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Was is T still going up

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Posted 10/11/2013 5:39 PM (GMT 0)
 Quick summary - Surgery in 09, IMRT in '10, HT started in '12.  Mets identified in march 12, multiple lesions. No pain. First visible only with a PET, now visible with regular bone scan. Started HT (zolodex and casodex)  in "12, PSA has been under .01 for some time now and continues to be undetectable.

Here is the question.  In march of '13 T levels started to rise dramactically, reaching 300. Oncologist (Petrylak) switched me from Zolodex to Degarelix. T dropped to under 20, but is once again on the rise, now over 100 with free T over the magic 25. Message from the oncologist is we will discuss on your next visit in 3 weeks, probably retest and new scans. 

Anyone ever hear of this, rising T during HT. I worry that the PC has mutated and is now producing its own T, but with a 0 PSA?????? I know I can wait to talk to petrylak, who is one of the best in the field, but in the meantime I'd thought I'd check to see is anyone else has heard of this 

Posted 10/11/2013 6:27 PM (GMT 0)
Hi Keeping Faith,
First, hope you are not on Casodex at this point. This medication can be promoting growth instead of blocking the androgen receptor (AR). Have they measured you luteinizing hormone (LH) level? It should be less than 1.0 IU/L while on an LHRH antagonist or agonist.

I have seen this happen before. The patient was prescribed Ketoconazole at the time to maintain testosterone at castrate level. One possible explanation for your situation is that your cancer is poorly differentiated and doesn’t make PSA. Your level of testosterone is an indication that the Degarex is not holding testosterone production down. If the cancer cells are producing their own testosterone you would not see such a high level of testosterone in your blood circulation.

It is possible that you qualify for newer meds like Zytiga and Xtandi. Also a switch to another LHRH like Trelstar for example, might do the trick. Wish you the best possible results.

RalphV
Posted 10/11/2013 6:39 PM (GMT 0)
still am on casodex. I haven't heard of it promoting growth . you have given a question to ask. thanks
Posted 10/11/2013 8:36 PM (GMT 0)
Hi Faith,

I 're-read some of your earlier posts and you had at least some PSA before surgery and other therapies. Given that, PSA can still be used as a valid marker to gauge progression...versus testosterone, which just gauges how close you are to castrate levels.

There are other markers that might me useful as a bone met guy, like me. Have you gotten your bone specific alkaline phosphatase level? Tracking this can be useful....

I have heard the same about casodex that it can have a reverse effect, but I would think psa would go up if that was the case...

Interesting that t is going up..
Posted 10/12/2013 1:43 PM (GMT 0)
Faith,

As usual Jerry L. offers some spot on advice. Bone alkaline phosphatase testing as well as n-telopeptide collagen monitoring would be well indicated in metastatic involvement with little or no PSA. Query your onc about these options.

Jim
Posted 10/12/2013 9:38 PM (GMT 0)
AAWD- anti androgen withdrawal is what Ralph is taking about and at some point and in some cases casodex and similar family line of drugs can feed PCa, the good news is drop the drug asap (like now) and get a psa within 2-4 weeks for comparison. The AAWD when going off the drug, you will witness a psa drop, then you know casodex was the cause. You can read about this phenomena it is in books and on the internet. Dr. Moyad has a book 'Beyond Hormone therapy' it is mentioned in there too.

Myself would drop it, as you have coverage with degarelix and then see your newer psa tests.

http://www.phoenix5.org/Infolink/refractory/antiandrogenwithdrawal.html

(one source)

Post Edited (zufus) : 10/12/2013 3:47:02 PM (GMT-6)

Posted 10/14/2013 12:02 PM (GMT 0)

tHANKS ALL, I will talk to Petrylak in 3 weeks, he wants to run another PSA. You have all given me some interesting things to discuss with him (Casodex). With my PSA still at 0, I'm not prepared to say Im refratory yet, just because T is rising.

Funny - I can always tell when my T is going up, I start having interesting dreams a few weeks ago and when I woke up some mornings, my brain is not the first thing was "awake". While its nice when that happens, I also knew before they took the blood what the reading was going to be!!!!!!.  

Posted 10/14/2013 5:02 PM (GMT 0)
That is quite unusual. You find yourself in a much better situation than most, my dad, for example, where his T is recovering very slowly after the first HT cycle but his PSA is rising. Undetectable PSA with rising T is very peculiar, but a much better combination. Having said this, you need to find the cause and address it appropriately now. While your PC is hormone-sensitive hopefully for many yrs, you NEED to find a drug that will lower your T sufficiently.
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