What is major source of PSA Expression after ADT Vacation?

[6357axbz]

Once one has become PSA undetectable, with prostate zapped with IMRT, and goes on ADT vacation what is the most likely cause of increased PSA expression? Micro tumors in blood? Remnants of prostate tumor (if any), or existing mets?

[Break60]

My guess would be pelvic lymph nodes since they’re closest to prostate but I have no basis other than experience. Google it.

[6357axbz in reply to Break60]

But to date I had no lymph node involvement

[tallguy2 in reply to Break60]

Absolutely. This was my experience, exactly.

[LearnAll]

If you have dormant, hiding PCa cells in spongy bone or prostate gland and surrounding structures, there is POSSIBILITY that they start dividing once again and start spitting PSA

But if you have very little dormant cancer cells left and you have good cell mediated immunity , you might stay totally fine as your macrophages, lymphocytes and Natural Killer cell will have breakfast,lunch and dinner of your left over cancer cells. Keep watching PSA..

[6357axbz in reply to LearnAll]

Thanks, I like that

[Tall_Allen]

You are metastatic- you will always have some PSA no matter what you zap

[6357axbz in reply to Tall_Allen]

Then where does it come from? Micro tumors in blood?

[Tall_Allen]

Could be anywhere - blood, lymph, bone, organs, lymph nodes ... anywhere and everywhere.

[6357axbz]

Thank you all for your thoughts and knowledge.

[RonnyBaby]

I am on an ADT holiday and have been since July of 2018.

My PSA at Dx was over 300 and I reached undetectable ( -< 0.002) in about 10 months of active treatment in 2017.

I was originally G9 and node positive,

My 'T' is back to normal (on the low side of normal) while my PSA slowly rises.

I'm checked every 3 months.

Last one (PSA) was 0.20.

It took about 1 year to get past the 0.0 point to the positive side of the equation (old readings where the second digit stayed @ 0).

I'm getting tested next week to see where I've landed .

They tell me there is no 'visible' sign of any macro cancer event - so I can look at my CTCs

as a possible source (there were some found by testing my blood about 1 year ago) for

an increase or there is supposed to be some natural source of PSA that will still trigger readings. You still produce some testosterone apparently to maintain proper brain function but I'm a little foggy as to whether there's another source in the body. If |i recall correctly, you produce just enough to keep the brain functioning.

IF post radiation claims that the 'nadir' of 1.0 is considered good, then there must be room to have readings without assuming the cancer is back.

My doctors won't give me a number to watch for, but based on what we've seen in this forum, I hope to stay well below the 2.0 mark ....

Have you been given any guidelines as to what kind of numbers you should expect ???

[LearnAll in reply to RonnyBaby]

Is your prostate intact ? 2.0 mark is only for folks whose prostate is untouched.

[6357axbz in reply to LearnAll]

My 2.0 mark considers IMRT to prostate. Presumably, hopefully that was successful and it’s totally fried at this point

[RonnyBaby in reply to LearnAll]

NO - I got radiated, so my reference point is going to look at that nadir (1.0). I still have my prostate or what's left of it, so it is (PSA) expected to rise to a certain level. My question or problem is to get THEM to quote some numbers or targets. So far, no comment seems to be the flavor of the day.

Frankly, I don't have a number or target I can bank on - I have to hope that it stays low. IF we progress, then the medical pros will have to drive the train again.

The odds are against me (apparently) so I need to be aware of that.

I might ask you a question - have you seen some report or stats that I could use as a basis for decision making ?

Sooner or later the pros will have to show their hand - I went against their advice when I went on my ADT holiday.

I am certainly willing to cycle on and off IF I could.

There are examples of patients who stayed castrate sensitive and successfully cycled - at least for awhile.

I can tell you that I am so happy NOT having to deal with the ADT SEs.

In fact, I'd push it to the limits before going back on ADT.

[6357axbz in reply to RonnyBaby]

Thanks Ronny! That’s a great reply to my question and very helpful in providing some perspective. Of course each case is unique but you seem to be on a positive track for IADT. I hope my PSA takes as long to climb as yours. I have not been given any specific guidelines except that my RO predicts I should get at least a year before PSA climbs up to 2.0, at which point he’ll zap my individual bone mets, assuming I remain oligometastatic and I’ll resume ADT (lupron/abiraterone/pred).

From reading your background it seems you are stage 4 with no distant metastices which is a curable disease if I remember correctly. I hope so. Your slow rise of PSA May be indicative of this.

[RonnyBaby in reply to 6357axbz]

I'm staged as T3B (node positive) with no distant mets, but there aree CTCs in the picture, but a year ago, the CTCs were quite low and there was hope that they might not become an issue in the future.

It is interesting to note that MOST people have some pretty nasty cells in their bodies that are pre-cancerous and potentially dangerous that our immune system deals with on an ongoing / daily basis.

It's about all that toxicity out there .....

The word 'cure' has been cautiously whispered, but the 5 year mark also hits home.

It's like don't even mention it until you've hit that milestone.

At 67, there's still some road ahead of me - I have to hope that goes with feeling like my old self again - after my full ADT withdrawal cycle ends.

It was predicted that this spring would be enough elapsed time to get it out of my system. At that point in time, I should (re)discover my quality of life moving forward.

I was also told that my body had been through a lot and that my recovery would be slow, but steady, assuming that nothing else goes wrong.