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Should PSA drop when adding Casodex or is Holding steady just as good

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Posted 2/26/2014 9:13 PM (GMT 0)
My husbands PSA was going up fairly rapidly while on Lupron and in early December we added Casodex. Just got the first PSA done since and it has gone up to 6.5 from 6.0. It took about 3 weeks from the last PSA test until the Casodex was added (for a number of reasons). I am just not sure if Casodex is expected to LOWER the PSA or just hold it as is.

Any one have any experience?
Posted 2/27/2014 2:00 PM (GMT 0)
I do not know the answer but take the cup half empty view with respect to all PSA measurements, regardless of type of hormonal therapy.

Not up is good, and a few consecutive ones at same level means you have reached your nadir level.

My thinking is you can't have a PSA doubling time if it is not increasing, and I pay more attention to PSADT than to the PSA metric itself.

When the PSA level gets so low like 0.20 or 0.12 or undetectible, I may alter the view since the percentages can be dramatic. So at that point I would think of it like a stock and having a price threshhod at which it is time to sell.

LupronJim
Posted 2/27/2014 2:20 PM (GMT 0)
Thanks you guys. I was looking at it that way myself and then stared second guessing myself. "Not up" is good
Posted 2/27/2014 2:29 PM (GMT 0)
littlenm- with your rough stats the risk of casodex working well or longer time frame is perhaps not going to do much but likely not known right now, although with PCa the condition or state of the AR (androgen receptor) is key as to when the receptor works best, I think the thing called PTen is a factor in all this.

You may be looking closely at second line options for control and there are many. As strange as it is nilandron might even work when casodex fails, just as Xtandi can bind better to the AR receptor and work when casodex fails.

best to your possible results....
Posted 2/27/2014 3:42 PM (GMT 0)
Yes Zufus. I think I agree with you. I honestly think we will be looking at other options in the near future but I guess you at least TRY Casodex. I don't want to seem like a pessimist...I like to think I am more of a realist. Some people around me I think are finding me to be pessimistic because all they know of PCa is that "everyone has it when they die but no one dies of it" so I no longer say anything to them. If his brothers wife says "what you think about you bring about" one more time......LOL

Thanks for the support
Posted 2/27/2014 4:04 PM (GMT 0)
Stable psa is good. Lowering psa is also good. Both good.
Posted 2/27/2014 6:40 PM (GMT 0)
littlenm ...

Hi ... I too am amazed at the people who tell me that no one dies of this and that they have a relative with it and he's ok. Given that, I don't think you're pessimistic; but I try to use the words vigilant and aggressive when dealing with this so that my mind keeps looking for solutions. My opinion is that we've got a tough strain of PCa and need to go after it just as toughly.

From that perspective i always encourage G9 and G8 brothers to go at it -- the Casodex might buy a little time, but it's unlikely to reverse the course of things. However, there are a lot of stronger drugs that can help you all now. Technically your husband is mCRPC (castrate resistant) so the NCCN recommendation starts to list other treatments Provenge, Zytiga, etc. I use Dr Scholz who helps me to use those new drugs as early and as aggressively as i can. One of the top Med Oncologists has more experience in dealing with high risk G9 cases like we are.

Bless you both ...

Ray
Posted 2/27/2014 6:58 PM (GMT 0)
Jim,

I agree with your comment, "...I pay more attention to PSADT than to the PSA metric itself."

Your psa at diagnosis was 3.68?  another thing we have in common...that is crazy low, isnt' it?

Jerry

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