Just had my annual physical. PSA last year at this time was 3.6. Now it is 6.9. The annual physical last year first discovered elevated wbc and immature cells that ultimately led to CML dx in June. Been on 400 mg Imatinib daily and PCR scores have been very encouraging. Anybody else had an elevated PSA following taking Imatinib? Any other wisdom?
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CML/Imatinib and Rising PSA
There was a study done quite a long time back to see the effect of imatimib on PSA - I guess in the hope that it could be used to manage prostate cancer.
https://www.ncbi.nlm.nih.gov/pubmed/16796694
However, the trial didn't produce much of clinical significance. So it sounds like there was a hope that imatinib could lower PSA but that didn't really turn out to be true in this case and I don't think any link between the two has been shown.
David.
My dad was diagnosed with prostate cancer about 14 years ago. He had surgery and radiation and is now cancer free, but has a lot of side effects from the radiation. He was 61 at the time, I'm 48 now. Doctors have said I'm at a pretty high risk for developing it myself, so I've already had a few exams seen the urologist a couple times. Last time I saw him, he had just returned from a conference and told me that psa testing is under a lot of scrutiny in his community. It's very similar to breast cancer testing... this heated question of overtreating someone based on a single, indirect, potentially misleading test. I wish I could give you more details, but I can just say that elevated psa would not necessarily indicate prostate cancer. And in some cases, even if they think you have cancer they might not treat it the same way they would have say 10-20 years ago. Seeing a urologist would at least give you insight from someone with expertise in considering these kinds of questions.
Can Tyrosine Kinase Inhibitors for CML Affect PSA Titers Unrelated to Prostatic Disease?
By: Celeste L. Dixon
Posted: Monday, December 10, 2018
A chance astute observation led to work, published in The Prostate, about the effect of tyrosine kinase inhibitors (TKIs) on prostate-specific antigen (PSA) titer measurements in men being treated for nonurologic diseases, including chronic myeloid leukemia (CML). Takeshi Sasaki, MD, PhD, of the University of Chicago Pritzker School of Medicine, Evanston, Illinois, and colleagues examined the effects of two TKIs, imatinib and nilotinib, on three patients with CML.
“Urologists must appreciate the effects of drugs provided for other diseases on PSA titers and be aware that sudden changes may not reflect underlying prostatic disease,” the investigators indicated.
According to the investigators, “the first description of changes in PSA [was] observed after switching TKI drugs from imatinib to nilotinib (and back) in patients with CML.” The team’s in vitro studies demonstrated that the second-generation TKI nilotinib was more potent than imatinib in its effect on PSA levels. Clinically, nilotinib and dasatinib reversibly reduced PSA titers compared with imatinib.
The initial impetus to study these “off-target effects” of TKIs on PSA levels came after the investigators observed a 71-year-old patient with CML with an elevated but steady PSA level who was being treated with imatinib. “When the patient was switched from imatinib to nilotinib, the PSA level dropped from 5.13 to 1.29 ng/mL,” the researchers explained. “Reversal of the treatment reversed the effect on PSA [level].”
Although “generally serum PSA levels are proportional to tumor volume and the clinical stage of disease,” the authors noted, their findings suggest that further research may be warranted, given the concern that “some therapeutic agents may affect PSA expression independently from alterations in tumor growth or volume.”
The Prostate
https://jnccn360.org/prostate/medical-literature/tkis-for-cml-and-psa-ti...
Currently taking 400mg/day Gleevec - 10/24/2022
PSA, ULTRASENS This result is high
4.800 ng/ml - normal (0.000-4.000 )
3.1 | Patient PSA levels and events
A CML patient with benign prostatic hyperplasia (BPH) and slightly
elevated PSA (4.60 ng/ml) received imatinib treatment for 7 years.
When he was 71 years old, in order to improve the CML remission,
the patient was switched from imatinib to nilotinib treatment,
concurrent with this therapy change, his PSA level dropped from 5.13
to 1.29 ng/mL (Figure 1A). After switching TKI drugs, his International
Prostate Symptom Score (IPSS) and prostate volume did not change
(Figure 1A), his serum testosterone was a normal 3.98 ng/mL (normal
range; 1.31–8.71 ng/mL). Due to an increase in numbness, the patient
reverted to imatinib treatment after 3 years. The PSA level rose to the
previously observed range (from 1.89 to 5.47 ng/mL). The patient
subsequently received dasatinib and the PSA level dropped again
(Figure 1A).
We have found similar two cases. A CML patient with
BPH and elevated PSA (9.921 ng/mL) received imatinib treatment for
4 years, and his prostate biopsy was negative. When he was 73 years
old, the patient was switched from imatinib to nilotinib treatment
because of side effects (anemia caused by gastric bleeding). The PSA
level dropped from 21.054 to 1.584 ng/mL when the patient was
switched from imatinib to nilotinib (Figure 1B). Changes in IPSS and
prostate volume data were not available in this patient.
A CML patient with BPH and elevated PSA (15.11 ng/mL) received imatinib
treatment for 3 years, and his prostate biopsy was negative. When he
was 71 years old, the patient was switched from imatinib to nilotinib
treatment because of CML disease progression. The PSA level
dropped from 15.372 to 4.879 ng/mL (Figure 1C). Changes in IPSS
and prostate volume data were also not available in this patient.
Sasaki, T., Franco, O. E., Ohishi, K., Filipovich, Y., Ishii, K., Crawford, S. E., … Hayward, S. W. (2018). Tyrosine kinase inhibitor therapy prescribed for non-urologic diseases can modify PSA titers in urology patients. The Prostate. doi:10.1002/pros.23730