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PSA not dropping fast enough?

User
Posted 10 Mar 2023 at 11:23

Hi everyone,

I'm posting this on behalf of my dad, who lives outside the UK (so treatment options may be different). He's 81 and was diagnosed last year (details in profile), and his doctor recommended quite aggressive treatment, monthly Firmagon injections, apalutamide tablets daily and 6 cycles of chemo. He was in very bad shape then, after his TURP surgery, with chronic kidney disease and so the oncologist decided not to pursue the chemo option then, and just see how well he would fare on the other therapies.

So 6 months on, here's what the PSA has been doing...

4 Oct 2022 (at diagnosis) 1698

27 Oct 2022              211

6 Nov 2022           96

9 Dec 2022       15

10 Mar 2023      4

 

His urologist thinks it should drop to zero in another month or so, but has already strongly urged chemo treatment if it doesn't drop to zero in 2 months. My dad is utterly distressed by this, and frankly, with CKD and all the rest, I'm not so sure that he will be able to cope?

Is this a worrying trajectory for the PSA so far, I know that it isn't zero-ing out as fast as we would have liked, but we have nothing to compare against. What are everyone's thoughts?

Worried Daughter

 

User
Posted 10 Mar 2023 at 13:33
I feel a bit cross with your dad's onco, to be honest - this looks like a fantastic response to the hormones! Some men never get to zero, especially not from a starting point in the thousands. I wonder, is there any financial benefit to the onco if chemo is given?

My dad is a little older than yours at 85 but there is no way that he would agree to chemo - his quality of life is far too important. If your dad is feeling better with the firmagon / apa combination and has a good lfe, I would be telling the onco no.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 Mar 2023 at 17:48

Hi 

A had a starting PSA of 2100 in 6 months I was down to 0.5,I'm only 53 with no underlying health conditions started with firmagon injections but now on Enzalutamide with 3 monthly injection of prostap,nurses did mention that in a lot of cases the higher the PSA on diagnosis the quicker you fall.

Regards Phil 

 
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