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Is PSA bounce possible for G9 on Lupron??

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Posted 10/19/2016 7:58 PM (GMT 0)
Hi all,

I know I'm probably worrying prematurely but I can't seem to help it. Yesterday my husband received the news that his PSA rose for the first time in the exactly one year he's been on Lupron. It doubled. It went from .27 (3 months ago in July) to .46.

10 months ago he finished 44 (81 gy) radiation sessions. I've read here about post-radiation bounces. What are the odds that this rise could turn out to be a bounce? Does this happen only with brachytherapy? Can it happen when someone is on Lupron?

Since he is a G9, I'm concerned that an aggressive PC is already starting to rear its ugly head.

Any input is appreciated!!!! Thank you.
Posted 10/19/2016 8:19 PM (GMT 0)
I can't speak to the "odds" you ask about, but a PSA-bounce is not un-common (20% of cases) after either brachytherapy or EBRT, and can happen even if one is on hormone therapy. The typical timeframe for PSA bounce is 12-36 months after radiation therapy, and it may last about 6 months and may be as much as 1 ng/ML higher than the nadir value reached after treatment.

G9 with 12/12 core positive is a serious case, and for now PSA measurements will be the key measurement of treatment successes. In general, if the rise goes over 2 ng/mL, then it's more than a bounce. The nadir of 0.27ng/mL (if I've read your details correctly) is also higher than one would expect from RT+HT.
Posted 10/20/2016 12:30 AM (GMT 0)
As I understand bounce it is for radiation therapy that does not include ADT. In my opinion and limited knowledge I suggest you treat this as some PCa working that needs to be knocked back down. Get with your docs and treat it. You have many great treatments that will manage this disease for a long while. I hope you are with a world class oncologist that has great results with cases like yours.

Best wishes

Jack
Posted 10/20/2016 3:12 AM (GMT 0)
Bounces can occur when he comes off Lupron. When PSA rises while he's still on it, it may signal the start of castration resistance and the need for some stronger drugs. This is something to discuss with his MO.
Posted 10/20/2016 12:51 PM (GMT 0)
Thank you all. Uro said we could add Casodex, which we will. And maybe he should have been on it all along. We haven't seen our MO since March. Didn't think we needed to since his numbers had been going down. We will make an appointment asap. I thank God for this forum!

It does make me wonder if we don't already have three progressive increases or not over 2.0 psa, whether insurance companies will cover moving to stronger drugs. We'll see what MO says.
Posted 10/20/2016 4:30 PM (GMT 0)
I was on Lupron and Casodex for my whole 3 years on hormone therapy (called ADT2, commonly).

My docs resisted adding Casodex at first, but during my first 2 months on Lupron only, before radiation therapy, the PSA hadn't come down as much as hoped. It dropped from 9.6 to about 0.5 in two months, but we were hoping for an undetectable before starting RT. So, added Casodex. With a stage cT3a, G9 5+4 case, we wanted to be as aggressive as possible.

My PSA was undetectable after that during the entire 3 year term on ADT2. No observable "bounce" after the radiation was done; the ADT2 completely masked any PSA response from the radiation.
Posted 10/21/2016 1:25 AM (GMT 0)
Casodex can be cheap and effective for a period of time. I would suspect your MO will move in this direction first...if / when this fails, THEN you will move on to the Zytiga or Xtandi..
Posted 10/21/2016 1:48 PM (GMT 0)
Great input again. Husband wants to wait to see what will happen with addition of Casodex then, after January recheck, we will see MO.

Thanks all!!
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