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Metastatic PC > PSA Creeping up: what next?

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Posted 4/25/2019 6:32 PM (GMT 0)
My husband has been on Lupron for a year, after his prostate cancer metastasized to a lymph node in his chest.
His PSA went from .36 to .597 in 3 months. The doc today was non-helpful, saying, "We'll look at other options when the time comes."

Can any of you, for whom "the time" has come, give me a sense of what to expect and when?

Joe was diagnosed in 2009, prostatectomy soon after. No other intervention until the PSA tripled a year and a half ago. Lupron and chemo started in January 2017.

I know that his numbers are way, way, way low....but it's not less scary for us to look at than for any of you with higher numbers, just cuz we don't know what to expect.

Is there a "better than any where else" to go?

Joe and I appreciate your help!
Posted 4/25/2019 6:46 PM (GMT 0)
I would want to add Zytiga or Xtandi ASAP to the Lupron. Since your husband has already been on Lupron for over a year I don’t know if insurance will cover these very expensive drugs at this point. Edit: If his PSA continues to increase, then he is already resistant, and insurance shouldn’t be a problem.

If your husband isn’t already under the care of a Medical Oncologist who specializes in PCa, it’s time to make that change imho.
Posted 4/25/2019 7:05 PM (GMT 0)
Maryam:

Thanks ever so much for your reply. This doctor, as well as his previous oncologist, seemed unaffected by the slight rising.

I’ll look for a PC specialist.

Thanks again!
Posted 4/25/2019 7:13 PM (GMT 0)
I expect Lupron to work for two to four years from now. Since you already combined ADT and Docetaxel, I would wait with Zytiga or Xtandi until he becomes resistant to ADT.

An alternative outside the guideline recommendations would be to radiate just the met with SBRT. This will reduce the amount of tumor cells in the body which may help.
Posted 4/25/2019 7:14 PM (GMT 0)
I would not worry about the rise too. There is nothing you can do at the moment but to stay on ADT until he becomes resistant.
Posted 4/25/2019 7:40 PM (GMT 0)
Cateydid,
I don’t want to send you into panic mode. I normally encourage people, based on my MO”s advice to me, is to consider that PSA can be allowed to increase substantially (20) before starting ADT. But Joe is already on ADT, so an increasing PSA is of concern. The fact that Joe has already been on Lupron for a year and has had chemo may complicate things. I’m not an expert on these things but my feeling, based on studies, is that he still likely will get better results by going on Zytigia or Xtandi earlier rather than “saving” it for later.

At this point I think the most important thing is to find an MO to whom you can pose these questions and who is willing to give you a good explanation.
Posted 4/25/2019 11:57 PM (GMT 0)
don't laugh…..what's an "MO"?
Posted 4/26/2019 12:02 AM (GMT 0)
Medical oncologist. They treat cancer with chemotherapeutic drugs.

Fund one that does a lot of advanced and high risk prostate cancer work.
Posted 4/26/2019 12:21 AM (GMT 0)
Cateydid, if you tell us what area you are in, some here may be able to recommend a good MO who specializes in advanced prostate cancer.
Posted 4/26/2019 3:05 AM (GMT 0)
we use a lot of abbreviations around here to save typing. A good list of them is on this sticky thread:
https://www.healingwell.com/community/default.aspx?f=35&m=1019612

Interestingly MO isn't on that thread...
Posted 4/26/2019 9:46 AM (GMT 0)
Cateydid-

I know rising PSA is scary and the urge to hit back is strong. As others have said, second-line ADT is likely one of the options your doc will consider when the PSA number becomes "actionable", and some people get very long runs on these drugs- this can give you time for treatments in the pipeline to become more mature and accessible down the road. One treatment down the road to be aware of is Lutetium-177 PSMA-617 radio ligand therapy. I am lucky enough to pass through the needle in the Phase III VISION study on this drug- I can say I have had good response after one infusion.

I bring this up to you now because, well, timing is everything in getting into clinical trials, and the following very recent paper describes very good responses with this therapy in men who have mets only to the lymph nodes- even compared with only one or two bone mets as well as nodal metastases. For men who will develop bone mets, the window of node-only disease can be small since PC goes to the bone very easily in most. This paper suggests that window to be a very good time for Lu-177 therapy and recommends that Phase II studies examine this idea. Maybe, down the road, such a study will be ongoing, or maybe even in practice when you need it.

Here is the paper:
http://www.oncotarget.com/index.php?journal=oncotarget&page=article&op=download&path%5b%5d=26789&path%5b%5d=83245

best wishes to you both

rockyfords
Posted 4/26/2019 6:39 PM (GMT 0)
mattam,

I would start with Zytiga or Xtandi when the patient has become castration resistant, not after one year of ADT. And you have to have a PSA value of 2.0 ng/ml + Nadir to be definitely resistant.

George
Posted 4/26/2019 9:39 PM (GMT 0)
George,
I respect your opinion and perspective - thats what forums are for. But I think studied are showing that second line ADT medications are working better when added earlier. The fact that he has had chemo could change that. Also, he has already been on Lupron for a year, which could also change the equation. But based on what is known with these medications I would want to add one to Lupron sooner than later.
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