Is treatment working?
orgovix 120 & zytiga 1000 but PSA went from 12 to 19 in 9 mo. now what?
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orgovix 120 & zytiga 1000 but PSA went from 12 to 19 in 9 mo. now what?
Interested in more discussions like this? Go to the Prostate Cancer Support Group.
Hi Duberdicus.
Replies to your question will be much more helpful if you share the details of your diagnosis, biopsies and treatments to date including Gleason and Decipher results.
Welcome to MCC!
Bill
treatment started in 2015:
radiation and ADT.
Ups and downs until 2024 ADT no longer worked.
2025 PSMA showed spine, spinal column, ribs, pelvic bone, pelvic wall, lymph nodes, iliac all involved.
started orgovix and zytiga but PSA continues to rise 12 to 19 in 9 months.
You need a PSMA pet scan. That can find a metastasis somewhere in your body usually. You need whatever’s causing that rise in PSA to be zapped so that you can get back to normal again? You really need to discuss this with your doctor and try to get this test.
There really isn’t any other way to find What is causing your rise in PSA.
The drugs you are on should have dropped your PSA down, to undetectable, The fact that it didn’t drop means that there’s definitely a metastasis or multiple metastasis somewhere.
This is discussed in the PCRI conferences. Some of the doctors strongly believe in just waiting for the PSA to rise finding the metastasis and zapping them. That can get you back to normal.
Chemotherapy or Pluvicto Are two other options, but they normally have to find metastasis using the PSMA PET scan before they will do those procedures.
Sounds like Pluvicto may be indicated since you have diffuse metastases. JMO…
Phil
Yes, PSMA completed.
Dr has suggested one mote ADT try before Chemo and then Pluvieto.
I told the Dr i will try anything that will work as what we are doing now isn't working.
Have you had somatic testing for BRCA2 mutation which might make immunotherapy an option during or after chemo?
Bill
While ADT can reduce your PSA to undetectable Holding off on treatment doesn’t make sense. Yes, they might go a couple months after the ADT shot to have it become more effective but at that point if you need chemo or Pluvicto that should be done Based on how many metastasis are found in the PSMA pet test.
If you have less than five, they may be able to zap them with SBRT, If there are a whole bunch, then chemo and Pluvicto are really the only way to get early Treatment. On top of that, they should have a plan to treat the prostate which if not treated would continue to spread prostate cancer throughout your body.
How About getting a second opinion . Are you working with a center of excellence? You want to make sure you have top notch doctors working on your case? A COE or a genito urinary oncologist would have the best treatment in mind for you. If you are working with a medical oncologist, they are just fine for chemo, but for a general treatment of your cancer, they are not the right doctor. If you’re working with a urologist, they are way out of their depths.
The doctor did not feel I was a candidate for that.
I'm going to echo what @jeffmarc and the others say. It seems based on the clinical data you describe, you are castrate resistant. If I understand the guidelines from NCCN and AUA correctly, you generally continue with thye ADT and ARI but now other treatments are in play.
Chemotherapy is certainly one of them
MDT using whatever form of radiation is another
Has the medical team discussed:
Targeted therapy (PARP inhibitors)
For patients with specific genetic mutations, targeted therapy can be highly effective.
Olaparib (Lynparza) and Rucaparib (Rubraca): Used for patients whose tumors have mutations in DNA repair genes, such as BRCA1 or BRCA2.
Radiopharmaceutical therapy - this approach uses radioactive substances that are selectively delivered to cancer cells.
Lutetium-177 (¹⁷⁷Lu)-PSMA-617 (Pluvicto): A targeted therapy for patients with PSMA positive mCRPC.
Radium-223 (Xofigo): A radioactive drug that is targeted to bone metastases to relieve pain and improve survival.
Immunotherapy
Sipuleucel-T (Provenge): A cellular immunotherapy that is customized for each patient and stimulates the immune system to attack prostate cancer cells.
Pembrolizumab (Keytruda): Approved for patients with tumors that have specific genetic features, such as high microsatellite instability (MSI-H) or high tumor mutational burden (TMB-H).
Palliative and supportive care - This type of care focuses on managing symptoms and improving comfort, which is a key part of treating mCRPC.
Factors influencing a decision:
Previous Treatments: The sequence of therapies is important, with some medications recommended for use after other treatments have failed.
Biomarker Testing: Genetic testing for mutations (e.g., in DNA repair genes) can help identify patients who may benefit from targeted therapies like PARP inhibitors.
Disease Location: The presence of bone metastases versus visceral metastases can influence the choice of therapy, such as the use of Radium-223 for bone-focused disease
This is "old" but may be useful - https://www.urotoday.com/video-lectures/nccn-2024/video/4172-2024-nccn-guidelines-update-metastatic-castration-resistant-prostate-cancer-treatment-rashid-sayyid-zachary-klaassen.html#:~:text=Rashid%20Sayyid%20and%20Zachary%20Klaassen,profiles%20and%20prior%20therapies%20received.
Kevin
Thank you Jeff.
The doctor holds the reigns here. He is part of a team at a well know and revered cancer center After I pushed a little he disclosed his plan. ADT, Chem, and Pluvieto which kind of resembles your suggestions.
Thanks