Labs Follow Up and the Clinical Trial

Well, my PSA has risen again, this time up to 37. This is the third consecutive rise of my PSA and three times is enough to consider my prostate cancer as castrate resistant and time start looking at second-line medication. But first an explanation of what's likely going on.

Castrate resistant cancer means your PSA is rising despite being at a castrate level of testosterone. The chemo I went through killed cancer cells. Not all of them, but a good number. The Lupron (which I receive as a shot every three months) signals my pituitary gland to tells my testes to produce any testosterone. Prostate cancer thrives on testosterone and Lupron is a first-line hormone treatment to prevent your body from producing it. However, my prostate cancer will eventually begin producing its own testosterone, which is known as castrate resistant prostate cancer, and that's where I am..

Last year I started first line standard of care treatment for for high volume stage 4 prostate cancer. Thanks to the CHAARTED clinical trial it was found that chemo (docetaxel/Taxotere) combined with Lupron had more efficacy than either alone. So that's the treatment I had the first time around and it was quite effective. Though my PSA is 37, I feel reality good considering. The Oxycodone works well with the pain I do have and I don't need to take it every day.

So on to the next step. Second-line treatment in my case would be abiraterone (Zytiga). There's a clinical trial currently open that I qualify for, the CHAARTED2 trial. It's very simiarl to the CHAARTED trial I mentioned previsously. CHAARTED2 is testing the efficay or abiraterone alone vs abiraterone compared to abiraterone with chemo, which would be cabazitaxel (Jevtana). It's a non-blind, randomized trial, so if I join the trial, I'll be randomized into one of two study groups.

A quick note: abiraterone will prevent the testes from producing testosterone, but it also prevents the adrenal glands, which also produces testosterone, about 10%, from producing testosterone. And abiratereone also stop the cancer itself from producing its own testosterone.

All clinical trials have fairly stringent inclusion and exclusion criteria, and generally some preliminary tests. So after talking to my oncologist we decided to  move forward with trial. She brought in a clinical trial coordinator and we went through the 21-page consent form (this process is called "informed consent") and since I was ready to start and I had no issues the consent, I signed the form and the wheels started rolling. I would have three scans before I got randomized: a PET scan, a bone scan, and a CT scan. Those would be scheduled within the next few days and we scheduled a follow up for two weeks from today, Monday October 22.

Year Two, Here We Go

I haven't been very good about writing here on this blog. If I want to document year one any more than I have, I'll have to go from memory. That said, this weekend is the one-year "cancerversary" from when it all began. A year ago today (I'm going by weekday, not date), October 6, 2017, I had my PSA checked because I was having some obvious symptoms, which I documented in an early blog post.

So today (one year from when my GP called me with  my initial PSA results), I'm going in for my six-week lab work. My PSA started at 5,306 last year and went down steadily during chemo and with Lupron shots every three months. Sometimes my PSA would go down by consistently by 30 or 40 percent each checkup while during treatment and for a few months after. We got all the way down to 22, which is still a pretty elevated level, but compared to where I started it was nearly miracles. As it stands, 22 is my nadir.

Twelve weeks ago my PSA rose to 24. Then six weeks ago it went up to 27. Depending on today's labs, we'll probably start talking about second line treatment. My oncologist and I have discussed various options, but we wanted to wait to see if the PSA would go up again. There's a clinical trial I might join. It's the CHAARTED2 trial that is a phase 2 trial testing the efficacy of Zytiga by itself as comapared to Zytiga and cabazitaxel (Javatana) together.

So I'm going to try and document year two more in real time. Chemo brain or not, my memory isn't what it used to be. And it didn't used to be much...