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Posted 5/23/2018 9:22 AM (GMT -5)
I've been on ADT for about 4 1/2 years, Lupron and lately Eligard (have had firmagon and casodex for very short periods), also radiation to pelvic region and pelvic LNs

My PSA has started to go up, it's too soon to jump to conclusions yet as I'll need confirmatory PSA tests, but I'm researching the future.

What are the typical FIRST treatments for someone who has become castrate resistant but are not yet metastatic. Also, are there treatments that have become recently approved for someone like that.

G9, pT3bN1, clear scans except a very small non-biopsible spot on lung
Posted 5/23/2018 1:07 PM (GMT -5)
I haven't kept up on the changing methods and care standards, but TallAllen will likely have some good information. I seem to remember a post not long ago that outlined the methods. Second line HT, chemo, immunotherapy are all on the table, but I don't know the nuances for their use and order.

Are you under the care of a medical oncologist and have you had any discussion of what is next?
Posted 5/23/2018 3:35 PM (GMT -5)
MO is next week, I was hoping to have an informed discussion.
Posted 5/23/2018 11:05 PM (GMT -5)
Erleada (apalutamide) was recently approved for non-metastatic CRPC.

/www.jnj.com/media-center/press-releases/erleada-apalutamide-a-next-generation-androgen-receptor-inhibitor-granted-us-fda-approval-for-the-treatment-of-patients-with-non-metastatic-castration-resistant-prostate-cancer

(If/when you may become metastatic, chemo with Docetaxel or Zytiga plus prednisone may be options, too. Or possibly Provenge, or possibly other immune combinations in Clinical Trials.)

Ask you doctor. Consider getting a second opinion from a prostate cancer expert at a regional center of excellence, if you have not already done so.

Just some thoughts...

Charles
Posted 5/24/2018 1:34 AM (GMT -5)
What have your recent PSAs been?
Posted 5/24/2018 8:20 AM (GMT -5)
Really low, but headed north. 0.06 --> 0.08

I know I have to have a another test or two AND that PSA has to get up to like 2.0 or so.
But if the rise is as quick this time as it was last time it won't be long. Last time it doubled every 6-8 weeks.

I'm just trying to get my treatment facts before I hear him discuss.
Posted 5/24/2018 6:37 PM (GMT -5)
I think you would be better off with a conventional PSA test. This ultrasensitive PSA test is causing you needless anxiety. And it is not giving you any useful information.
Posted 5/24/2018 9:28 PM (GMT -5)
Be sure you are connected with your insurance company because from here on out, things can get very expensive...
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