My husband was off ADT for ten months at the recommendation of his MO. When T hit a normal'ish level (around 476) PSA started rising pretty quickly (from a low of <0.01 to 0.07 when T hit 476. And as his T rose (back to 672. He restarted Firmagon (two injections to restart) and in 33 days his T has gone from 672 to 125 and PSA from 2.09 to 1.16. I had hoped for a faster drop.
When he first started Firmagon in 2018 his T went from 630.5 to 22.5 in 36 days. PSA went from 24 to 0.66.
BACKGROUND: He had RP in 2018 with PSA of 34 and very large prostate, EPE, positive margins, and PSA stayed very high after surgery (17). Started on ADT before any scans (except bone scans which were all negative .... and yes I know those are not foolproof). He's had several image studies/scans since and no mets have ever been found.
Had Axumin in February when PSA was just over 2 and there are a couple of spots of activity in his prostate bed on the right side where margins were positive and one iliac node. His doctors believe his prostate cancer is confined to his pelvic region and are recommending pelvic bed radiation. We've consulted with the proton beam guy (who told him he shouldn't have it in 2018 because it was assumed he was likely metastatic b/c of high post surg PSA, but now believes he is likely to benefit from it). He is planning to start proton beam radiation in the next couple of months after he gets an AUS in April. He just had a procedure for bladder neck scar tissue so we're waiting for him to heal before AUS.
I have a call in to the doc. I'm wondering if he should add something to drop his T faster?
I'm just wondering what others' experiences are and if there was a difference in rate of drop when restarting hormone deprivation.
I don't think there is no set time for T to drop when starting ADT. In some men it drops much faster than others. In my case, it dropped from 4.48 to 0.17 in three months and then to 0.06 in the next nine months. The rate of drop may depend on what fraction of cancer cell is castrate resistant.
Thank you for your reply. I’m mostly puzzled by the slower drop in testosterone. I don’t think he’s reached castration resistance yet, just hasn’t hit castration level testosterone.