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PSA Rising on Lupron, G9

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Posted 4/19/2012 12:43 PM (GMT 0)
We met with the oncologist yesterday for Dad's appointment.   2 weeks ago when it was time for Dad's Lupron shot his PSA had risen from .03 in January to .19.   At the oncologist yesterday they tested his PSA and it was 0.6 (up from 0.00 at their lab in January).   Testosterone is still less than 20.   Oncologist said "these things can happen and we will know more at the next appointment in August".   My fear is Lupron is no longer effective, with a G9 and suspected/confirmed Bone Mets not sure what to think. Also, the fact it's up from .19 to .60 in two weeks is concerning to me (although it was two different labs).   He's still got the cough, doctor doesn't think it's PCa related but if it continues for another 2 weeks they will repeat an XRay and/or CT Scan.   Thoughts... what comes next if Lupron is out?   Also, should we be excited about the testosterone level and less concerned about the PSA?  
Posted 4/19/2012 12:58 PM (GMT 0)
Concerned,

Where are the confirmed mets and have they been treated?

There is a good book by Mark Moyad entitled, "Beyone Hormone Therapy"

There are many new options for hormone resistant patients --- Zytiga, Provenge, MDV3100 soon, etc...

Hang in there,

Jerry

Posted 4/19/2012 5:09 PM (GMT 0)
I think you are right to be concerned about the PSA rise. I don't think waiting until August is a good idea given the possibility of castration-resistant PCa developing. You might seek to get a confirming PSA test to verify the .6 results. If those results are valid, you might want to push for more proactive treatment planning. This is Gleason 9 after all.

To help galvanize your thinking about your father's current treatment, you might want to view this recent video from Dr. Myers that talks about a case of a person having aggressive PCa and bone mets who he feels was incorrectly treated with just Lupron.

askdrmyers.wordpress.com/2012/03/14/pca-one-disease-or-many/

Wishing you the best,
Nellie
Posted 4/19/2012 5:28 PM (GMT 0)
I actually see Dr. Myers if you have any question.
Posted 4/19/2012 5:39 PM (GMT 0)
Wow, Jerry, it seems your case is quite similar to that of Concerned's father. And look at the aggressive and already successful results of going right after the mets. I'm impressed with how fast Dr. Myers reacts: two months from finding mets to treating them, after what looks like a preparatory month of HT. Congrats!

Nellie
Posted 4/19/2012 6:18 PM (GMT 0)
Nellie,

Thanks for the kind words.  Actually, after I saw the increase I decided that if I'm going down, I'm going down swinging.  I worked with my local doctors (all of whom had different opinions) to be as aggressive as I could.  I convinced my radiation oncologist to radiate the one spot and my local med. onc started me on XGEVA.  I also decided at that point to see Dr. Myers to fine tune hormone therapy.  He added casodex and avaodart. 

Concerned---

And to that point, it might be a good idea to see Dr. Myers (or at least read what he has to say) just on that point.  He has seen countless patients with PSA rising and where Lupron appears to not be working.  He has a lot of experience on using different combinations successfully.

Aside from Myers, there are other medical oncologists that you might want to add to your team of doctors.

Thanks,

Jerry

Posted 4/20/2012 10:34 PM (GMT 0)
I had been on Eligard/Lupon for a couple of years when my PSA suddenly started rising while Testosterone was flat at a low level.

Bone scans, MRI's, etc., indicated nothing going on. But the PSA numbers doubled every couple of months. I figured I was now "refractory", where the PCa no longer is testosterone-dependent, but my oncologist put me on Casodex, too, and that brought the PSA down significantly for a couple of months. To me, the "writing was on the wall" that the cancer was weaning itself off testosterone and "looking" afield, and that further HT would NOT be working. I went on Provenge, and later got radiation and am now on Taxotere. The addition of Casodex (that inhibits a slightly different type of testosterone than Lupron) to the Lupron bought me a couple of months, that's all. But don't be complacent and dither--this Gleason 9 monster is relentless and aggressive.

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