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Time to PSA nadir prognostic in metastatic CRPC

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JimmyToowong

Cancer. 2009 Mar 1;115(5):981-7.

Time to prostate-specific antigen nadir independently predicts overall survival in patients who have metastatic hormone-sensitive prostate cancer treated with androgen-deprivation therapy.

Choueiri TK, Xie W, D'Amico AV, Ross RW, Hu JC, Pomerantz M, Regan MM, Taplin ME, Kantoff PW, Sartor O, Oh WK.

Dana-Farber Cancer Institute/Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. toni_choueiri@dfci.harvard.edu

Abstract

BACKGROUND: The objective of this study was to evaluate the relation between the kinetics of prostate-specific antigen (PSA) decline after the initiation of androgen-deprivation therapy (ADT) and overall survival (OS) in men with metastatic, hormone-sensitive prostate cancer (HSPC). METHODS: The authors' institutional database was used to identify a cohort of men with metastatic HSPC who were treated with ADT. Patients were included if they had at least 2 serum PSA determinations before PSA nadir and at least 1 serum PSA value available within 1 month of ADT initiation. Patient characteristics, PSA at ADT initiation, nadir PSA, time to PSA nadir (TTN), and PSA decline (PSAD) in relation to OS were analyzed.

RESULTS: One hundred seventy-nine patients were identified, and they had a median follow-up after ADT initiation of 4 years. The median OS after ADT initiation was 7 years. The median PSA level at ADT initiation and PSA nadir were 47 ng/mL and 0.28 ng/mL, respectively. On univariate analysis: TTN <6 months, PSAD >52 ng/mL per year, PSA nadir >or=0.2 ng/mL, PSA >or=47.2 ng/mL at ADT initiation, and Gleason score >7 were associated with shorter OS. On multivariate analysis, TTN <6 months, Gleason score >7, and PSA nadir >or=0.2 ng/mL independently predicted shorter OS.

CONCLUSIONS: To the authors' knowledge, this was the first report to demonstrate that a faster time to reach a PSA nadir after the initiation of ADT was associated with shorter survival duration in men with metastatic HSPC. These results need confirmation but may indicate that a rapid initial response to ADT indicates more aggressive disease. © 2009 American Cancer Society. {jm: my projected TTN = 9 months}

PMID: 19152438 Forum: Metastatic prostate cancer Title: Time to PSA nadir prognostic in metastatic CRPC

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free).

Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.

This page was found on the Advanced Prostate Cancer Community for Australian men at http://advancedprost...lia.ipbhost.com.

The link is hard to remember.

An easier way to find it is to go to JimJimJimJim.com and click on Prostate.

That's the word Jim four times, no spaces, followed by .com.

If you need other help - to perhaps find someone to talk to or a local support group:

Click on the Contact Jim button at http://JimJimJimJim.com.

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Roscoaus2000

Mine went 9000, 0.76, 0.11,0.450.66, 1.00,  over 12 months with ADT only.

nadir is 0.11 took 5 months.

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Admin

Rosco

A spectacular fall in PSA.

While time to nadir of less than 6 months is a negative, the nadir of less than 0.2 is a positive.

Hopefully the second trumps the first!

Jim

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Roscoaus2000

CT scans at 6 months intervals indicate significant resolution of cancer in soft tissues. Latest bone scan suggests less prominent activity in skeleton and no new sites in skeleton.

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Roscoaus2000
On 2 November 2017 at 8:17 PM, Roscoaus2000 said:

CT scans at 6 months intervals indicate significant resolution of cancer in soft tissues. Latest bone scan suggests less prominent activity in skeleton and no new sites in skeleton.

 

On 2 November 2017 at 8:17 PM, Roscoaus2000 said:

CT scans at 6 months intervals indicate significant resolution of cancer in soft tissues. Latest bone scan suggests less prominent activity in skeleton and no new sites in skeleton.

Latest r

 

On 2 November 2017 at 8:17 PM, Roscoaus2000 said:

CT scans at 6 months intervals indicate significant resolution of cancer in soft tissues. Latest bone scan suggests less prominent activity in skeleton and no new sites in skeleton.

Latest results went 0.66,(change from bicatulamide to  Cyrpione)1.0,1.6,(change to enzalutamide), O.01. Each of these readings approx 3 months apart

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DiRi

What is the interpretation of original PSA of 100+, then a nadir of 1.8 after chemo and Zolodex , then after 14 months from start of treatment, PSA now 2.2.   Oncologist will measure PSA again in 3 months and then look at doubling time.  I would really appreciate any information on doubling time and likely next step for my husband.  I don't want to ask the Oncologist about time left etc as I feel that is very negative for my husband, but by the same token if his time is limited, he needs to go and do what he enjoys while he can.  Thanks

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JimJimJimJim

Di

Your oncologist has a range of options available.

  • Seeing that the docetaxel chemotherapy worked once, it will often work again.
  • Xtandi (enzalutamide) or  Zytiga (abiraterone) are super hormones which the doctor may choose. (only one on PBS, not both).
  • A second kind of chemotherapy Jevtana (cabazitaxel)
  • Perhaps a trial of a new treatment

As the oncologist has indicated, the order these drugs will be used depends upon how fast the PSA is rising, and other factors like your husband's general health and how well he tolerated docetaxel the first time.

 

I spoke to one of our members in Western Australia yesterday who started his prostate treatment in 2002, then was in your husband's position (rising PSA after a set of docetaxel treatments) ten years ago (2008).

He had a second set of docetaxel, then later (starting 2013) Jevtana (cabazitaxel).

Five months ago he started on a new treatment Xtandi (enzalutamide). His PSA rose for a couple of months, then settled to around 90 for the last 3 months.

 

So, your husband could be looking at 10+ more years like this member. Unfortunately, he could also be a man who has a much shorter prostate cancer history. Your oncologist can't tell which until each of the treatments are tried. Till then he/she may be reluctant to take a punt on how long your hubby may last.

 

The story you tell does not sound to a non-doctor like the end is near.

But, if you sense that things may be looking bad, ask your oncologist a very general question.

Something like: "Are we running out of options?", or "Are you reasonably happy that hubby will be still with us a year down the track?

 

Good luck to you both

Jim

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Roscoaus2000

Latest update on my metatastic Prostate cancer.

Had to abandon Enzalutamide after 8 weeks because I suffered from a seizure resulting in hospitalisation and a 5 hour memory loss. This followed 2 -2 min. Memory losses shortly after starting on this drug. I am now on Arbariterone and my psa early June is < 0.01. I feel better than I have for 2 years and am walking exercise and golfing. My general health is excellent and all other blood indicators are within normal range.

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