PSA and T Continue to Drop Post ADT - Advanced Prostate...

Advanced Prostate Cancer

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PSA and T Continue to Drop Post ADT

6357axbz
6357axbz

Just received my first PSA and T results since my ADT vacation about a month ago. Both continued to drop. PSA from 0.028 to 0.0161, and T from <7 to < 2.5. Is this to be expected?

18 Replies
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The vacation doesn't start until the Lupron clears sufficiently for T to begin to recover.

-Patrick

6357axbz
6357axbz in reply to pjoshea13

Thanks, how long for L to “clear”?

pjoshea13
pjoshea13 in reply to 6357axbz

I don't know, but T recovery is very slow.

-Patrick

6357axbz
6357axbz in reply to pjoshea13

Patrick doesn’t know!!!😩 A hush falls over the room.

Seriously, thank-you

Kudos, Patrick.

gregg57
gregg57 in reply to 6357axbz

From what I've read, T takes a year to recover to 90%. I'm not sure how linear the progression is so I would guess you get quite a bit back before that long. Depending on how long you have been on ADT, full recovery may still be below original levels for you.

6357axbz
6357axbz in reply to gregg57

Thanks Gregg

6357axbz
6357axbz in reply to gregg57

Hopefully all those little PSAs take as long to increase

Lucky guy! My psa went up right after vacations! Not good!! Can’t take vacations so switched to estradiol patches with great results; see profile!

It takes a while for the pituitary-hypothalmic-testicular axis to restart - usually within 6 months, sometimes up to a year.

6357axbz
6357axbz in reply to Tall_Allen

Thanks TA

As I understand it, the length of time it takes for T and PSA to rise depends on age (older men take longer), length of time on ADT (longer treatment time takes longer to recover), and how much T you normally had before you went on ADT (men who produce a lot may recover faster.) I've been told that PSA rise follows T rise. In other words, the T will rise after some period of time off ADT, then the PSA will begin to rise after some period of higher T.

I think some doctors prescribe light weight ADT during the off periods in intermittent ADT. They may prescribe dutasteride, or maybe even low dose bicalutamide. But I don't know whether that is scientifically proven to be better or worse than taking no ADT drugs.

Alan

6357axbz
6357axbz in reply to AlanMeyer

Thanks for the thoughtful reply Alan. That’s something to consider. Dr. Robert Gatenby, who was instrumental in developing intermittent ADT therapy

wired.com/story/cancer-trea...

Alternated between lupron and Zytiga and lupron alone.

pjoshea13
pjoshea13 in reply to AlanMeyer

The AVIAS trial "showed no benefit to the addition of dutasteride to an IAD regimen."

As expected, T appeared to recover faster with Dutasteride (little or no conversion of T to DHT), but surprisingly (to me), PSA recovered faster too.

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

-Patrick

6357axbz
6357axbz in reply to pjoshea13

Good reference. Thanks Patrick.

Of course results for localized may not apply to stage IV metastatic.

AlanMeyer
AlanMeyer in reply to pjoshea13

Hello Patrick,

This study appears to contradict the study by Scholz from the year before ( ncbi.nlm.nih.gov/pubmed/166... ) that found that time off ADT doubled with finasteride. However it too wasn't a big trial and it had a different design from this one.

I looked for a bigger clinical trial but didn't find one. Like so many aspects of prostate cancer and cancer in general, there is conflicting data and lots of unknowns. I think our understanding of the underlying biology is still too limited and so we rely on trials where we don't really know exactly what we should be measuring, exactly who we should be recruiting for the trials, exactly how long the trials should run, and on and on.

But I guess that's life. A thousand years from now our successors might look at our age with something like the horror that we have when we look at a thousand years ago.

Alan

pjoshea13
pjoshea13 in reply to AlanMeyer

Hi Alan,

When I understood the options I had 15 years ago, I looked "at our age with something like the horror that we have when we look at a thousand years ago."

...

This is how Klotz deals with the Scholz study:

"In contrast, a retrospective analysis of 101 patients on IAD reported by Scholz and colleagues showed that finasteride increased the time off treatment from 15 to 31 months.13 This study involved a different drug (finasteride), and different criteria for initiating and discontinuing treatment. Finasteride was administered in the off-treatment interval only, in contrast to this present study. The PSA threshold for re-treatment was reduced to 2.5 ng/mL in the finasteride group and 5.0 in the historic control group. In the current study, the time off treatment was defined as the time from stopping ADT until the PSA level increased to ≥5.0 ng/ mL; no distinction was made between patients treated with dutasteride or placebo."

...

I'll take this opportunity to wish you a healthy 2020.

-Patrick

AlanMeyer
AlanMeyer in reply to pjoshea13

And a happy and healthy year to you and everyone.

I saw the paragraph on Scholz and looked briefly at his article. I see that the design of the two studies was quite different but, in spite of that, it's difficult to reconcile their findings.

Scholz is a bit more suspect to me since he has reported many results in the past that are in conflict with the findings of others. It makes me wonder if there is a touch of wishful thinking in his observations, or perhaps some bias in his randomization of subjects. But on the other hand I'm not aware of any evidence against him.

Regards,

Alan

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