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My husband's PSA rose after two Lupron treatments. Thoughts?

Posted by caheil @caheil, Dec 29, 2025

My husband’s psa rose to 6.4 after two lupron treatments. We are being referred to a medical oncologist and pet scan. Wondering if anybody has experienced this or has treatment advice. Thanks!

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Jeff Marchi | @jeffmarc | Dec 29, 2025
In reply to @johndavis60 "@northoftheborder Hi North, they have me on Firmagon and Abiraterone. Will that slow the transition to..." + (show)
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@northoftheborder
Hi North, they have me on Firmagon and Abiraterone. Will that slow the transition to castrate resistance?

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@johndavis60
It’s not Firmagon specifically that makes a difference. Any ADT to which they add an ARPI like Zytiga will delay the time it takes to become castrate resistant.

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northoftheborder | @northoftheborder | Dec 30, 2025
In reply to @johndavis60 "@northoftheborder Hi North, they have me on Firmagon and Abiraterone. Will that slow the transition to..." + (show)
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@northoftheborder
Hi North, they have me on Firmagon and Abiraterone. Will that slow the transition to castrate resistance?

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@johndavis60 There are no guarantees, but hopefully it will. The LATITUDE trial show a significant improvement in overall survival for patients with high-burden (polymetastatic) castrate-sensitive PCa starting Abiraterone and Prednisone at the same time as ADT, and part of the huge, multi-track STAMPEDE trial showed that the benefit extends to patients with low-burden (oligometastatic) castrate-sensitive PCa as well.

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caheil | @caheil | Dec 30, 2025
In reply to @northoftheborder "@caheil @jeffmarc Also note that median survival numbers come from older SEER data, before many of..." + (show)
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@caheil @jeffmarc Also note that median survival numbers come from older SEER data, before many of the latest treatments and medications were in widespread use.

We won't know our own prospects for another 5–10 years at least, but it's looking promising so far:
https://www.scientificamerican.com/article/treating-prostate-cancer-at-any-stage/

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That is encouraging- thank you!

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zmarkv | @zmarkv | Jan 3 7:01am
In reply to @northoftheborder "To distill what Jeff wrote, prostate cancer can be "castrate-sensitive" or "castrate-resistant." If it responds to..." + (show)
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To distill what Jeff wrote, prostate cancer can be "castrate-sensitive" or "castrate-resistant."

If it responds to hormone therapy (ADT) like Lupron, then it's classified as castrate-sensitive.

If it does not respond to hormone therapy, then it's classified as castrate-resistant.

Sometimes metastatic (incurable) prostate cancer like mine starts out as castrate-sensitive, but then becomes castrate-resistant after a few years.

Oncologists used to assume that transition would *always* happen for metastatic prostate cancer within a couple of years, but researchers have recently discovered that newer drugs like the -lutamides, if started at the same time as an ADT like Lupron or Orgovyx, can delay or even prevent the transition to castrate-resistance indefinitely in many cases. My cancer is still castrate-sensitive after 4 years, 3 months on ADT + Apalutamide.

There are excellent treatments available for both situations, but they're somewhat different, which is why it's important for your husband's oncology team to determine which classification currently applies to the OP's husband's cancer

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@northoftheborder the only thing that I’d like to comment on regards the phrase “incurable”. Too many places give up prematurely. I’m realistic about the challenges but have no interest in doctors that toss out that term and quit trying to cure. It’s their job unless they specialize in palliative care.

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caheil | @caheil | Jan 3 10:51am

Great point - totally agree.

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northoftheborder | @northoftheborder | Jan 3 12:08pm
In reply to @zmarkv "@northoftheborder the only thing that I’d like to comment on regards the phrase “incurable”. Too many..." + (show)
Profile picture for zmarkv @zmarkv

@northoftheborder the only thing that I’d like to comment on regards the phrase “incurable”. Too many places give up prematurely. I’m realistic about the challenges but have no interest in doctors that toss out that term and quit trying to cure. It’s their job unless they specialize in palliative care.

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@zmarkv Yes, 100%. Parkinson's, diabetes, and HIV are all likewise incurable, but that doesn't prevent the medical community from *managing* them so that people can often live out the full terms of their natural lives.

With the latest treatments and medications, many advanced prostate cancer cases (especially oligometastatic cases) are either at that point or very close now, but unfortunately not all practioners have shifted their focus yet from short-term palliative care to long-term disease management.

That means we have to advocate for ourselves assertively. I was very sick, post-surgery, paralysed, and in emotional shock when I got my stage 4 diagnosis out of the blue in 2021, but the most important thing I did was tell the oncology team that I was ready to fight, hard. That freed them from any ethical concerns they might have had about giving me harsh, "curative-intent" treatments. They promised to "throw the kitchen sink at it," and they have.

p.s. That doesn't mean a patient is wrong to choose purely palliative care, especially if they're very elderly or have other diseases, but it should be a choice offered to the patient, not a choice made for them.

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caheil | @caheil | Jan 3 1:36pm

Yayyy for you! Keep fighting- so glad for you that it is working!

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