New Blood Tests interrupting a friendly trend. Seeking advice.

[Philly13]

I started Firmagon on May 8th and Zytiga/prednisone on June 9th of this year. Blood work indicated very good progress until this week when my PSA increased to 6.0 from 4.7 in the last month.

ALP= 64

steady. Alt=15 and AST=16 steady, LDH increased from 119 to 145 up but in the normal range. The only troubling number in the rest of the comprehensive blood work is Creatinine, which is low. The distance on my drives is evidence that I am losing strength. Interestingly, I played well. My new theory is that the absence of testosterone is good for golf. I don't take stupid chances on low % shots. Better course management. Two birdies on the front nine for a 40.

I am disappointed but trying to convince myself that PSA measurements can be erratic and I should wait to see if this is a trend. I go for my Firmagon shot next week. I am not scheduled to see the doctor until December.

My current plan is to wait a couple of weeks, repeat the test to see if there is a new trend or this was an aberration. If it goes up further, then I will notify the Dr and discuss if a further reaction is warranted.

If anyone has an opinion on whether prompt attention is required or a little patience at this time. I am obsessive about testing every month, and I track everything while watching the above for signs of cancerous growth besides PSA. the Docs try to discourage me from testing, but I think it has saved time for me and I have experienced very rapid escalation kast spring when my Psa shot up from 6 to 47 in less than a month.

Thanking everyone in advance for sharing thoughts.

Steve

[Tall_Allen]

Hi Steve,

I'm struggling to understand your current situation. I'm guessing you had surgery but no salvage radiation, just metastasis-directed therapy on 3 bone mets, and ADT with Zytiga. You are currently castration-resistant and possibly failing Zytiga. Is that right? If so, you may get some extra mileage from Zytiga by switching from prednisone to dexamethasone. After that, Xofigo or docetaxel (either with Provenge) would be a good choice. If your cancer is PSMA-avid, you can pursue a PSMA-based therapy.

[Philly13 in reply to Tall_Allen]

Thanks.

I had surgery in December 2017. PSA nadir was .58 at 90 days. It then started to rise and after it got to 1.1, the oncological radiologist convinced insurance to approve an Auximen PET scan. It indicated 3 METs with no evidence of further involvement. I decided to radiate the hot spots and see what happened. (against your advice) I began monitoring my PSA monthly, and it went down to .6 shortly after the radiation. I continued to monitor and PSA bounced around between 1 and 2.5 until January-February of 2019. Up to 3.5 down to 2.7 and then up to 4.6.

I requested another Auximen scan and got it on April 12. It showed significant progression in METS. Still no evidence there of activity in any lymph nodes or organs. I went to MSK on May 6th and PSA progressed to 47 in less than a month. I immediately started Firmagon in New York while searching for a coordinating Oncology team in Philadelphia. I started Zytiga on June 9th and I was making steady progress on all fronts. PSA dropped to 4.7 by September 10th which. The other cancer indicators like ALP and LDH dropped. ALP peaked at 149 now steady in the 60's. LDH peaked at 190, dropped to 119 in August and up to 145 this month. WBC is now 3.3 and RBC is 4.17. WBC was 6.48 on June 12 and RBC was 4.82.

I have one off-trend PSA test from 4.7 in early September to 6.0 in early October. I suppose after reading your question, my question is if that is a sign I am becoming castration resistant.

Best

Steve