My latest PSA and Testosterone

[dac500]

I went on ADT vacation in November 2019 when PSA was 0.06 (Last 3 month Lupron shot in September 2019). Three months later my PSA is 0.07 and Testosterone 20. I don't expect my T to rise above castration level in the next 3 to 6 months. Will a small increase in PSA, say by 0.2 or 0.3, indicate possibility of developing castrate resistance?

In October 2018, about 10 pelvic and abdominal lymph nodes lighted up with abnormal intense DCFPyL uptake. To quote retrocaval node (SUV 75.4), perirectal lymph node SUV 60.3). Biopsy of the perirectal node confirmed metastatic prostate cancer. Why then a nurse practitioner implied that I don't have metastatic prostate cancer?

[Tall_Allen]

The NP probably doesn't know that metastases to distant lymph nodes (M1a) count too.

[Hidden]

I don’t know? You’re brave to be on vacation. I hope it serves you well. Good luck 🍀

[RonnyBaby]

It appears that you haven't reached undetectable (nadir), therefore, the ADT did not have enough TIME to deal with what you had at the outset. Specifically, the node area.

I was (G9) node positive and did ADT for nearly 18 months (they recommend 18 months to 2 years OR permanent, depending on your origina DX and status.

That was less than 3 years ago from Dx to today.

You don't need to be metastatic at this point in time to understand what is 'probably' happening.

I suspect that you haven't met the conditions to take an ADT holiday without undue risk. The amount of time on ASDT also closely relates to the withdrawal time on a roughly 1:1 ratio.

You haven't met those conditions either.

I would certainly not panic, but I believe you need to rethink this one out.

It is too early to quit ADT, IMO.

Perhaps a second opinion might be in order ?

Please keep us posted.

[dac500 in reply to RonnyBaby]

I am not sure whether you are aware of my unique situation. I was initially diagnosed with low volume (10% of 2 cores out of 12) Gleason 3 + 3 prostate cancer in 2011. I had brachytherapy in June 2011. That should been the end of story for my cancer.

Unfortunately, that didn't happen. I had an extra-capsular recurrence in 2016, which was treated in 2016/17 with cyberknife and ADT (nine months). Again the story didn't end there. Probably, there were microscopic cancer in some lymph nodes.

So in 2018, my PSA shot up from <0.1 in January to 4.48 in November. A DCFPyl PET/CT scan found strong signals in about 10 lymph nodes. A biopsy of one of the lymph node confirmed metastasis. I started Lupron + Casodex in November 2018. My PSA dropped very quickly to 0.06 in November 2019 when I started my ADT vacation. Now my PSA is 0.07 and T is 20. I am still at castrate level and expect to stay there for three to six months.

I am watching my PSA quite closely. Currently, my intention is to start ADT when my PSA exceeds 0.2. In the meantime, my cancer may become castrate resistant. That would be entirely a new ball game.

Thanks for your concern about my cancer. I am seeing one of the best MO in my locality. I stopped going to the local cancer center when I had lymph node metastasis. Now I have to travel 50 miles to see my MO.