PSA Spike after Triplet Therapy - Anxious

At this point, some doctors recommend removing the prostate to eliminate its ability to produce PSA. The next thing is to try and zap the metastasis. They might do radiation to eliminate the prostate and then radiate the prostate bed. After that, they can use SBRT on some of the other metastasis.

This depends a lot on how many metastasis there are and where they are located. If there are more than six or seven than this is a real problem. And most doctors will not start zapping a lot of metastasis.

Another step is Pluvicto. It’s a treatment that can handle many metastasis at once, In the six treatments, he can get. It works really well in 1/3 of patient. It works OK and 1/3 and not at all in 1/3 But it is the next step usually in treatment unless they can do the above things first.

He should get both a Hereditary and a somatic, genetic test. If any of them show that he has BRCA, he can probably go on a PARP inhibitor which can give him some more time.

With a case like this, you should be meeting with a Genito urinary oncologist, They specialize in prostate cancer as medical oncologist, work with all different cancers and can’t specialize enough for a case like your father has.

You should get a second opinion from a center of excellence. There’s many places you can go, but another option would be to Go to Marina Del Mar, California and meet with Dr. Mark Scholz. He doesn’t take insurance and charges about $500 for a visit, but he really knows his stuff. If you go on YouTube, you can look at PCRI conferences and hear him give talks on treatments for prostate cancer

Your father has a tough case and you really need to address it immediately. PSA numbers are usually counted for how long they take to double so your father‘s jump Is quite excessive.

@phil89

As @jeffmarc indicated, your Dad will probably be given two choices, removal or radiation. I also agree with the center of excellence suggestion. A second or third opinion is also helpful and you can do that via telehealth at most centers of excellence.

I had radiation using the Mridian radiation machine that has a built in MRI vs fused images. It is worth discussing this with your oncologist (or the Elekta Unity machine which also has built in MRI). More precision means less healthy tissue impacted and therefore less side effects or toxicity. Here is a link to the Mirage randomized trial discussion which compared non-mri radiation machine to built in radiation machines:
https://www.urologytimes.com/view/mirage-trial-margin-reduction-with-mri-guided-sbrt-reduces-toxicity-vs-ct-guided-sbrt

JeffMar has given great advice and obviously is very well informed.
A very good source of on going developments (and they're coming fast and furious w all of today's clinical trials, and usually w good news) is the internet.
Suggest Uro Today- covers all the latest urology conferences.
Good luck!!

Another really good source of prostate cancer treatment information Is on YouTube if you look up PCRI Their conferences are really good and the speakers really know what they’re talking about.

Thanks for the heads up.
I know there's a belief that the docs don't like we patients informing ourselves as thoroughly as possible. That's not true - at least not at Georgetown Medstar and the NCI/NIH I'm treated and in a clinical trial.
Not unsurprising - it saves them a lot of time in getting and keeping us up to speed.

Thanks for the advice, it is really reassuring that there are other treatments and options available. I am trying hard to get his oncology appointment bumped forward, and look forward to discussing all of the above options with my dad's MO. Scary time but I am choosing to remain hopeful!

I also took Nubeqa , have been on it for over 2 years. That combined with chemo back in 2022 brought my PSA below 1.0. But last year it started going back up. at 16.3 now. The cancer has become resistant of the treatment. Looking into more options SBRT or pluvicto theroapy.