Definition of Hormone sensitivity

[CoastalTex]

I was diagnosed with Stage 4 prostate cancer in summer 2023...PSA peaked at about 10. Using Firmagon and Zytiga, PSA dropped to 0.03 in December 2023. My MO declared I was 'castration sensitive' around that time. Over the next 15 months, my PSA increased to 1.21 (while still on Firmagon, Zytiga for a bit before switching to Xtandi because of liver enzyme issues) After starting docetaxel infusions last month, my PSA is back down to 0.18...hopefully to drop further.

Clinically, should I now be categorized as 'castration sensitive' or 'castration resistant? The reason I ask is that some potential treatments (Erleada, Nubeqa) will depend on how my condition is classified.

Any help is much appreciated. My doctor's only comments was that I seemed to be 'on my way' to castration resistance, but that was before by PSA dropped to less than 0.20.

[Tall_Allen]

If your bone metastases did not show up on a bone scan, you are classified as non-metastatic castration-resistant. That qualifies you for Erleada and Nubeqa.

[CoastalTex in reply to Tall_Allen]

Currently multiple bone mets in torso (hence, Stage IV), so should I assume I'm not eligible for Erleada and Nubeca?

[Tall_Allen in reply to CoastalTex]

Try for it. Insurance will sometimes cover it anyway.

The PRESIDE trial showed that Xtandi resistance can be reversed:

prostatecancer.news/2022/10...

[God_Loves_Me in reply to Tall_Allen]

Learning questions -

I failed Xtandi and MO suggest for Docetaxel and I asked for Xtandi with it however he said NO. He told me Xtandi already failed and insurance will not approve with Docetaxel . Why does he is saying that ?

[Tall_Allen in reply to God_Loves_Me]

He should send Insurance the PRESIDE results and at least try to get authorization.

[CoastalTex in reply to God_Loves_Me]

My consulting (out-of-state) MO said Xtandi would be stopped when docetaxel was administered. My local (San Antonio) MO was ready to combine docetaxel with Xtandi as part of triplet therapy, but he changed his mind and told me there were drug interactions between the two. Not sure if that's true. My San Antonio-based MO is an experience oncologist, but advanced PC is not his specialty. I've been unable to find a PC specialist in San Antonio, and might eventually end up in Austin or Houston...long drives from where I live.

[NecessarilySo]

From healthline.com/health/prost...

Diagnosing castrate-resistant cancer

After you begin hormone treatment, your doctor will regularly measure levels of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by prostate cancer cells. If PSA levels start to rise while you are on hormone therapy, this can be a sign that the treatment has stopped working and the cancer has become castrate resistant.

Another sign that hormone therapy has stopped working is the spread of cancer outside the prostate or the growth of existing tumors.