New Test Results

[dac500]

I stopped Lupron last November. On Feb 26 my PSA was 0.07 and T < 20. On May 28 my PSA has increased to 0.135 and T is 114. Bone scan is clear, CT shows all pelvic and abdominal lymph nodes avid in PET/CT scan are normal size.

My personal feeling is that the doubling of PSA in three months is probably due to increase in T. Now my question is should I ask MO to restart Lupron because it might lower my risk with Covid-19. Or, should I wait and see how much PSA increases during the next three months?

[Tall_Allen]

The only benefit to your vacation is that you get a vacation. If you have more compelling reasons to not take a vacation, only you can weigh the relative benefit for yourself.

[dac500 in reply to Tall_Allen]

Thanks. That is precisely my thought. Am I right to think that the rise in PSA is due to waking up of hormone-sensitive cells due to increase in T?

[Tall_Allen in reply to dac500]

Yes. PSA always goes up during vacations as T recovers.

[dac500 in reply to Tall_Allen]

A tele-health appointment was scheduled with my MO on June 1. I get a call from his office that he wants to have a face to face appointment with me because of the scan results. I am puzzled because I don't see anything of significance in the reports posted on patient portal.

[Tall_Allen in reply to dac500]

Let us know.

[Hawk56 in reply to Tall_Allen]

I am not sure I would says "always." I finished 18 months of Lupron in May 18, that was in conjunction with six cycles of taxotere in Jan 17 and 25 IMRT in July 17 (45 Gya) after surgery in Mar 14 (T2CNoMx, GS 8, ECE, SV and margins negative, 10%) and SRT in March 2016.

My T was 135 by October, PSA <.1. By Feb 19 T was 482, labs on 5 May had PSA at .07 (Urologist switched me to USPSA). Next labs are in August.) So, Lupron "cleared" my system say by Aug-Sep 18 so I'm roughly 20 months into this first vacation.

Perhaps you are right, always, eventually I suspect this vacation may end. Perhaps always means for some period, some short, some long but eventually for most, PSA will eventually rise...

[Horse12888 in reply to Hawk56]

I would say: PSA **always** rises when T recovers if it was ADT that lowered it in the first place. If you had IMRT, it's possible that it killed every cancer cell in your body, in which case PSA would not rise.

[Tall_Allen in reply to Hawk56]

You were never diagnosed with advanced prostate cancer, so your experience is irrelevant here. You weren't on an ADT vacation, your ADT ended.

[Hawk56 in reply to Tall_Allen]

Hmmm, the C11 Choline scan said differently, while no bone or organ involvement one of the four affected lymph nodes was outside the pelvic area which I thought met the definition of advanced PCa...

No disagreement that advanced PCa is not curable, that generally when on ADT alone and you stop treatment that as T returns so does one’s PCa.

I am cautious about the use of always.

I personally think everyone’s experience is “relevant” as others reading the posts may glean information useful to them even if it doesn’t fit the exact parameters of the post.

[Tall_Allen in reply to Hawk56]

This piecemeal info isn't helpful. You didn't say that earlier. I will stick with "always." If you have metastatic PC, it will always progress. It isn't curable with current methods.

[Magnus1964]

Lupron may not be as effective any more. But maybe you should try. If it doesn't work any more then it's time to move on to another ADT drug.

[pjoshea13]

I think you should enjoy the vacation. Since vacations always end, you should ask your doctor to define a reasonable "end" point.

It is normal to see PSA rising while T rises through the hypogonadal range (<350 ng/dL) - at least until the "saturation" point is reached (~250 ng/dL). It is the behaviour of PSA after that point which reveals the true PSA doubling time. I realise that this can be an anxious period.

Are you at great risk for COVID-19? I wouldn't use the virus as an excuse to restart Lupron. With a T of 114, you are still almost castrate anyway.

You can afford to be patient IMO.

Best, -Patrick

[dac500 in reply to pjoshea13]

When you are on ADT for metastatic prostate cancer, taking a vacation is useful if your QOL is better during the vacation. Some people can argue that vacation might delay cancer becoming castrate resistant. Others say it makes no difference.

In my case, QOL has not changed significantly during the vacation I am having since November 2019. Hot flushes are nuisance to me, which I can tolerate. Decrease in cardio-vascular risk is probably very marginal - my blood works have remained the same as during the active ADT period.

I will wait until my face-to-face appointment with my MO on Monday. I am intrigued by why he changed tele-health appointment to a face-to-face appointment. In the meantime, I will try not worry too much during this three days. I will take into consideration my MO's recommendation and decide when to end my vacation. Who knows may be MO might want to change my treatment plan.

[pjoshea13 in reply to dac500]

As to QOL, a hefty shot of testosterone [T] usually helps [LOL]. Dr. Freedland has commented that the off-phase is largely a continuation pf ADT. Recovery of T is very slow. Except for Nalakrats!

-Patrick

[cigafred in reply to pjoshea13]

Well, while certainly not in the Nalakrats league, I (also 77) can offer the following for those hoping for testosterone recovery:

Last 3-mth Lupron shot Aug. 8, 2019

Testosterone June 18, 2019=8, Dec 9, 2019=10, Feb 4, 2020=432

I will admit to taking 1150 mg/day of avena sativa for part of that time (h/t you-know-who, Nalakrats of course)

[dac500 in reply to cigafred]

I am least concerned with testosterone recovery.

[j-o-h-n in reply to dac500]

Easy answer, doc is probably a month behind on his mortgage payment... (SHOW ME DA MONEY!!!)

Good Luck, GoodHealth and Good Humor.

j-o-h-n Friday 05/29/2020 7:19 PM DST