PSA 1550

Hi there,

I think he must have been referring to a suspicion that new metastases have become large enough to be visible on a scan.
Prostate cancer grows and metastases at very different rates depending on the type, we have to hope that this is one of the more indolent types.
May I suggest asking your doctor if your husband can be changed from Lupron to Firmagon as it seems to be more effective in lowering PSA and maybe controlling the rate of growth of metastases.

Best wishes,

Georges

Sid,

I also believe that the side effects are from the treatment but the surge of the symptoms at four weeks makes me think that your husband is taking the Olaparib inhibitor for real. This sort of medication takes time in starting its effects (depleting the body from those enzymes along its action) which alters in time the body response to what is missed. Olaparib attacks one of those switches in the DNA that provides survival to the cells we are trying to destroy. This resists and acts against the treatment. Pulling down these switches allows free access to Zytiga to act fully. Surely the immune system reacts trigging along a series of symptoms until the situation stabilizes. I wonder what his doctors will tell you but you may inquire what you can do to counter the effects and if the treatment can be stoped earlier in case the situation doesn't improve.

I am sorry for the occurrence. I hope things get better.

Here are details on the drug and possible side effects. There is a note of caution that you should consider because the treatment will pull down some of our natural defenses;
http://chemocare.com/chemotherapy/drug-info/Olaparib.aspx

Best wishes.

VGama 

Sidtippy2 said:

Ineresting update...I

Ineresting update...I mentioned last week that my husband was feeling worse than ever the last week or 2.   He ended up getting admitted to the hospital for a perirectal abscess and had surgery yesterday.  We couldn't visualize the abscess until thursday night, saw dr friday and got admitted.  He was really really sick, surgery saturday and is much better.   The abscess was even larger internally than externally, and called it a horseshoe abscess which means it went up both sides of the pelvic cavity, only happens in 5% of abscesses.  He is MUCH better post op, has 2 rectal drains that he will go home with, home in a couple days.  At first we were afraid the abscess was related to the cancer in his pelvis, but it looks like it was a random abscess, not related to cancer.  Perhaps such a fast growing infection is related to him being more immunocompromised than we realized.  

They are holding all study drugs until he is over this infection, so probably 4 weeks or so.  We are disappointed ok but totally understand the need to heal first.  

We did get good news, his PSA is down to 300, and it was 911 last month.  So the new meds and/or study drug was working. 

And sorry to not answer sooner Kidclutch, I'm not aware of the genome sequencing series being done, though he did have many labs done before being approved.  Interestingly my hubby was initially on Casodex and that worked for about 6 months.  When it stopped working is when they realized he might qualify for this study.   His meds now are Zytiga and prednisone, plus either Olaparib or placebo med.  He's now off all 3 of those for now.  I hope your father is doing well. 

No apology necessary, so happy to hear your husband is on the mend and there was a PSA response. Hope he gets back on those medicines soon to get even better!

Sidtippy2 said:

Quick update, hubby continues

Quick update, hubby continues to improve from recent illness.  We was approved to go back on study with 2 days to spare, whew, that was way too close.  More great news, his PSA is down to 70, even though he was off meds for 3 weeks.  

Now for the not great news, he also had bone scan and full CTs scans.  He had a nodule on rib, it is now much larger.  He also had one nodule in right lung, now he has multiple lesions.

We were shocked there is new growth given his PSA had decreased.  Any perspectives or opinions?

thanks, as always

sid,

The nodules can probably be killed via spot radiation. Doing this is somewhat common agains PCa on the bone or other organs.  Radiation might beat it back far enough to significanly improve prognosis.

ma

Hi Sid,

I think that I have written elsewhere on this subject but maybe it was eaten in the great data loss.
There is a close to direct relationship between the size of the tumour and the amount of PSA produced in the earlier stages of prostate cancer eg the bigger and more extensive the tumour the more PSA it will produce. It should be noted that some tumours can be very small but produce a lot of PSA, the process for making PSA is in overdrive in these cells.
There is also a relationship between PSA and Gleason number. There is a grading between Gleason 3, 4, and 5. Gleason stage 3 cells are really very like normal prostate cancer cells, 4 is in the middle and 5 are only very poorly like prostate cancer cells. Men with cancers with low Gleason grades will often have high PSA scores and those with high grades will have lower PSA scores for the same size of tumour activity. This is because low grade prostate cancer cells are still trying to be prostate cells to a certain extent while higher grade cells have given up on that.
It is also the reason that low scores like Vasco and myself have local invasion, usually in the prostate bed but it can be in adjacent tissues. The cells do not metastase easily and they do not go far, even when they get there they still try to be prostate cells, making PSA, and crucially in some cases continuing to require stimulation by testosterone, etc to grow for a long time so various ADT strategies can be used to teat it almost like diabetes. It might get you in the end but it will take some time.
A high score like your husband has cancer cells that are very unlike normal prostate cancer cells, they tend to metastase quite fast so he had quite extensive mets, they also tend to adapt quite quickly to the absence of androgens. So his PSA fell on the start of treatment and then rose again as the cancer adapted to the new environment. I would guess that the treatment is affecting some of the cancer so his PSA has fallen but the most aggressive cells in the mets are not making much PSA and they do not seem to need a lot of androgens to grow either.
If there are relatively few mets then maybe spot radiation will help.
You need some luck now!

Best wishes,

Georges

 

Hi Sid,

Good luck, these things can turn and get better.
You never really know with prostate cancer.

Best wishes,

Georges

Sid,

Thanks for the update. I am glad for knowing that the treatment managed to extend the refractory condition (since 2018). The pain could be due to compression to the nerve bundle surrounding the bladder or kidneys. The scan may identify the inflammation but to treat it will be challenging. One could increase the dose of opioid painkillers (oxycodone) but high doses are risky as it may cause liver failure. Ibuprofen is used in migraine pain and rheumatoid arthritis which usually involve affected nerves. You may inquire his doctor on the matter.

The increase of the PSA is hard to avoid for the several metastases. In any case, the treatment should be now directed to alleviate symptoms. The quality of life is now more important than PCa. Be careful with any condition of anemia. I advice you to have more frequently a full blood panel test.

I hope things turn into your favor. Best wishes for yout husband, another hero in this our fight.

VG