Increase in PSA after Enzalutamide

User

Posted 23 Dec 2021 at 16:25

Hi there,

My partner has been on Enzalutamide for 11 months now, since his original diagnosis of PCA (Gleason 9, PSA 177 spread to lymph nodes) in Jan. His PSA continued to drop and reached 0.04 after he went through a trial of Focal Cryotherapy of his prostate in July. the last two readings have been 0.05 and 0.09. His oncologist is now talking about alternative treatments and to prepare for a further rise. I am currently in bed with Covid so couldn't be part of the conversation but he was talking about a trial at the Royal Marsden? Does anyone know what options he has after Prostap/Enzalutamide? I know they took a biopsy after his Cryotherapy but nobody has got back to us to let us know whether he has the correct genetic make-up for other drugs such as Oliparib. I can't believe this has happened so soon- I thought the Enzalutamide would last a bit longer- it just feels like we are going through the same worrying Christmas we had last year and I really need to be able to give him some hope.

User

Posted 24 Dec 2021 at 00:03

General rule is that PSA should remain at or below 2 after cryotherapy, but that is assuming there is no hormone treatment suppressing the PSA.

These are tiny numbers, it seems premature to be thinking about stopping the enzalutimide already as there is very little option after it. Research data suggests that the average period of effectiveness for enza is 15 months although some do far worse and some far better.

NHS / NICE guidelines are that you can only have enza OR abiraterone OR apalutimide - all the data is that once one fails, the others would also fail. It makes no difference which one you have first.

If the onco decides that enza is failing, the next step would probably be docetaxel or, if he has had that before and it didn't help, cabazitaxel. If there are bone mets and these are causing pain, radium 223 might be a possibility although this doesn't treat the actual cancer.

Edited by member 24 Dec 2021 at 00:04 | Reason: Not specified

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

User

Posted 28 Dec 2021 at 01:42

Hi rrworkshop

I share your views on the treatment limitations for advanced prostate cancer. My husband diagnosed last year age 54, psa 793, T3b widespread bone mets. Abiraterone was great since Nov 2020 but only got a year with it and now just started docetaxel. His oncologist has also mentioned oliparub. Praying the docetaxel works for longer than abiraterone! Best wishes to you and OH

User

Posted 07 Jan 2023 at 12:06

Hi there,

apologies for delay in replying! As we suspected, his PSA continued to rise, doubling every month so although it seemed small at first, it very quickly rise to beyond 50. Infact, it was so distressing getting the results, he decided he didn’t want to know any more. He is now on the SPlASH trial at the Royal Marsden Sutton, an incredible place which has cutting-edge research and amazing doctors/nurses. It has 2 treatment arms, randomly assigned: Abiraterone and lutetium 177. Unfortunately he got on the Abiraterone arm but that didn’t work so they have swapped him to the lutetium 177 arm and treatment begins in feb. It has spread again with prostate and lymph nodes near prostate but he actually still feels ok and is continuing to run and go to the gym. Hoping this next treatment works. New things are being discovered all the time, there are definitely other alternatives to Enzalutamide, you just need to push your GP to refer him or contact the trial yourself, which is what I did. Keep an eye on what new trials/treatments are available: cancer research website often has list of them or go onto the royal Marsden website. Best of luck .

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User

Posted 23 Dec 2021 at 21:40

This isn't making much sense - can you check your numbers again? There would be no reason for an oncologist to be concerned that enza is failing and talking about a change of treatment based just on PSA if the readings were 0.04 / 0.09 so either the decimal point is in the wrong place or there is something else like further scans have shown new mets, the biopsy has turned up a rare form of prostate cancer or something like that? While on Enza, you wouldn't normally see an onco talking about stopping it unless the PSA was up beyond 20 or the cancer was clearly active and spreading.

You have said here that his PSA went down to 0.04 but in previous posts, it was 0.45 in March and 0.26 in July.

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

User

Posted 23 Dec 2021 at 22:58

Thanks for your reply. The figures are correct. His PSA went down to ) 0.04 in September. I know it seems very low to start worrying but I think that after focal Cryotherapy, as with prostatectomy, the PSA should be almost undetectable , ie less than 0.1. The fact that it has risen in the past 2 tests suggests that there is possibly a pattern and if it continues to do so, we need to have a plan in place, but perhaps we are worrying unnecessarily. He is an extremely experienced Oncologist, so I would like to think there was some rational reasoning behind it. I just can't seem to find much written about further treatments as Abiratone seems to be ineffective after Enza, though not the other way round.

User

Posted 24 Dec 2021 at 00:03

General rule is that PSA should remain at or below 2 after cryotherapy, but that is assuming there is no hormone treatment suppressing the PSA.

NHS / NICE guidelines are that you can only have enza OR abiraterone OR apalutimide - all the data is that once one fails, the others would also fail. It makes no difference which one you have first.

Edited by member 24 Dec 2021 at 00:04 | Reason: Not specified

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

User

Posted 24 Dec 2021 at 12:35

It's quite hard to hear that there is 'very little option' after Enzalutamide fails. I spoke to the cancer nurse this morning and she has said he would be eligible for a trial of Oliparib, which is a PARP inhibitor. Perhaps none as effective as Enzalutamide has been, but nevertheless we have to keep hoping. I am very grateful to my oncologist for thinking ahead and wanting to put something in place if the numbers continue to rise.

User

Posted 28 Dec 2021 at 01:42

Hi rrworkshop

User

Posted 04 Dec 2022 at 09:44

Hi RRWORKSHOP Apologies for replying to an old post my father has a very similar presentation to your OH. I wondered how your OH has responded to the treatment so far? Thanks

User

Posted 07 Jan 2023 at 12:06

Hi there,

User

Posted 07 Jan 2023 at 21:02

Thank you for your post. I hope your OH responds well to further treatment. I will also take on board your advice regarding looking for any research that is available. Thank you.

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