How concerning is this psa rise?

That is why they did not do L next to one he radiated Concern for disc to collapse

Thank you bro

Precious Blood of JESUS please heal me daily prayer

You say the plan is Zytiga in January? I’m a little surprised since such a high PSA would really imply that you needed ADT and a second drug like Zytiga right away. Did your PSA rise while on Enz And that’s why he wants to do Zytiga? Unfortunately That seldom works (5% success). If you got off Enzalutamide Before your PSA rose, then it may work to move to Zytiga.

Pluvicto (Lu-177) Is good for removing a number of metastasis from your body. It only works in about 1/3 of people real well 1/3 of people OK and 1/3 of people not at all. Sounds like a good thing to try.

Before doing Pluvicto You should get a somatic test. You need to find out what genetic anomalies might be in your body, Even if you don’t have hereditary problems, they can show up in your blood after having cancer If you have the Genetic problems of PTen or RB1 Then Pluvicto May not work very well. If you have BRCA then it is more effective.

In 2020 I did one year Enz, then next year Radium 223 PSA gradually up

Caused by Radium 223 https://pubmed.ncbi.nlm.nih.gov/29785515/

Then this Sept I did one Chemo PSA Flare still Now 181
Oncologists say it should come down 30 % can get this flare
2nd chemo caused fluid on lungs and a small embolism clot which both are being treated with drugs
Nuclear scan showed chemo killed most in bones Praise God Small spot in T 10
Had BRCA test No hereditary shown
CT Scan for chest tomorrow Concern is why Zytiga over Darolutamide, and why not right to LU 177 if it becomes standard of care

What path is best??

ken247:
One other test you could request to have done now in parallel with the MRI and possible biopsy is one of the new urine based tests that look for biomarkers that indicate prostate cancer. I had a stable PSA and normal DRE but requested one of these tests from a urologist just to make sure that I did not have prostate cancer. I was given the ExoDx test (there are other tests besides this one and all seem to be excellent) and the result came back elevated and indicative of a 36% chance of treatable prostate cancer. An MRI a month later was completely clear but my urologist recommended a saturation biopsy 'just to make sure'. Two of the 24 cores indicated a very small percentage of aggressive cancer that required surgery for treatment. I am very grateful for the development of tests like the ExoDx test that provide another screening mechanism to potentially detect prostate cancer very early and when more conventional screening might suggest the absence of cancer.

Since you brought it up, here is a chart showing all the major tests.

I’m sort of partial to the PSE test because of its reliability.

I Had a better copy of the tests.

Ken, Yes , you need a further look , it could be a swollen prostate, infection, or cancer. However, we won't know this until we get more extensive images. Keep us informed of what the MRI results are and what your doctors are saying. You were consulting with a urologist and the radiation oncologist at this point? Both should be on your team to discuss things. What part of North America are you in? The geographic location sometimes depends on the treatment . Keep us in the loop of your progress. James

I am currently working with my urologist. MRI is 12/28 and, as of ow, my next appointment with the urologist is 1/13/25. I am in North Carolina. I am also having a hard time to start to pee and it is weak.

Ok, Ken ... let me know how the MRI goes . Im in Canada ( Vancouver Island ) so we have slightly different approaches here . At 4.5 PSA you should have started to investigate . Why didn't your GP insist on further investigation at 4.5 PSA? Depending on your age, if you are under 70 or so, it is normal practice here to have a work up done starting with the bone scan, MRI, and possibly ultrasound to start with at around the 3.5 to 4.0 range. Biopsies are usually after that if they discover anything on the ultrasound, bone scan or MRI. Also, I had about 3.5 PSA, they would start various bloodwork and a few more PSA tests. If any other tests are negative in tone, meaning that there is a suspect lesion, they would definitely assume a defensive rule and do a biopsy. Anyway, if your age is above 80, they may be a little bit slower in reacting to a 4.0 PSA. PSA generally goes up with age and it is considered around 78 years old to 80 years old they expect your PSA to be 1.0 to 3.5. However it all depends. So age is a factor with the aggressiveness of the investigation. I take it you're under 80 years old?. Keep us in the loop on the MRI and let us know what the doctors have to say. Also it's worth noting that if you're over 75 years old and depending on any comorbidities, doctors tend to go to the radiation route rather than the operation route. If you're under 75 years old and in good shape, an operation is definitely an alternative for you. Anyway, I will pray for you to have great results and let us know. James.

I am 67 and my psa has fluctuated from 2.5 to 5.3 prior to the 4.55 reading in 12/23. They did a biopsy back in 2016, nothing at that time. The feeling was that the 4.55 reading was within my "range". MRI scheduled for 12/28) a Saturday, and they will let me know if there is and earlier date. Oh, and I mentioned earlier, my prostate was measured at 60cc back in 2016. God knows what it is now.