph node mets which lit up scan in August 2024?Thanks for any input.

[Tall_Allen]

If your PSA goes steadily up to see if it's time to change therapy.

[GP24]

Wait until the PSA value gets above 2.0 and get the PET then.

[EdBar]

My onco, Dr. Sartor, recommends a scan once I hit 0.2. I’ve done that twice in the past 2 years and each time it showed a met on a rib that I treated with SBRT and PSA fell back to nearly undetectable. He said that I can continue to do this indefinitely depending on number and location of tumors.

Ed

[dhccpa in reply to EdBar]

That's good advice in my opinion, but I suspect Dr. Sartor is in a tiny minority. Agree or no? Either way, sounds like he is a great doctor based on everything you've told me. He's on my short list for warmer weather if I can get in to see him.

[SilverSeppi in reply to dhccpa]

0.2 sounds awfully low (to me) to be of concern...

[Rcole727 in reply to SilverSeppi]

Agreed.

[dhccpa in reply to SilverSeppi]

I understand, but he said each time they found a met that he then treated. With ongoing metastatic PCa over many years, I suspect you grow to appreciate a very proactive doctor. Admittedly, they have to make good decisions based upon their actions, but I wish my own local doctors were much more proactive without me having to prompt them.

[garyjp9 in reply to EdBar]

Does he recommend waiting until there is trend upwards of the PSA (usually 3) or does he recommend getting it as soon as you hit 0.2, even if there has not been an upward trend? Tks

[EdBar in reply to garyjp9]

As soon as I hit 0.2, usually by the time you get everything scheduled it’s a tad higher.

[jazj in reply to EdBar]

It seems so strange to me that one could have positive results for metastases on a PSMA PET at a PSA of 0.2 and yet most Oncologists don't recommend doing any sort of salvage treatment for early stage recurrence until at least 0.2. Now if the MO said, it's because we have no proof the cancer can metastasize prior to a PSA 0.02 I can see the rationale. I guess the standard of care for those patients at that early stage is to error on the side of undertreatment vs overtreatment?

I guess maybe the point I'm missing is a patient that came up to a 0.2 never having gone higher is much different from a patient who had already confirmed advanced stage and came down to a 0.2 with systemic therapies? But if you aren't on systemic therapy, isn't a 0.2 a 0.2 despite your stage? (Excluding the 10-20% of patients that have PCa that does not produce much PSA?) What am I missing?

[Carnivore45]

Rcole 727, you have already received some good advice , but the Health Unlocked asked me to comment on the Firmagon and Nubeqa. Adding to Tall Allen's comment, it is the trend line that gives you direction, so watch the next few monthly blood tests.

You did not say why you are not having Docetaxel chemo along with the Firmagon and Nubeqa. Chemo could be a factor in determining the timing of the next scan. With or without chemo, the Nubeqa will extend your life so as long as you can tolerate any side effects, you should continue taking it.

Firmagon is the initial ADT drug of choice because it has fewer cardio events and does not cause a spike in testosterone as Lupron does. However, at this point in your treatment, you might discuss with your MO the idea of switching to Lupron for a few reasons. 1) Once on ADT for awhile, you do not need to worry about a T spike or cardio event. 2)The Lupron IM shot is much less painful than a Firmagon subcutaneous injection and also has no back pain as does Firmagon for several days after the injection. 3) You can get the shot every 3, 4, or 6 months instead of monthly which gives you more flexibility in life. I personally switched after one year and am very happy that I did so.

I wish you well in your treatment!

[Rcole727 in reply to Carnivore45]

Thanks for the insight Im ok with Firmagon.... mild injection site pain that really doesn't disturb me. No back pain exerienced. I dont mind the monthly trek to the urologist's office.I elected not to add Doxcetaxel and after reviewing the recent Phase III ARANOTE trial results I'm ok with my decision.

[jazj in reply to Carnivore45]

I'm just curious, is there a big reason why one would use Firmagon instead of just taking Orgovyx tablets other than fear of forgetting to take the tablets? My general knowledge is that they are about the same as far as testosterone suppression long-term but Orgovyx does it quicker, has a better safety profile for cardiovascular events and doesn't require painful injections.

[j-o-h-n]

Wondering when I should have 2nd PSMA-Pet scan to check on bone & lymph node mets which lit up scan in August 2024?+

You're asking us, the jury, when it may be best if you ask your M.O., the judge .

Good Luck, Good Health and Good Humor.

j-o-h-n

[Rcole727]

Yes, of course....the combined knowledge of all you warriors is, to me, worth the ask.

[Eieio in reply to Rcole727]

It’s usually something you want to track with DURATION of doubling time.how many weeks months etc. Also if you have had historically low PSA. So the relative percentage increase instead of just a number.

[WildBillTesla]

I have had a biospy 2 years ago, as my PSA has gone up & down over the years, since 30 years but in trying to get a clearance for a position the doctor has to be coached on PSE, NanoKnife, ozone therapy, so it shows how much of a deficit of knowledge the urologists profession seems to be about prostate issues! It's too tempting to get another biodpy, push a few more pills.

[jfoesq]

My understanding is that the PSMA is usually not going to detect much or anything, until pSA hits at least .20 My PSA steadily increased a few yrs ago and after it rose above .20, I had the PSMA that revealed a particular tumor was likely the culprit. I had it radiated and PSA dropped below .05 for a few about 6 months before steadily increasing the 18 months or so. When it reached exactly .20 my MO suggested we wait for one more 3 months period before having it tested again. I waited, and my PSA hit .35 and then I had the scan. A different tumor appears to be the cause of the rising PSA and it will be radiated this week. I hope it will reduce the PSA to below .05 again

[Noname1960]

I had Gleason 9 prostate cancer in 2017 and had surgery to remove my prostate less than a month after it was discovered. They said it was caught early since it was only in 3 of the 12 biopsies they took. I had surgery less than a month later and it was already in 19 of the 22 lymph nodes they removed. Since then I had to have 40 radiation treatments a little over a year later and my doctor said he didn't even want my PSA to hit 0.1 because the Gleason 9 was so aggressive and since I didn't have a prostrate I shouldn't even have a PSA that you could detect unless the cancer was coming back. A little over a month ago it hit 0.1 again and I am having a PET scan tomorrow and see my oncologist on Wednesday which he will probably want me to do radiation again. I would do as the doctor suggests especially if you had a Gleason 6 or higher.