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Metastatic Cancer PSA Doubling time LESS THAN A MONTH! Dr. Myers said Dads case is very rare.

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Posted 5/8/2014 11:55 AM (GMT 0)
Good morning everyone, I hope you are all doing well. It is nice to see familiar faces here.

Since some of you are new I would like to give you a background of my dad's case and hope that you can chime in and give us some direction and/or advice.

Initially my dad had surgery (T3a) his first post op psa was .55, then he had RT and hormone combo. Not too long after his PSA starting rising and consulted with Dr. Myers,  who sent my dad to the Dattoli center after we had detected it was metastatic and had spread to his ribs. After completing radiation to his ribs (with hormone therapy) my dads psa went to 0, and Myers decided to try intermittent hormone therapy and had him stop all treatment. After 6 months of a 0 PSA, my dads psa starting to increase rapidly!

Just this month it went from 2.14 to 5.15, we are all so worried. He recently did scans at Sandlake Imaging and they found new involvement in his back T8-11.

My question is, has anyone experienced or known someone who had such a rapidly rising PSA and a doubling time of less than a month. What concerns me the most is that Dr. Myers, one of the most renown PC doctors, said it is very rare. Ive seen people on this forum with a PSA in the thousands with a clean bone scan, then others with a PSA of 5 with a very spotty bone scan. What is more important the PSA number or the results of a bone scan? Does PSA doubling time have anything to do with effectiveness of hormone therapy? Please any background or information would be greatly appreciated!

Posted 5/8/2014 12:14 PM (GMT 0)
After Surgery & IGRT, my PSA doubling time was down into the low 20's (days). At that point I had 4 spots that were on a later scan confirmed as mets. I hit a PSA of 7, and did a 6 month round of Lupron, which got T and PSA to virtually 0. I went on a Lupron holiday. A later bone scan finds the 4 spots (vertebrae) still there but less significant, but also adds 5 spots in ribs. As the PSA doubling time is now just around 90 days, and is approaching 5 again, I'll be back on Lupron in June.

In my case we consider the mets a more important indicator, as they show actual damage that can be seen. But as we all have seen, PSA is an indicator as well. In my case we suspect that I have a very aggressive, but low PSA-producing variant. The good results after the first batch of Lupron reinforces this, as it may have killed off the less aggressive, but higher PSA-producing cells, and left me with the rest.
Posted 5/8/2014 1:21 PM (GMT 0)
I would agree with 142 that of the 2 bad choices rising PSA and confirmed mets, the latter is the worse of the 2.

LupronJim
Posted 5/8/2014 1:44 PM (GMT 0)
Thank you both so much for your replies...

I am assuming my dad has also has a highly aggressive low producing PSA type of cancer. So is it safe to assume 142 that doubling time can be different after each therapy? Since now you have a 3 month doubling time?

Also, from what I have been reading PSA doubling time is also predictive of time to death after a person becomes hormone refractory? I am so worried. Dr. Myers is going to start him on Firmagon and Zytiga and adding prednisone now. He did mention leukine before but hasn't prescribed it yet. Do you have any experience with leukine? do you mind telling me what hormone treatment you are no now? THank you both so much for your responses.

Posted 5/8/2014 4:55 PM (GMT 0)
Looks like PeterDA had already started a thread on leukine

www.healingwell.com/community/default.aspx?f=35&m=3036926

Obviosuly from my user name I am on Lupron every 4 months and Xgeva monthly. Doing well so far with PSA @ 0.12 and has not stopped dropping yet with next test May 13th. Testosterone <003 so best I can do there is break even on May 13 test,

Not sure how pertinent my situation is since my PSA never doubled as fastly as your Dad's or 142'a.

Good luck and please continue to keep us informed on what Dr Myers prescribes next and how it helps your dad. He is blessed to have you as his advocate.

LupronJim
Posted 5/8/2014 5:34 PM (GMT 0)
When my Hormone treatment ran its course (see sig) My psa rose from .13 to 155 very quickly and at certain times my doubling time was right at 2 weeks. Like from .13 to 1 and from 19 to 44. It scared me and concerned my Onc.

I have multiple mets to bones besides. I am Hormone "refractory" and am now on Zytiga pill form with the Prednisone daily. From Dec to now my psa has dropped from a high of 44 to 6.7 which included 2 rounds of radiation which, by the way, played a significant part in psa reduction. Also added into the mix was an orchiectomy in February.

My doctor is thrilled as am I that this new treatment seems to be the correct course of action. For me Zytiga is hard on the joints pain wise and Prednisone is important to keep the aching in check. Slight nausea, slight dizziness, but to know its working is worth it.

from what I have read here on the forums, it appears I am in the top percentile of aggressiveness with doubling times. I am one of those who now sees that psa (in my case) is not a primary indicator of progression as I had many more mets with a lower psa # and fewer mets with a high reading of 155 at one point.
Posted 5/8/2014 6:45 PM (GMT 0)
Luv,

You asked:
So is it safe to assume 142 that doubling time can be different after each therapy? Since now you have a 3 month doubling time?

I have no clue that the therapy impacts the doubling time. Onco, uro, and I think that the various therapies have killed off / removed certain parts of the cell population, leaving that which produces the least PSA. Since I still have evident bone mets, I don't much have to worry about PSA. The doubling time is overall, and if you consider that there can be mixes of aggressive / less-aggressive cells, those which survived will set the new doubling time.

I would rather have a PSA of 500 and no identifiable mets than a PSA of 5 with 9.
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