Just looking for some guidance regarding my dad’s PSA results.
24 days ago his PSA was 44.5. That day, he received a Firmagon injection.
He had his PSA redrawn today and it is 3.4 (more than a 90% drop).
I was initially very excited and happy that it’s so responsive until I started doing more research. Is it true that a rapid decline could indicate that the cancer will become castration resistant sooner? Does anyone have any info or even just reassuring personal stories following a rapid initial decline?
He will also be starting nubeqa and docetaxel very soon.
Thank you!
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Luka1212
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It does not indicate that the cancer will become castration resistant sooner. Actually, it may be the other way around: the sooner the drop, the better.
Hopefully your dad will tolerate the treatments well.
Is it true that a rapid decline in your Prostate Cancer's PSA could indicate that the cancer will become castration resistant sooner?
ChatGPT said:
Yes, a rapid decline in prostate-specific antigen (PSA) levels during initial androgen deprivation therapy (ADT) can be associated with an earlier progression to castration-resistant prostate cancer (CRPC).
PubMed
+4
PubMed
+4
Europe PMC
+4
Key Findings:
Velocity of PSA Decline: A study involving 185 prostate cancer patients found that those with a PSA decline rate exceeding 11 ng/mL per month had a higher risk of progressing to CRPC. Specifically, these patients had a hazard ratio (HR) of 2.12, indicating more than double the risk compared to those with slower PSA declines .
PMC
+3
PubMed
+3
Lippincott Journals
+3
Time to PSA Nadir: Patients who reached their lowest PSA levels (nadir) within 9 months of starting ADT were more likely to develop CRPC sooner. A shorter time to PSA nadir was associated with an increased risk of progression .
Europe PMC
+6
PMC
+6
Cancer Cell International
+6
Possible Explanations:
Tumor Cell Heterogeneity: A rapid PSA decline may primarily reflect the suppression of hormone-sensitive cancer cells, leaving behind hormone-resistant cells that can proliferate, leading to earlier CRPC development .
PMC
PSA Expression Suppression: ADT may suppress PSA production without effectively eliminating all cancer cells, potentially masking ongoing disease activity and leading to a false sense of treatment success .
Clinical Implications:
Monitoring the rate of PSA decline and the time to PSA nadir during ADT can provide valuable prognostic information. Patients exhibiting rapid PSA declines may benefit from closer surveillance and consideration of additional or alternative therapeutic strategies to address potential early progression to CRPC.
Lippincott Journals
+6
PubMed
+6
Annals of Oncology
+6
It's essential to discuss these findings with your healthcare provider to tailor a treatment plan that considers your specific risk factors and disease characteristics.
In August 2017 within 3 months of my RP and within 7 months of my first Lupron injection, my PSA had dropped to <.02 and has been there ever since (my PSA is measured quarterly).
These are results for rapid psa undetectability on adt abiraterone and long term
AI Overview
Learn more
Rapid PSA undetectability on ADT (androgen deprivation therapy) with abiraterone is associated with improved long-term outcomes, including longer survival and a reduced risk of progression. While the benefits of combining abiraterone with ADT are well-established, the optimal duration of treatment and whether to continue abiraterone indefinitely after achieving undetectable PSA levels is still being investigated.
Also to be remembered: there are more arrows in the treatment armory for CRPC and more being added all the time.
I ran the exact same question in Grok 3 and it differs with the ChatGPT search that J-O-H-N posted. I am not saying one is better or more accurate. Obviously there are variations in AI search products and what sources it pulls from so as with any information be cautious, look at the sources and discuss with your physicians.
The below is just the overview from the search. The full report is too long to post here. Use the link if you want to read the full report with associated links and references. Take care, Bill
Grok 3
Is it true that a rapid decline in your Prostate Cancer's PSA could indicate that the cancer will become castration resistant sooner?
Key Points
Research suggests a rapid PSA decline is generally a positive sign, indicating effective treatment for prostate cancer, not earlier castration resistance.
The evidence leans toward PSA declines being associated with better prognosis, especially in castration-resistant prostate cancer (CRPC) treated with therapies like docetaxel and enzalutamide.
There is no strong evidence linking rapid PSA decline to faster development of castration resistance; instead, rising PSA is typically the concern.
Explanation
A rapid decline in PSA (Prostate-Specific Antigen) levels usually means the cancer is responding well to treatment, such as hormone therapy or chemotherapy. This is often seen as a good sign, suggesting the treatment is slowing cancer growth. Studies, including those on CRPC, show that early and significant PSA drops are linked to improved survival, not to the cancer becoming resistant to treatment sooner.
Castration resistance happens when the cancer grows despite low testosterone levels, typically indicated by rising PSA, not declining PSA. If you're concerned about your PSA levels, it's important to discuss them with your doctor, as they can provide personalized insights based on your treatment and health history.
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PSA DECLINING WHILE IT WAS RISING
PSA 1 month after SBRT
prostate cancer that does not produce psa
Update on my fathers 1st Lu-177-PSMA-617 treatment 
Significant decrease in PSA?
