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Should PSA over 4 be a concern during treatment

Hi, I'm JohnDavid

First the details.

I was diagnosed with Stage 4 prostate cancer in late Sep 2018. My Gleason score was 9. The cancer had metastasized to my bones, from my skull to below my knees, especially in my pelvis, spine and ribs. No surgery was done to remove my prostate because of the extent of my cancer. On Oct 2 my PSA was 152. I started Lupron on 9 October and Zytiga a week later. On Nov 13 my PSA was 33.8. In early Jan my PSA was 4.786. In early March my PSA was. 4.760

I’ve had 29 radiation sessions, ending in January, to relieve bone pain.

My full body bone scan just done 15 March showed no significant changes since the first full body bone scan down in September. So, the cancer has not spread further since my treatment was started.

Given the dramatic initial PSA drop from 152 to 33.8, then from that to 4.786, I’m disappointed my PSA hasn’t gone lower. I’m trying not to be discouraged. My doctor says “we’re in good standing and would like to see it drop further after this plateau”.

The scores I’ve seen here and know of other men with stage 4 prostate cancer are typically 1 while under treatment. I had hoped to be near 1 by now to help indicate the Lupron and Zytiga are fully effective.

Has anyone had problems with their PSA getting below 4?

If you have PSA above 4, has your doctor expressed concerns?

  • Post #1
  • Thu Mar 21, 2019
Hi, I'm Paul S

How old are you?

  • Post #2
  • Mon Oct 7, 2019
Hi, I'm JohnDavid

66 on Sunday. Since my post my PSA continued to rise, had scans showing progression of cancer, tried Xtandi which didn’t work, and will start Xofigo this Friday. That’s my current status. I’ve been feeling pretty well. I’ll be interested to see how things go with Xofigo.

  • Post #3
  • Tue Oct 8, 2019
Hi, I'm Richard F D.

You sound a lot like my brother. He is 70 and has a lot of different experimental medications administered to him. In 2010 he had the 43 radiation treatments and made his PSA go down to below 1. I have seen so many patients that have received the radiation then they do better for a while but then comes back. Today his PSA is up in the 300’s and has a lot of pain in the same areas as you. If you have any sons please tell them to make sure they get checked. I also was diagnosed with prostate cancer in 2010 but chose to get mine removed. The PSA has stayed down below in the 0.1 range. Good luck hope your doctor can find something for you.

  • Post #4
  • Sat Jan 25, 2020
Hi, I'm WILLIAM C B.

Thank you for posting as it gave me some idea of what I was going through. I was diagnosed with aggressive stage 4 prostate and bladder cancer in March 2020. It had already spread to my lymph nodes and bones. My normal PSA had been between 5 and 12 since 2010. I had blood in my urine and went to the doctor in March. My PSA was 172. He took it 5 days later and it was 283. I have no idea how high it went after that before I got the ATD shot. I just got back the result of my PSA taken May 6. It was 8.5. I am currently taking radiation treatment on my pelvic region. I have also had a second ATD shot and an Xgeva shot. I will be starting Xtandi as soon as my insurance approves it. I will post again when I have more results.

  • Post #5
  • Sat May 23, 2020

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