Nadir Testerone

[Cynthgob]

ADT treatment for 12 months and husband reached nadir testerone. But psa keeps going up. 6.9,7.1, and 9.6. After reading about how important nadir T is. Do we have to worry about the psa if T is so low??? Gleason score 8 , many metastasis . Thoughts? Has had 6 rounds chemo.

[Hidden]

What was his PSA before starting ADT? What is his actual testosterone level number (ng/dL)? That number should ideally be less than 20.

[Cynthgob in reply to Hidden]

4300 on diagnosis. 0.35 T

[Cynthgob in reply to Cynthgob]

Psa 4300

[Hidden in reply to Cynthgob]

Sounds like he got a good initial response to ADT, but now he is what is called "castrate resistant". This does not imply that his cancer is no longer sensitive to the deprivation of hormones, but that it can reproduce with the smaller amounts present with testosterone at "castrate" levels (<20). This typically happens at around 1 to 1-1/2 years after starting ADT, it's predictable.

The typical next step in treatament is what are known as second-line ADT drugs such as Zytiga or Xtandi. Zytiga shuts down all male hormones, including those made in the adrenal glands and is taken with Prednisone or Prednisolone. Xtandi blocks the androgen receptors on the cancer to make them unavailable. These are treatments that many of us here are on including me. Things he can discuss with his doctor. Wishing him the best for his treatment.

[Cynthgob in reply to Hidden]

How much prednisone do you take? And have you had a lot of side effects from zytiga? Did you psa go to nadir ?

[Hidden in reply to Cynthgob]

I'm taking 5mg per day. This is the best amount so that your adrenal gland has a better chance of making it on its own later. 5 mg is the replacment amount for what you lose by shutting down your adrenal gland.

No side effects from either Zytiga or Prednisone for me. PSA down to 0.1, pain reduced to almost zero. Very pleased with the results so far.

[Cynthgob in reply to Hidden]

Thank you so much. Talking to team today and they will probably want to wait until psa goes higher so I want to be prepared. Husband feeling well.

[Hidden in reply to Cynthgob]

Sounds very similar to my case. I didn't do anything at 12, but then when it jumped up to 26 in short order, my doctor called me and told me he wanted to start Zytiga. He called me before my appointment and had it ready when I got there. Arranged for the Pharmacist to be there too. Great doctor.

[GP24]

Sometimes the PSA value surges after a Chemo:

ncbi.nlm.nih.gov/pubmed/183...

On the other hand, if you start with a PSA of 4,300 and many metastases, resistance may begin after 12 months as well.

I would observe if the PSA value drops again, i.e. whether its a surge after Chemo. Otherwise you could start with Zytiga or Xtandi.

[Hidden]

How long has it been since he did chemo? We were hoping the "chemo surge" was the case with me, but it was too long after chemo ended in my case. Once my PSA got over 20 (doubling every 5 weeks), I figured it was time to start Zytiga. Now my PSA is 0.1 and my pain has gone down to almost nothing.

[Cynthgob in reply to Hidden]

Feb 20

[Haniff in reply to Hidden]

Hi gregg57,

May I check with you bro, what is "my pain" that you are referring to, as in what sort of pain. For myself, I completed my six cycles of chemo on April 17, 2018 and have been on 3 monthly ADT of Luprin inoculations since. At the moment my PSA is at 1.93 from 192 at diagnosis on October 9, 2017.

Best regards,

Haniff

[Hidden in reply to Haniff]

I've had pain in my lower back, pelvis and right femur due to extensive mets. My latest bone scan showed quite some improvement. The first time I was pain free was after about 3 cycles of Docetaxel. It came back again, but has improved since I started Zytiga.

[Haniff in reply to Hidden]

Noted with thanks bro.

Do take care and my very best to you.

Regards,

Haniff

[monte1111]

Do the mets include bone mets? If liver scores are ok, alkaline phosphate is good indication of bone met activity. Hopefully if out of range at start they have been gradually going lower towards normal.

[Cynthgob in reply to monte1111]

Yes they have dropped! 109

[petercraig2]

Don't know if it would work for you but I have been on transdermal Estrogen patches for about 16 months now.

PSA went from 8.9 now .038 and still falling. Testosterone dropped very quickly to <.1 and remained there.

No sweats, heart palpitations just tender man boobs.

Peter