Question on PSA rise after starting intermittent therapy

[snoraste]

I started my intermittent therapy last month. My PSA has been undetectable for almost a year and my MO suggested I should consider it as an option, which I did. I remember folks here who are also doing the intermittent therapy (some version of it). My testosterone is now 200 (from almost zero) and My PSA has gone from undetectable to being detectable at 0.1 after a month. I know everyone is different, but curious to know what your experiences are with this treatment.

[tallguy2]

I am not happy with this intermittent ADT therapy idea, and here's why. I went on an "ADT holiday" from early 2016 to early 2018. This is SOP for many urologists. What did this accomplish for me? My PSA started rising quickly over that 2-year time period, going from 0.2 to almost 2.0, the so-called "take action trigger point." I was lucky enough to have an MRI for an unrelated back problem that in early 2018 revealed mets. Then came chemo and radiation ins 2018-early 2019.

Were the mets there all along? With a Gleason of 9, probably. What was your Gleason score?

What I am saying is, what's the intent here? Is the doctor trying to bring back some libido? While my t-level rose to about half of "normal" during that holiday I'm more interested in stopping this beast or at least slowing it down. My wife is 100% with me on this. Funny how priorities change.

[snoraste in reply to tallguy2]

I'm also G9. But point taken. I do plan to have yearly scan done. The point is multi-fold. First to see if I can have an extended PFS without the added toxicity, increasing libido and getting my head back is another important one for me, and last but not least is doing an alpha-beta-PSMA treatment while hormone sensitive with low mutation burden (I did the PSMA twice, both with little avidity). I read thru a half dozen papers last night on the subject. Just curious, why did you stop it? Because of new mets? Like you said, that's very hard to pinpoint at the IADT.

[tallguy2 in reply to snoraste]

Yes, as soon as the scan revealed the mets my urologist restarted the Eligard shot immediately. I expect to be doing ADT the rest of my life.

[Hidden in reply to tallguy2]

Me too.

[Hidden in reply to tallguy2]

I agree .

[tango65]

it is extraordinary that your testosterone went from castration level to 200, in one month and that your PSA increased only to 0.1. It usually takes several months for the testosterone to recover after stopping ADT.

[jdm3]

I started my vacation last month after 15 months of ADT. My MO said to wait 3 months (vs 1 month?) before testing so I go back to Dana Farber in June. This makes me anxious - needless to say, we all want to remain undetectable.

I don't know the answer to this... is it normal to have a slight PSA rise after starting IADT? The laws of probability suggest that we will need ADT again, but how soon? What I have been told is that there are only a few who will remain undetectable and some who will have low PSA for many years after treatment and either not need treatment for a long time (or never!). For those with a slight rise in PSA, presumably the ADT killed the bad stuff and they are left with "relatively" benign and very slow PSADT PCa.

None of us want to see anything, but undetectable. But, to try to put a positive spin on it... you had an excellent response to ADT the first time and if you need to start again, you will very likely have a good response again. It buys you time until the impending scientific breakthrough in PCa treatment/management.

But let's hope your PSA remains low or even reverts to undetectable again. Wishing you the best!

[snoraste]

Thanks for your optimism. I'm not too worried, was more curious if - even in healthy men - there should be a rise in PSA if we put them thru ADT and then stop. And you are echoing what my MO said. That we killed a whole lot of the PCa cells, we just don't know the aggressive ones or not - but we're about to find out! As I mentioned in my response to Tango65, the plan is to stay vigilant and pursue Lu/Ac therapy while still hormone sensitive.

I'm glad you're on the same path. Hopefully you will have a long term remission. My MO said he had someone come back in 8years with PSA of 2.

[Magnus1964]

Intermittent with what drug? Have you been on any other ADT drugs?

[snoraste in reply to Magnus1964]

I was on Zytiga+ADT plus Finasteride. I dropped Zytiga+ADT, keeping finasteride.

[jdm3]

My thoughts exactly. If needed, I will also likely pursue the Lu/Ac therapy next. As I'm sure you know, some studies suggest starting ADT again before any such treatment because the cells are more PSMA avid.

Stay well!

[Tall_Allen]

There is no standard optimal way to do intermittent. I've talked to guys who do it by time, PSA, PSADT, testosterone, scans or just "feel more like myself." It is expected that PSA will rise along with testosterone.

[George71]

Here is a good article about it: See link below

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

[Hidden]

I was a G8 but T-4 aggressive and I don’t want to go back there . I’ve had 3 T and Psa < .04 for 31/2 yrs now. I’m on test adt until failure . My docs don’t suggest I quit... only time will tell . Good luck

[michaelk501]

I started my holiday 10/1/2018. Over 13 months PSA went from 179.5 to .01. I am enjoying not having to sit down each morning to 1000 mg of zytiga, not to mention the Lupron shots and prednisone. I still get the xgeva shot every 3 months. so mid november I was .4, January 2019 I was at 1.0. Bone scan showed that they could only see 1 of my 3 bone mets and the lymph node didn't show. I go to the oncologist this coming monday, fingers crossed! I think it's important to note that these are serious drugs we take and they tax your mind and body. I for one am all for a "holiday"!

[SeosamhM in reply to michaelk501]

Great post and great news, MichaelK!