NADIR -PSA Numbers

[Larryfanman]

Once you start treatment for advanced prostate cancer with mets to the lymph nodes and bones, how long does it usually take to get your PSA down to the nadir number? Once there, what is usually an indication of long term survival?

[Tall_Allen]

Are you talking about salvage treatment or primary? And does it include long-term ADT or not? With primary treatment and no ADT, it takes about 4-5 years to reach nadir. With salvage radiation and no ADT, it will take a few months, depending on your starting PSA. Because both treatments are experimental with no prospective data to judge by, no one knows what the prognosis is.

[ctarleton]

If I recall correctly, you had a positive biopsy, and then the detection via CT and Bone Scans of at least two spinal bone mets and some enlarged lymph nodes, possibly before getting any treatment?

If you should be advised to skip any prostate surgery or radiation treatment, and go on systemic treatment with something like Lupron, or perhaps Lupron + early Docetaxel, the PSA can come down pretty rapidly, ... in a matter of a few months.

How low or how long the PSA remains at low level could be one of those individual things. In general, only having a very few mets as opposed to a Bone Scan that lights up like a Christmas Trees might be favorable at the margins, in terms of statistical Overall Survival.

Once diagnosed as advanced metastatic, it's likely to be more helpful to find a good oncologist who specializes in advanced prostate cancer than to speculate about how long each of your future treatments may remain effective. The more important thing is to keep exploring and expanding your Options, and living as well as you can in the meantime.

Just some thoughts....

Charles

[Larryfanman in reply to ctarleton]

Yes CTARLETON

You are correct

Right now I am using the VA hospital — but in a matter of about five or six months I will be on Medicare with a supplement — then hopefully my options will open -

When they found out about the cancer ( through a general check up ) the VA put me on LUPRON and DOCETAXECL

At that point I had no other options — because of my Insurance situation

Which has been about 4 months ago – my PSA at that time was 28 it is now .17 — I was thinking the PSA usually took about six or eight months to get down to the NADIR Number

— I’m trying to learn as much as I can about this stupid cancer — including a second opinion for maybe even more aggressive options —- maybe even radiation after chemo – – I just don’t know yet

That’s why my question was – – I was wondering how long it usually takes after starting treatment— for your PSA to come down as low as it’s going to go

[Canoehead in reply to Larryfanman]

You’ve had a great response. Your PSA is getting close to undetectable. I also think you got the current best systemic treatment, ADT and early Docetaxel.

Once the chemo is done, it gets more complicated. Should you add Zytiga to the Lupron? If you only had a few Mets and they have not progressed, are you oligometastatic? Is removal of the prostate advised? Could radiation to the Mets, lymph nodes, and maybe the entire pelvic area wipe the disease out completely? I believe recent studies suggest that surgery and/or radiation after a good initial response to systemic treatment can be very beneficial.

So now you need a good oncologist, contrast MRI and scans.

I think your future looks bright. I have a bias in saying that, because I am 4 months further along than you, my PSA started at 36 and went to undetectable before I finished Chemo. I then added Zytiga, and in 5 days I am starting a 40 day course of Radiation. And my oncologists are using the “C” word that was unspeakable for stage 4 metastatic PCa as recently as a year ago —- CURE. God Bless....

[Larryfanman in reply to Canoehead]

Conehead

Thank you very much for your kind words – – I just have to figure out where to go from here —

[Larryfanman in reply to Canoehead]

Canoehead

You say my PSA is getting close to undetectable —- what number are you thinking is undetectable ??

Thank you for your time

[Canoehead in reply to Larryfanman]

0.05 is the typical detection threshold. So if you get <0.05, your PSA is undectable. You’re close, and your chemo is not done yet. So find yourself a center of excellence, usually a university affiliated teaching hospital, and get the best direction for your next steps.

[Larryfanman in reply to Canoehead]

Canoehead

Thanks again for helping me

I guess the next step is trying to figure out if it’s really Oligometastatic

At diagnosis PSA 28

Gleason 5+4 = 9 —

2 vertebral spots in spine

And ENLARGEMENT of our RP node’s

Then I guess next step would be to find The best doctors that deal just in prostate cancer and have the latest scanning equipment ??

[Larryfanman in reply to Canoehead]

Canoehead

This is Larryfanman

Is there a way I can get your email address – I would like to talk to you a little further in depth about what you’re going through

[Hidden]

PSA nadir and time to nadir have to been shown to be prognostic for overall survival in patients with advanced PCa. Generally the lower the PSA goes and the longer it takes to get there, the better. Of course, these are only statistics and we are all individuals. Here's an article on the subject.

ncbi.nlm.nih.gov/pmc/articl...

[snoraste in reply to Hidden]

Gregg

This relatively new study on time to nadir indicated .06 as the threshold, and does not show any impact of “time to

Nadir”

So the jury is out there -

ncbi.nlm.nih.gov/pmc/articl...

[Hidden in reply to snoraste]

The study you reference is for localized prostate cancer patients, not metastatic patients. This information is not valid for stage 4 prostate cancer. Time to nadir is a factor for advanced PCa.

[Hidden in reply to Hidden]

My PSA dropped immediately with adt and Rt .Its stayed<.004 for two years. Are you saying that this quick drop in PSA was not good for me in my long term survival. ?

[Hidden in reply to Hidden]

Everyone is different and they are general statistics. On average, they found that PSA time to nadirs of 1 year or more and PSA nadirs of .2 or less had the best prognosis.

I believe they also found that those who treated locally first and then went on to ADT had much longer overall survival than the ones that started out with advanced stage 4 like I did. Sounds like you are in that group.

I'm going to find the information I read about those with local treatment. I do remember that they had the longest overall survival. I believe they were the longest.

Of course we are all individuals so the most important thing is that you are doing well right now. Now is all we have anyway.

[Larryfanman in reply to Hidden]

Thanks for responding Gregg

I was diagnosed February 2, 2018 – – about 4 1/2 months ago — with stage 4–

At that time my PSA was 28.366

After the Lupron shot and 5 chemo treatments — my PSA now is 0.077

And could even come down a little more

Which I think is good

HOW ARE YOU DOING ??

[Hidden in reply to Larryfanman]

That's a great response! In general, the lower it goes, the better. Of course that's not 100% as we all know. Some PCa cells don't make PSA. In my opinion, you're giving yourself the best possible chance with early chemo. If I had to do it over again, I would definitely do early chemo again.

I'm doing fairly well, thanks for asking. My PSA bottomed out at .19 in 6 months. It started going back again fairly quickly and was 10.6 last check in early June. In the next few months, I'll be starting on either Radium 223 or second line Zytiga or Xtandi. My excellent oncologist at the VA wants me to hold off on second line ADT and do the Radium first. I've done quite a bit of reading on the subject and there is quite a consensus that Radium should be done early on after CRPC occurs. I'm leaning toward doing the Radium first at this point.

[Larryfanman in reply to Hidden]

greg

You use the VA hospitals ??

Do you like them

I use the VA – – here in St. Louis

[Hidden in reply to Larryfanman]

Yes, I use the VA in Sacramento. At first I wasn't sure because I would be seeing a different doctor every time and none of them seemed that knowledgeable. Finally, I ended up having an appointment with the head of the department. Huge difference, I was very impressed with him. I asked him about all of the other doctors and he told me that on Mondays they rotate in doctors from nearby UC Davis Med center. Up until then I had been going in on Mondays. So I asked him if he could be my doctor from now and he said he would, I feel very confident with him.

[Larryfanman in reply to Hidden]

gregg

When did you get diagnosed ?

Did you do the chemo upfront ?

What was your PSA ?

Stage 4 with bone Mets ?

[Hidden in reply to Larryfanman]

I was diagnosed with stage 4. Here's my history:

Age 59 at diagnosis

Diagnosed 2/24/2017

Prostate Cancer, multiple bone mets, 2/27/2017 PSA 463

2/28/2017 Bicalutamide

3/6/2017 ADT Lupron first shot

3/31/2017 PSA 12

4/7/2017 Docetaxel start

4/27/2017 PSA .6

5/18/2017 PSA .5

6/15/2017 PSA .3

7/6/2017 PSA .2

8/4/2017 PSA .2

8/24/2017 PSA .19

6/2/2018 PSA 10.6

[Larryfanman in reply to Hidden]

gregg

Looks like the Lupron and Docetaxel

Brought your PSA down pretty quick

you was diagnosed about a year before I was — are you starting to get over the initial shock of the diagnosis ?

It’s really been hard on me- and I’m sure it has on you

but we will make it through it

Thanks again buddy

[Hidden in reply to Larryfanman]

The treatments were very effective and I recovered very quickly. It really felt miraculous to me since I felt like I was dying right around the time of my diagnosis. Before I started treatment, I could hardly get up out of the chair I spent most of my time sitting in. I was taking opiate-based pain meds, having drenching sweats all night, fever on and off.

I remember walking out of the my family doctor's office in shock when she went over my bone scan results. I'd never seen a bone scan before, but I knew it wasn't supposed to have all of those bright spots everywhere. She told me my PSA was over 300, I can't remember the exact number although it would go up to 463 before I started treatment. It took me a few weeks to come to terms with the whole thing. I couldn't really process everything until I started recovering and my pain subsided. Soon after that, I realized that I needed to get through my sorrow as quickly as possible so I could get the most possible out of whatever time I had left. I really made a decision to do that. I must say, I am happier than I have ever been in my life and the cancer has helped me in a lot of ways that I would never have expected. I could go on about that.

Are you still getting through that shock? It takes a while for everyone.

[Larryfanman in reply to Hidden]

gregg

Do you feel that you have a better handle on how your cancer is responding to treatment

And do you have a sense that it might not be as much of a death sentence as you originally thought ??

I know when we first got diagnosed is extremely hard to think about anything else

[Hidden in reply to Larryfanman]

I still feel that it is a death sentence, but the possibility for a longer life is much better than I initially thought.

I remember going around the room at a support group and one guy proclaimed: "I'm probably not going to die from prostate cancer". I started thinking about it and realized that my goal wasn't to die from something else, it was live my life to the fullest. When it was my turn, I said: "I probably will die from prostate cancer, but it's not how you die that matters, it's how you live." So in that sense, I don't feel like I'm any different than anyone else. I am more aware of my mortality than a lot of people, but that's it. I don't see that much difference between the length of my life and those of others. Life is temporary for everyone.

And yes, I have much more knowledge about prostate cancer and its treatment. I wish I had known what I know now at the beginning when diagnosed. I could have insisted on better treatment at the beginning and had a quicker recovery.

[Larryfanman in reply to Hidden]

gregg

You said - You would’ve insisted on better treatment at the beginning — what treatment would you have done differently ??

[Hidden in reply to Larryfanman]

When I was first diagnosed, I had an appointment with my general practitioner. She showed me my bone scan and notified me that my PSA was over 300. At that point, stage 4 prostate cancer was almost certain. My general practitioner got an oncologist to conference in during my appointment. He said it was necessary to first do a biopsy of one of the lesions before starting treatment. According to him, they had to make absolutely sure it was prostate cancer and also that it was not neuroendocrine prostate cancer because that would require different treatment. Not knowing any better, I went ahead and agreed without objection even though I was in a ton of pain and knew that it would mean waiting another 3 weeks to schedule the biopsy, then wait for the pathology report.

Now I know that the chances of me not having prostate cancer or having neuroendocrine prostate were very small. They could have gone ahead and scheduled the biospy, but then also prescribed bicalutamide for me to start right away. My PSA could have been restested in a week or two and it would have gone down, probably significantly along with my pain. This would have been an indication that I had androgen sensitive prostate cancer, 90% chance of that. At that point, I should have gotten my first lupron shot. To me this requires only a minimal knowlege of prostate cancer. It's hard for me to believe a doctor would not know better. This is the treatment plan I would have inssisted on, had I known. Instead, I went through an unnecessary and very painful period of 3 weeks waiting for the biopsy and the pathology report. It seems to me that my doctor was more concerned about covering her ass, than giving the best and quickest treatment possible. To her credit though, she did push me pretty hard to do chemo and for that I am thankful. Hindsight is 20/20 as they say.

[Larryfanman in reply to Hidden]

gregg

Did you do early chemo ???

[Hidden in reply to Larryfanman]

Yes, but it was at Kaiser. They were excellent, just had to pay a ton of co-pays which added up to almost $5K. VA is much cheaper.

[Larryfanman in reply to Hidden]

Actually it’s been about 5 months ago since I was diagnosed

[Hidden in reply to Larryfanman]

One thing I see often in people when they are newly diagnosed (including me) is the tendency to look at survival statistics. I think the first question we naturally have after diagnosis is "how much longer do I have?" It's normal to ask that, but we are all individuals and mileage may vary as they say. I think it's fairly safe to say that we probably won't have a really long life, but we have lots of company in that. As Mohammed Ali said "don't count the days, make the days count."

[cesanon]

I don't think there is any usual. I be interested to see the answers to your question.

[leo2634]

Hi Larry I was put on Zytiga,Prednisone,and Eligard as First course of treatments PSA went from 14.7 to 0.1 in one month almost undetectable.

Best of luck.

[Shooter1]

Survival statistics?? I was diagnosed and in pain in April. Spent the month in blood tests, biopsies, CT scans, Bone scams. All contained we can get it out. RRP mid June. Pathology report absolute disaster. All margins Gleason 9/10. No defined margins to prostate. lymph nodes checked were substantially replaced Gleason 8/9. Tissue samples not related to visible cancer and in none adjacent area showed all neural and vascular bundles contaminated Gleason 9/10. Full spider web of bad stuff and no target for radiation with out major peripheral damage. PSA up from 52 to 62 before 6 week check up. Full blown stage 4, fast growing, invasive, it"s going to kill you.

Prognosis 12-18 mo. if I was lucky. Now 14 months later PSA 0.118 down from a month ago at 0.137 and still dropping. When to nadir??. CT shows all soft tissue mets. undetectable, two small mets pelvic and sacrum and one large upper pelvic met. Bone scan shows two small, barely active mets, and largest one as scar tissue displacing bone marrow but inactive. On reduced dose of Xtandi acct. untolerable Toxic side effects . Now on 120 mg dose and and PSA still dropping. Survival statistics ??? Yesterday oncologist said "in remission" . Day before VA Dr. said "looks great, see me in 6 mo." Guess their early estimates were a bit off. Let's aim for another 10 years and see were I stand then. Survival statistics??? Believe them if you want and cry, or get crying out of the way and fight the beast with all you've got!!