There is evidence that when you are on Lupron and Bicalutamide for metastatic prostate cancer and your PSA starts rising, stopping Bicalutamide may, in some cases, lead to drop in PSA.
In my case, I was on Lupron + Bicalutamide for one year for metastatic prostate cancer. My PSA dropped from 4.48 to 0.06. On advice of my MO, I went on ADT holiday by stopping both Lupron and Bicalutamide. In three months my PSA increased to 0.07 and T was < 20. My question is did my PSA increase straight from 0.06 to 0.07 ( which is an insignificant increase) ? Or it decreased to a level lower than 0.06 due to Bicalutamide withdrawal and then increased from the lower value to 0.07?
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dac500
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A .01 change in PSA is insignificant. This is in the "noise". Your PSA may very well go up at some point as Bicalutamide can eventually become an agonist for the cancer and help it to grow. Right now it's looking good. You may now do a happy dance.
There is an "anti androgen withdrawal syndrome" (AAWS) usually described in bicalutamide withdrawal but also sometimes in regards to enza or abi withdrawal. It can go from 1 month to maybe 8 or so and PSA can go down by statistically significant but not large amounts. Your result so far is insignificant.
My question was did stopping Bicalutamide lower my PSA, no matter by what amount. Let me do a little undetectability dance. As you mention there is a + or - error within 0.02. So, it is possible for the reading of 0.06 to be actually 0.04 and the reading of 0.07 to be actually 0.09.
I know I am a bit paranoid about my PSA because rising PSA by small amount has led to my initially diagnosed of low volume Gleason 3 + 3 eleven years ago come back with vengeance as more serious, not once but twice.
When my PSA increased from 0.4 in July 2015 to 1.5 in July 2016, the RO who performed brachytherapy on me in June 2011 brushed it as PSA bounce and gave me an appointment for PSA test in January 2017. Luckily, I had an appointment with my URO, who performed DRI and another biopsy and discovered an extra capsular recurrence. An MRI verified a large mass of about 1 inch in diameter attached to my prostate. It was treated by another RO with 9 month ADT and cyberknife.
Guess what my PSA started rising again in 2018 from < 0.1 in January to 1.8 in October. Luckily, I was able to join an NIH study on 18F-DCFPyL PET/CT. The scan found multiple pelvic and abdominal lymph nodes light up with abnormally high intensity. Subsequently, biopsy of one to the lymph nodes (one easily reachable) confirmed metastatic prostate cancer.
By November 16, 2018 my PSA rose to 4.48. I started Lupron + Bicalutamide and my PSA went down to 0.17 in Feb 2019, 0.10 in June 2019, 0.07 in Sept 2019, and 0.06 in Nov 2019. At that point, on recommendation of my MO I started an ADT holiday. My PSA in March 2020 was 0.07. When data has error bar, you plot your data using the center points. So, I am correct to say that my PSA increased from 0.06 November 2019 to 0.07 in March 2020 within experimental errors.
I will have another PSA test on May 28. In March, my Testosterone was < 20. By May 28, I don't expect my Testosterone to rise much because I am still having hot flushes. So, if my PSA turns out to be around 0.10, I will celebrate in a befiting manner.
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