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PSA Spike after Triplet Therapy - Anxious

Posted by phil89 @phil89, 6 days ago

Good afternoon everyone,
I just got a call from the oncologist on my dad's recent PSA test and was shocked. It went up from 0.16 in October 2024 to 3.43 in Feburary 2025. He was diagnosed de novo in June 2023 (stage IV, gleason 9, mets to lymph nodes and spine), started hormone therapy immediately, then commenced taxotere chemo and darolutamide in Aug 2023. He has been on darolutamide since then and his PSA dropped from 800 to its lowest which was 0.1. I am trying hard not to panic but I was not expecting darolutamide to start failing only 18 months after starting. We have a meeting with the oncologist on March 5th which I am trying to get moved forward; however, I really would appreciate any information anyone has of similar situations or other treatment options my dad could try from here. I know that one PSA rise shouldn't incite panic as it is a trend that matters more; however, a spike of 21x is definitely leaving me feeling like a bit of a punch to the gut.

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sademotts | @sademotts | 3 days ago
In reply to @jeffmarc "Have you had a PSMA PET scan to see if your cancer has spread outside the..." + (show)
@jeffmarc

Have you had a PSMA PET scan to see if your cancer has spread outside the prostate? That is what can cause your PSA to rise so much. SBRT on metastasis found could reduce your PSA. If your cancer has spread only/mainly to the bone, then radium-223 Could also be useful as well.

Pluvicto is also a next step To try. You should be aware that is only really successful in 1/3 of the cases somewhat successful in 1/3 and not successful at all in 1/3.

One thing you could try is switching from Nubeqa to Zytiga. It may not be successful, but it could be worth a try.

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My original CT and bone scan back in 2022 showed it was stage 4. It in my spine T12, pectoral right bone and prostate. I just completed an PSMA Pet scan a few weeks ago. It's still only in those areas , not spreading thank God.

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sademotts | @sademotts | 3 days ago
In reply to @phil89 "@sademotts I am sorry to hear that you are in the same situation as my dad...." + (show)
@phil89

@sademotts I am sorry to hear that you are in the same situation as my dad. If you don't mind me asking, was your PSA rise gradual? Also, did you have any symptoms that accompanied the rise?

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Yes I feel it was gradual over the last year. Aside from the meds side effects I feel great.

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jeffMar | @jeffmarc | 3 days ago
In reply to @sademotts "My original CT and bone scan back in 2022 showed it was stage 4. It in..." + (show)
@sademotts

My original CT and bone scan back in 2022 showed it was stage 4. It in my spine T12, pectoral right bone and prostate. I just completed an PSMA Pet scan a few weeks ago. It's still only in those areas , not spreading thank God.

Jump to this post

If it is only in bone radium 223 Is used to try to attack bone metastasis. You might ask your doctor if that’s possible to do with your condition.

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