My dad (73) was diagnosed with stage 4 prostate cancer in february 24 after he lost a lot of weight, was really weak and in a lot of pain. He had a initial PSA of around 3.900 (yes, threethousandandninehundred), ALP of 900 and bone mets through his whole body but fortunately not one in his organs or lymph nodes. His Gleason is 9. He underwent the triplet-therapy with Nubeqa, Lupron and Docetaxel which brought his PSA down to 26.9 and his ALP down to 150 in September 24. All was stable, he gained 20 kgs and he has no longer any pain and feels well.
In October 24 his PSA was 30.1, in the end of November 31.4. The ALP dropped to 90. Problem: the PSAs were from different laboratorys. In December 24 an January 25 he had a lot of water in his body and went to the hospital. He had also signs for an infection in his body but was treated for the water. He lost 8 liters (2.11 gallons) in one week. Prior to hospital his PSA was taken and was a shocking 47.8. His ALP dropped at the same time to 70, all time low.
A few days after the hospital we spoke to his urologist about his treatment. He took also his PSA and prescribed him Xtandi instead of Nubeqa because he thought he is now castrate resistant. The PSA from this day came back with 34. So his PSA dropped prior to Xtandi from 47.8 back to 34 and maybe further as his infection got in the next weeks better. Now he is on Xtandi but as i understand the numbers, the rise was maybe triggered from the infection and not from a castrate resistance. he also peed a lot at this time. What do you think? Was the change from Nubeqa to Xtandi to early or was it maybe good to get rid of the rest of the active cells in his prostate?
His next appointment at his urologist is next monday with his first PSA after 8 weeks on Xtandi. He feels good besides extreme fatigue and hot flashes every hour.
Dad’s latest blood results - PSA down , ALP down , T up 
Can psa fluctuate while on adt?
Xtandi fail chemo next
Keytruda update 
