What is the nadir on ADT for men who did not have operation, radiation or chemo? How low does it get with a prostate?

Undetectable PSA is the target after operation or radiation or when on ADT after recurrence.

But what about ADT before radiation, what would be the best nadir expected?

[tango65]

Pre RT PSA nadir may not be an independent predictor of biochemical recurrence according to this study:

"Summary

Three hundred and seventy five patients with intermediate or high risk localized prostate cancer were treated by definitive radiation therapy and androgen deprivation therapy (ADT). Baseline PSA, T-stage, Gleason’s score, radiation dose, PSA pre-radiation therapy, and nadir PSA (nPSA) were found significant variables affecting biochemical relapse (BCR) in univariate analysis. Time to nadir was not significant. However, only nPSA with a cutoff at 0.06 ng/ml, T-stage, and Gleason’s score were found to be independent predictors of BCR."

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

[j-o-h-n in reply to tango65]

I can't remember (who can remember anyway) if I complimented you before on your knowledge and your valuable posts/answers/help to member's post. If I didn't, then here is my compliment to you. Good Job and heartfelt thanks...🥇🥇🥇🥇🥇

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 08/18/2019 8:07 PM DST

[tango65 in reply to j-o-h-n]

Thanks, best of luck. I like your humor, keep the good work.

[TommyTV]

I have had no surgery, chemo or radiation. I have been on ADT with Zytiga and Prednisone for approaching 8 years. My PSA dropped to immeasurable within 12 weeks from 571 with multiple Mets. It’s stayed immeasurable since then.

Cheers

Martin

[Hidden in reply to TommyTV]

Excellent result, congratulations! Are you still on Zytiga? What was your Gleason score? Side effects got worse or manageable?

[TommyTV in reply to Hidden]

Gleason 4+3. Still on Zytiga as part of the Stampede trial in the U.K.

Side effects worst for the first 4 or 5 years and then easily manageable, but severe muscle wastage, combined with large Mets in both femurs and pelvis have left me somewhat disabled, and very unsteady on my legs. A small price to pay.

[Break60 in reply to TommyTV]

So have you considered sbrt to those mets?

[tango65 in reply to TommyTV]

Congratulations. Best of luck

[Hidden]

If the ADT alone gets the PSA down low for some months (or even years as many of us have experienced) the original cancer in the prostate gland has probably been "dealt with" by the immune system and effectively out of the picture. If you have a doctor who then wants to cut it out or blast it with radiation (or impatient to see if the ADT works), you need another doctor. You need to think of the cancer burning its way through your body like a grass fire - it moves on and the "old" active cancer disappears from the scans to be replaced with new ones. How fast this happens is hugely dependent on how good your immune system is working - bearing in mind that all the poisons we take to "help" actually weaken the immune system as well as the cancer.

[Jbooml in reply to Hidden]

Am I correct to infer that your suggesting old ‘tired’ cancer cells may not have the wherewithal left to cloak themselves from our immune complex. That in itself is revolutionary in its implications toward future treatment strategies. Holding the raging wildfire in check may lead us to uncovering what our natural responses rely on in mopping up the smoldering aftermath and moreover enhance their abilities as front line ‘smokejumpers’.

[Hidden in reply to Jbooml]

Could not have said it better myself! But 4 things go wrong for many of us: (1) We keep doing (lifestyle) what got us the cancer in the first place

(2) Enhancing the immune system as part of the INITIAL strategy is rarely tried - it is more usual to "throw everything at it" (and trash the immune system) and sadly use a knife on parts that would soon recover.

(3) the medical profession IGNORE the immune system's role as the only real cancer killer around. We falsely get to think all the chemos do the killing (they just slow things down).

(4) Patience .. it takes years of daily battles with no straying for a compromised immune system to seek out the "old" cancer cells and neutralise them, while dealing with new (hopefully much fewer) mutations that start the process all over again.

We end up with with a balancing act - the artificial Help also Hinders. The immune system is what tips the balance.

[taylor123]

My Dad got to 0.21 from 438 on his first round of hormone therapy.

[tango65]

I just saw this article, it adds more info:

redjournal.org/article/S036...

"Conclusions

Patients with a PSA level >0.1 ng/mL after neoAS and before the start of RT had less favorable clinical outcomes than patients whose PSA level was ≤0.1 ng/mL. "

[timotur in reply to tango65]

Good article, thanks for posting.

[Tall_Allen]

Lower is better for maximizing radiosensitivity. Nadir is usually achieved in 2 months.

[Hidden in reply to Tall_Allen]

So an very low, almost undectable PSA is also possible before any treatment?

[Tall_Allen in reply to Hidden]

Yes, ADT is supposed to stop all active growth for a while.