HealingWell
Search Close Search
☰

When to resume treatment?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 4/2/2022 6:14 PM (GMT 0)
Diagnosed in 2010, surgery in 2011, PT3b. RT in 2012. PSA recurrence in 2014, PSMA scan negative at PSA 0.8.

Treated with Casodex since 2014. Drug holiday since Sept 2020 (18 months) and continuing . PSA 18 months ago 0.02, gradually increased to 0.9 in 18 months. Last PSMA scan in June 2021 negative. PSADT around 7 months.

I know I have to start treatment at one point. Which one is better:

A) Start treatment at a certain PSA level even if scans are negative. If yes, what would be that magic number? or

B) wait until scans show mets, if feasible radiate them and start treatment

Since Casodex did not fail yet, I plan to start treatment with Casodex again.

Your comments will be much appreciated.

Posted 4/2/2022 7:32 PM (GMT 0)
The good news is that you're still castrate sensitive. I'm thinking I might go back on ADT sooner than later. Hopefully, you won't become castrate resistant for a long time. Your "system" seems to be working well enough.
Posted 4/2/2022 9:06 PM (GMT 0)
I'm in agreement with Mattam.
I'm of the belief that waiting for something to show up on a scan isnt a great idea, because by the time it does show up, even if you can radiate it, there's a good chance that there are other mets that cant be seen on a scan yet.
Good luck. Keep us posted.
Posted 4/3/2022 2:25 AM (GMT 0)
Question - Are you implying that you had a PSMA scan in 2014 @ PSA of 0.80? I am not sure I am following your scans and testing.

If your cancer can be detected by PSMA, then your PSA is high enough that something should show up. Some PCa does exhibit high levels of PSMA which can be checked out as far as I know.
Posted 4/3/2022 3:43 AM (GMT 0)
Mumbo, yes PSMA scan back in 2014 when PSA was 0.8 was negative. Psa scan in June 2020 (during drug holiday) was also negative.

How do you check if your cancer expresses PSMA?
Posted 4/3/2022 7:26 AM (GMT 0)
My Dad had a PSMA Pet scan at .3 and he had a recurrence in the prostate bed and 3 unmeasurable (very small) spots on ribs, prostate removed in 2012, recurrence in 2017 in prostate bed, hit with radiation but apparently was radiation resistant. PSA bouncing around in 2021. Scan done at .3 and showed the above. He is now on Lupron. PSA check in January 12, 2022 was less than .1. His PSA after scan on Dec 1, 2021 was .4. He started Lupron right after that.
Posted 4/3/2022 2:36 PM (GMT 0)
Traveller - When I think of PSMA scans, I am talking about the newest PSMA tracers approved in the US in the last two years, Ga-68-PSMA-11(2020) and Pylarify-F18-PSMA (2021) which are game changers in sensitivity. Prior to the last few years, there was no availability of these tracers other than in testing trials. You may want to check what exact tracers were used in previous scans. If it was not one of these two, you should inquire about availability.

I think you have to have a sample of the prostate cancer to check for PSMA sensitivity. I would assume there is some sort of pathology staining process to check for such things but beyond my knowledge level. Just have heard that a small percentage of prostate cancers do not exhibit much PSMA which is not unlike PSA not always being a reliable indicator of the seriousness of a cancer.

Not sure what you should do at this point if your last scan used one of these new tracers. That is probably a good discussion to have with your oncologist. Targeting lesions is a good plan if they can be identified and there are only a few. What the PSA number is would be anyone's guess given you have had the main treatments which failed and been on ADT for a while which seems to work.
Posted 4/13/2022 2:17 PM (GMT 0)
Hi Mumbo, I’m facing similar decision and am now biochemical recurrent, although my PSA doubling time is shorter at 3-6 months (latest PSA 0.67) and I previously completed adjuvant ADT and EBRT following unsuccessful RP.

My Axumin scan was negative so am getting a Pylarify PSMA PET in another week. I’ve talked with quite a few of the west coast expert MO’s and am settling on starting intermittent ADT after the scan regardless.

If something is seen I will pursue local therapy in addition to ADT. All the recommendations I’ve received are to start soon (regardless of and before any metastasis is detected), and then if something is detected we will add intensification which may include some or a combination of aberaterone, apalutamide, or docetaxel.

The big question for me is whether to pursue intensification now. Studies and standard of care aren’t yet available to prove the value of chemo or intensification when only BCR and nmCSPC.

I will say that all the recommendations are for intermittent ADT, about 9 months.

Good luck and hope this helps.
Posted 4/13/2022 2:56 PM (GMT 0)
IMHO
Having gone 8 years until I reached castrate resistance, with three treatment holidays.
I went back on ADT when my doubling time dictated it.
That for me was a second rather fast rise in PSA.
The first two holidays PSADT was 6 weeks.
This last one was 2 weeks.
✚ New Topic ✚ Reply