ADT AND PSA LEVELS

[DiRi]

I have a question for the experts - my husband has had his first blood test after initial hormone therapy of one month of Firmagon (in April) and then a six month injection of Lucrin.  From what was an original PSA reading of 100 in March, his level has just been tested and come back at 77.

We have no idea what to expect, but thought it would be lower.  The GP said that it would have peaked at about 166 prior to treatment beginning in April, so I'm guessing that the current reading of 77 isn't too bad.  I'm wondering also what is the significance of the alk phos levels.  He is to begin 6 x Doxetacel in a couple of weeks.

[tonymax]

DiRi,

I attach my history files for your perusal.

I started with PSA 7, Gleason 8 and failed radical in 2003.

Lucrin controlled things for quite a few years and now getting good results by adding pre chemo Enzalutamide in a clinical trial.

There are big variations in responses to these treatments from patient to patient.T Max Medical Map.xlsT Max Medical Map.xlsT Max Medical Map.xls

Happy to talk by phone if you wish.

I will be overseas at a cancer meeting next week for one week.

 

Regards          Tony Maxwell

Tony Max PSA Results 1.xlsx

[tonymax]

T Max Medical Map.xls

[Kezza2]

Your post is a bit short on detail to make much of a comment.  Has he had a biopsy or a PSMA PET scan yet to confirm the extent of the problem ??  Have you seen a urologist or just the GP ??  In my case I had ADT (Lucrin) followed by external beam radiation and then intermittent Lucrin for 15 years before the Lucrin began to fail.  I am currently on a Lucrin plus Abiraterone trial and my PSA is stable after 15 months at 1.6.

[DiRi]

sorry - most of the details of the story so far was posted under 'our story'.  He had a bone biopsy which confirmed PCa adeno carcinoma with extensive mets in the bones  A PET PSMA scan revealed some lymph node involvement.  He has had 5 x radium sessions that have worked well in relieving the bone pain.  We have seen Urologists, Radiation Oncologist and most recently Oncologist (all public).  I guess as long as the PSA has decreased we know things are working - how quickly it decreases is what I was trying to gather information on (I realise everyone is different). I'm curious as to why the Urologist gave him a six monthly injection of Lucrin as everyone else seems to talk of shorter doses.  I wondered if the 6 month strength gave him a bigger spike in testosterone as there was nothing else given to counteract that.  All new to me really, thanks Tony too for your info.

[Walter]

DiRi

Sorry to hear you are still having problems.

I did not have any Firmagon, I was placed on Lucrin 4 monthly injections immediately after my diagnosis.

At that stage my PSA level was 72 and after 3 months it went down to 8 and now after 14 months it is below 1. 

I have had a second PET/CT scan and the results indicate the bone metastese have decreased significantly. But I still get significant back pain, but my radiation oncologist believes it is due to the spine gradually fracturing.

my belief is that while your PSA level is going down it is good. If you are in doubt I would speak to your oncologist or urologist and let them know you are concerned. I have found that unless you ask and are persistent they won't tell you much. Just keep nagging them and best of luck

[Kezza2]

5 hours ago, DiRi said:

sorry - most of the details of the story so far was posted under 'our story'.  He had a bone biopsy which confirmed PCa adeno carcinoma with extensive mets in the bones  A PET PSMA scan revealed some lymph node involvement.  He has had 5 x radium sessions that have worked well in relieving the bone pain.  We have seen Urologists, Radiation Oncologist and most recently Oncologist (all public).  I guess as long as the PSA has decreased we know things are working - how quickly it decreases is what I was trying to gather information on (I realise everyone is different). I'm curious as to why the Urologist gave him a six monthly injection of Lucrin as everyone else seems to talk of shorter doses.  I wondered if the 6 month strength gave him a bigger spike in testosterone as there was nothing else given to counteract that.  All new to me really, thanks Tony too for your info.

Ahhh I see.  I believe you may have answered the question.  It is usual to give something like Androcur for a couple of weeks before Lucrin to stop the "Flare".  I would guess that was what the Firmagon was for, but not sure.  The lucrin should release consistantly over the full period of its formulation so I guess its just wait and see how the PSA goes next blood test, as long as it is still trending down its a good thing.

[Charles (Chuck) Maack]

The prescribing of GnRH antagonist Firmagon/degarelix provides a couple good results: It does not cause the flare effect experienced with an LHRH agonist, will not cause a flare effect when switched to an LHRH agonist (in your case Lucrin), and usually provides a more rapid response to see if the testosterone level is effectively dropping as well as PSA level - both initial indicators that androgen deprivation therapy will likely serve in helping control and manage any rapid cancer cell development and/or proliferation.  Thirty-days is a bit too early to expect significant drop, but the 100ng/dl to 77ng/dl is a good sign.  His testosterone level should also have been checked since that is why "androgen" (testosterone) deprivation medications are administered.  With chemotherapy on the near horizon, it would appear from what you have provided that his prostate cancer at diagnosis was high grade and the finding of cancer already on bone confirms that as likely.  Thus, with the PSA drop, the physician felt it was okay to move directly to a 6-month injection of Lucrin that will continue working in company with the docetaxel/Taxotere and beyond.