Many years since radical prostectomy: PSA values rising

Well, as you can see, there is no definitive answer.

Your answer lies in your clinical data, GS, GG, PSADT, PSAV, age, co-morbidities....

A GS of 3+4 or less, GG 2, PSADT and PSAV >12 months could favor that decision.

Family history as others mentioned, living to 95-100 may indicate do something.

MDT by itself may delay the need for systemic therapy, you're 87, ergo...

As @jeffmarc days, ARI monotherapy is a feasible choice, especially Nubequa.

You pull combine systemic therapy with radiation, 6-24 months. For those with a PSA >.5 and or high risk, 24 months. But, if you're not high risk and your PSA is>.5, what to do?

If you do radiation and systemic therapy, then which agents and how long? Monique and Orgovyx might be the two if choice for 6-12 months!what would I do, in order...
MDT only
Nubequa only
MDT + ADT + ARI, 6-12 months, PSA drops to undetectable in the first six, de-intensify.

Kevin

Yes, doing nothing is an option...that may friend on

@jeffmarc
Yes the side effects do vary from person to person but Orgovyx is easier on your heart compared to other ones like Lupron. Also your testosterone recovers faster than on Lupron.

Dave 3+4

@clevelandguy
I was looking up at who wrote this a couple of times, because it was something I just said in another set of messages.

Correct information for sure.

In 2003 my husband was diagnosed with prostate cancer, he had surgery. 2011 the cancer returned and he had radiation 38 treatments. 2024 his PSA rose to 4.65 and he had a pet scan which showed recurrence in the prostrate area and urethra. He was put on Lupron shots every 3 months. I asked the doctor for another pet scan which showed increasing activity in his lymph nodes, abdomen and pelvis which means the cancer could be more active in those areas, nothing in his bones per the oncologist. We have an appointment on Monday to add other medications to control the cancer. If anyone else has had this happen and been given other medications to control their cancer I would appreciate any input so I can be prepared with questions. Thanks so much

@jeanadair123
For one, you should ask to switch to Orgovyx. It has fewer side effects for most people, It is better for your heart since it doesn’t cause arterial sclerosis buildup and the testosterone comes back much quicker when you stop taking it.
Normally, it would go on another drug like Darolutamide, It has almost no side effects, but works very well to get the PSA down.

Then there is another option chemo or Pluvicto Are pretty commonly used with the condition your husband is in.

Check out this study which covers a way your husband could be treated without Lupron.
https://connect.mayoclinic.org/discussion/pluvicto-without-adt-for-castrate-sensitive-patients/
Since this treatment discusses using Pluvicto you should be aware of these things

Be aware that it works really well for 33% of people OK for 33% of people and not at all for 33% of people.

If you have certain genetic issues, either hereditary or somatic, it can affect how well Pluvicto Works. You can ask for a somatic test before doing Pluvicto To find out if you’ve got Genetic changes Due to the cancer.

If you have BRCA2 or ATM It seems to work better. If you have RB1, PTEN or TP53 They are Pluvicto resistant.

@jeffmarc Thank you so much that was really helpful. It certainly will give me plenty of questions to ask? Do you know if most of these are good for recurrent cancer and cancers that have metastasized? I must say my husband has had little if no side effects to the Lupron other that dreams while sleeping which could be associated with his dementia Aricept medication. He also has a cardiologist which he has semi annual checks and all seems ok. Again thank you.

@diverjer
I’ve mentioned a few times about people coming into the ancan.org Weekly online advanced prostate cancer meetings with their PSA rising after 30, 25 and 20 years following radiation or surgery.. I’ve heard everything at that weekly meeting, and we are seeing a mirror image of that here.

I mentioned the problem with Dorman cells. That before prostate, cancer is even diagnosed it spreads dormant cells throughout the body, and they get hidden in organs all over the place. When there is stress on the body, dormant cells can reactivate, and become cancer. Have you missed all of those articles I have mentioned.

@jeanadair123
I’ve had my cancer reoccur four times. I had a metastasis on my spine zapped about three years ago. I am on Orgovyx and Darolutamide They have been undetectable for 31 months after 16 years of PC. So the answer is the drugs probably work for exactly what your husband has. You can discuss this with your doctor and see what they think. What they’re doing now is working. Maybe you don’t need to change it. The thing is if he does get off ADT at some point, his testosterone will come back quicker with Orgovyx than with Lupron. That will get him feeling better sooner. So many possibilities.

@jeffmarc

Now that you mention it, I remember. Tell you the truth there is so much new information to absorb and then dealing with these mental/physical issues form everything- I forget a lot.

@jeffmarc Thank you so much for the information I will discuss this with his doctor. I have to say though that the Lupron was supposed to prevent any further cancer it appears it didn’t since it has spread? But at least he didn’t have any side effects.We wouldn’t have known if I had not asked for a new pet scan. It’s exhausting being so proactive all the time.
Excuse my ignorance but what is PC? Chemo?