PSA still very high on lupron

[6251]

PSA over 300 at diagnosis, down to 55 after first one month Lupron injection, down to 40 after second injection. Does this count as good enough progress?

[Tall_Allen]

Discuss adding an ARPi (abiraterone, enzalutamide, apalutamide or darolutamide).

[6251 in reply to Tall_Allen]

What's the downside of adding ARPI?

[Tall_Allen in reply to 6251]

Side effects.

[MarylandGuy in reply to Tall_Allen]

Darolutamide is what I was given with a psa of 200. It took it down under 1 in a few months. It is also known as nubeqa.

[JohnInTheMiddle]

Please fill out your bio, including your jurisdiction. You're on the advanced prostate cancer forum, which suggests metastasis, as does the measure of PSA. If in fact you are metastatic then your current treatment is strangely minimalist. As for side effects, one of the side effects of adding an ARPI is "you won't reach the end so quickly". If of course it is appropriate. I'm on it.

[6251 in reply to JohnInTheMiddle]

metas to bone. I live in Asheville NC. What do you mean ...the end so ..? the ultimate end? the TTN? the time ADT becomes ineffective?

[JohnInTheMiddle in reply to 6251]

I was trying to be polite. The end is the end of our time on earth.

And as for your monotherapy, from the little information that you have shared it seems to be not just strangely minimalist, but criminal under treatment. Because as you say you have mets. In other words you are metastatic.

Advanced combination therapies are now becoming standard of care and based on huge randomized control trials the probability of living longer with some okay quality of life is very high. Just being on Lupron is the standard from 15 or 20 years ago.

May I ask what sort of doctor you were being treated by? A physician, a urologist, an oncologist? And are you covered by insurance?

The good news is that combination therapies can be very tolerable, in addition to delivering a longer lifespan.

[Mike65g in reply to JohnInTheMiddle]

Not helpful reply. This is underscored as my reaction and opinion.

[32Percenter in reply to Mike65g]

What wasn't helpful about it? He was literally telling the guy that if he intensified his therapy he'll have a longer overall survival. Should this have been private?

This is a forum, fora are where groups gather to have discussions and share ideas. If we DM everyone answers to their questions about treatment we may as well just be exchanging email addresses.

[Seasid in reply to 6251]

You should get early (upfront) chemotherapy 6 cycles as soon as possible because you are diagnosed de Novo polymetastatic.

[Seasid in reply to Seasid]

I had early docetaxel chemotherapy,

and my PSA is now almost 7 years later still only 2.3 and still going down.

After chemotherapy I stayed on ADT injections only for a long time and two years ago I had SBRT radiation to my prostate and a year ago at PSA 2 I added Bicalutamide.

[Mike65g in reply to JohnInTheMiddle]

This is fine but could have usefully be sent as a dm? I am posting this in the spirit of helpfulness and constuctivity.

[JohnInTheMiddle in reply to Mike65g]

People visit this site looking for answers. It's not a kindness to allow terrible information to stand. While many people find support here, it should not be at the cost of clear and up-to-date information. Especially because it seems that adoption of demonstrably better therapies is a little patchy.

[Lettuce231]

Definitely 👍,

[Newtonmore]

In UK, my understanding is: Abi is prescribed to patients with high Gleason score & PSA who have "locally advanced PC" as an addition to ADT and rads. Enzalutamide is for those with metastatic cancer, apalutamide is only prescribed for those with "castration resistant" PC, i.e., stoppped responding to ADT etc

[lcfcpolo]

On the positive your PSA is trending downwards. Some say that the longer you take to get your PSA down to a low point of under <1 the better and the longer it will stay low. I'm on Lupron shots, now every 3 months but after 8 weeks from diagnosis also started on daily Enzalutamide (Xtandi).

[Teacherdude76]

My personal experience is: G9, aggressive, 20.6 PSA in 2015. Radiation & HDR Brachy.Monthly lupron, my choice, PSA dropped to 0.24. Minimal side effects, hot flushes at night often, low energy offset by gym time.

PSA Rose to 3.24 after18 months. Nubea & Luprin dropped PSA to 0.08. After three years(Ish) vacation from meds for 10 months & back in Nubea/Lipton with psman scan showing an L2 spine met. Radiation zap& all gone.

As to side effects? The usual but very manageable. Well worth to treatments.

[Teacherdude76]

Heading the right direction! Stay the course. Ask about Nubea in addition

[Professorgary]

if you have bone Mets you want it to take at least 9 months to hit nadir, no bone Mets you want it to take at least 12 months. It’s still going down, don’t make any changes until it starts to rise for 3 readings in a row. If you research it you will find that a rapid drop to nadir equals a poor prognosis. God bless.

[32Percenter in reply to Professorgary]

I believe your last assertion applies only if the nadir fails to drop below 0.2

[Professorgary in reply to 32Percenter]

I honestly do not remember that however I do remember that prognosis was worse for men who did not go down to .2.

[j-o-h-n]

Greetings June 2, 1951,

Would you please be kind enough to update your bio. All information is voluntary, but it will help us help you and help us too. Thank you and keep posting!!!

Good Luck, Good Health and Good Humor.

j-o-h-n