When does rising PSA indicate mCRPC

KM Clark I was DX 10/14 with close to the same markers on I being 63 was offered Lupron It did lower my PSA 1.4 . Not content went to MD Anderson They recommended IMRT for local control and continue ADT. No SE from IMRT but still dealing with ADT have been able to keep strength up with diet and exercise. PSA now .23

It depends on whom you ask and for what purpose the definition is being used (e.g., a clinical trial). The general definition is consistently rising PSA in spite of castrate levels of testosterone. But your clinical trial may have its own definition. For example, the Prostate Cancer Working Group 2 definition of biochemical progression (used in many clinical trials) is "the date that a 25% or greater increase and an absolute increase of 2 ng/mL or more from the nadir is documented, which is confirmed by a second value obtained 3 or more weeks later."

However, your insurance company may allow you to have the medicines that are FDA-indicated for mCRPC (i.e., Xtandi, Zytiga, Provenge, and Xofigo) based on your current PSA values (check with them). You are eligible for Taxotere now irrespective of castrate resistance, based on your metastases alone.

- Allen

Hello KMCLARK1,

Welcome to our band of brothers here ! Looks like you've had tremendous response to the ADT hormone shots, bringing your PSA down to low decimal levels. That's tremendous, and looks like you are doing well.

I had a similar PSA level at diagnosis. The ADT hormone shots also brought my PSA down to low decimal levels, similar to yours. After a few months, I reached a plateau, the nadir point. My PSA wasn't going down any further, and then began to rise.

Right at that time, the new "early chemo" plan was adopted across the nation, based on the success of the CHAARTED study, which showed survival advantage for fellows like us. So, in the summer of 2014, I went through a series of six Taxotere chemotherapy infusions --- one infusion, every three weeks, for a total of 18 weeks.

As my oncologist explained, the chemo treatments are able to attack against many of the residual cancer cells that the ADT hormone shots can not attack.

Adding chemo treatments to your current treatments is certainly an individual decision. However, based on the statistics you shared, I think it would be beneficial to have a frank and honest talk about the possibility of pursuing chemo treatments for your case, whether you pursue them now or down the road. Having that conversation at your next appointment would be a conversation worth pursuing, just in the interest of due diligence and considering all treatment options that are now available to you.

Because I had advanced prostate cancer upon diagnosis, which had already spread into both of my lungs, my insurance immediately covered the cost of my chemotherapy treatments. Following the release of the CHAARTED study, oncologists all over the country began to adopt the "early chemo plan" into their medical treatment plans for advanced prostate cancer patients. It's something to think about, something to consider, and something to discuss in-depth with your doctor.

If you don't already have an oncologist added to your medical team, that can be an important aspect of your medical care. I have both a urologist and an oncologist who work together as a team, with ADDITIONAL consultation advice from a urology oncologist who specializes in advanced prostate cancer. We all deserve the best medical doctors we can find !

Wanted to wish you continued success in your medical treatments --- your PSA is staying relatively stable over time. Stay in touch with us here, and we're here to support you, now and in the future ! Continued success to you !

Sent with my best,
"Cyclone Fan" From Iowa State University