PSA drop VMAT-radiation

[TheTopBanana]

My father is 68 years young, G-9 recurrent, removal of prostate in 2017, PSA went up to 0,24-0,26 in May 2020, two small bone mets iliac and pelvis discovered on PSMA, T was 720 ng/dl in May 2020. The doctor suggested only vmat-radiation 7 weeks to bed + mets starting beginning of June. Now 4 weeks of radiation the PSA had dropped to 0.14. What does this mean? Is it even good? I think my father should get ADL as well? We are talking to the doctor today and I’m going to suggest Firmagon but I know that the doctor might (not sure) think that we ”destroy the instrument” of PSA-testing.

[Tall_Allen]

Treating PSA is not the goal. I agree with you - it is fruitless without ADT

[TheTopBanana in reply to Tall_Allen]

The doctor agreed (after some discussion) to give a triple single dose of Firmagon. This made me very happy!! Even if it is a single dose we can get a second opinion now for the treatments in the future. But at first the doctor said that ”perfect, treatment is working, no need for ADL”.

[Hidden in reply to TheTopBanana]

The PSA test marker on the RT success outcome has already been devalidated regardless of firmagon dose. It would had some info if RT only had been applied. Now, no-one can tell for sure where from the decline of the PSA comes from, i.e. RT or ADT. Most probable answer is from both, but only when ADT is stopped and T resumed it's normal level you will know. It is currently blurred.

[TheTopBanana in reply to Hidden]

No he has not had any ADL, first dose is tomorrow.

[Hidden in reply to TheTopBanana]

You wrote: "T was 25". No way for an ADT naive person.

[TheTopBanana in reply to Hidden]

Do you mean it is too high for getting ADT? I’m confused.

[Hidden in reply to TheTopBanana]

I mean he was already on ADT at the time his "T was 25" and this does not wears off within weeks time. It takes months.

[TheTopBanana in reply to Hidden]

No. He has never had ADT, First dose is a triple dose of Firmagon tomorrow.

I checked more in detail now, it was in May:

AnalysResultat

* markerar resultat som kan vara avvikande ReferensintervallOm provet

P--PSAVisa i kumulativ lista0,24 mikrog/L <3,0Svar ej vidimerat

P--TestosteronVisa i kumulativ lista23 nmol/L 6,7-26Svar ej vidimerat

P--CalciumVisa i kumulativ lista2,39 mmol/L 2,15-2,50Svar ej vidimerat

P--AlbuminVisa i kumulativ lista37 g/L 36-45Svar ej vidimerat

P--BilirubinVisa i kumulativ lista10 mikromol/L <26Svar ej vidimerat

P--ASATVisa i kumulativ lista0,42 mikrokat/L <0,76Svar ej vidimerat

P--ALATVisa i kumulativ lista0,37 mikrokat/L <1,1Svar ej vidimerat

P-ALP (Alk fosfatas) Visa i kumulativ lista

Saknar verifierad NPU-kod0,7 mikrokat/L 0,7-1,9Svar ej vidimerat

P--Laktatdehydrogenas (LD)Visa i kumulativ lista3,3 mikrokat/L <3,5Svar ej vidimerat

P--Kreatinin (enz)Visa i kumulativ lista64 mikromol/L <100Svar ej vidimerat

Pt-eGFR(Krea)relativ Visa i kumulativ lista

Saknar verifierad NPU-kod86 mL/min/1.7 >60Svar ej vidimerat

P--NatriumVisa i kumulativ lista141 mmol/L 137-145Svar ej vidimerat

P--KaliumVisa i kumulativ lista4,3 mmol/L 3,5-4,6Svar ej vidimerat

B--LeukocyterVisa i kumulativ lista4,1 x10(9)/L 3,5-8,8Svar ej vidimerat

B--ErytrocyterVisa i kumulativ lista4,4 x10(12)/L 4,2-5,7Svar ej vidimerat

B--Hemoglobin (Hb)Visa i kumulativ lista143 g/L 134-170Svar ej vidimerat

B--EVFVisa i kumulativ lista0,44 0,39-0,50Svar ej vidimerat

B--MCVVisa i kumulativ lista99 fL *82-98Svar ej vidimerat

Erc(B)--MCHVisa i kumulativ lista32 pg 27-33Svar ej vidimerat

B--TrombocyterVisa i kumulativ lista217 x10(9)/L 145-348Svar ej vidimerat

--

[TheTopBanana in reply to TheTopBanana]

It is in the Swedish but the numbers are easy to read, let me know otherwise I can translate (just copy pasted in a hurry)

[Hidden in reply to TheTopBanana]

Triple dose will do it . Adt has not been a cake -walk for me . I’ve been on it over five years.now...it with imrt pushed my aggressive pc down for now.for over 4 yrs. That isthe best that we can hope for .If dad can eat healthy and get daily exercise he can help stave off Osteo and cardiac issues brought on by treatments . By the cutting out of our T we lose muscle and then bone . Weight bearing exercise can help mucho . Fatigue set in on me as I got into the 4 th week of my 8 weeks of imrt . I was greatly weakened but I was messed up with tubes and a foley . That took me down. You Dad won’t get there . I think he will do well with you by his side . Peace ✌️

[TheTopBanana in reply to Hidden]

Why would a high testesterone be impossible for a ADT naive person? Does my father’s high T mean he is unsuitable for ADT?

[Hidden in reply to TheTopBanana]

Wait a second I am converting the nanomols/L to a unit we usually use here

[TheTopBanana in reply to Hidden]

Ahh the different units might explain the confusing!! Pjuu..Yes please let me now after you have, would love to hear your opinion. Thank you!

[Hidden in reply to TheTopBanana]

720 ng/dl very good for his age. So we go back to square number one. What is more valuable for you, To know what is happening now or the prospect for a better RT outcome. Personally I would have gone by the first encouraged by the drop in PSA but this is philosophical question not a medical one.

PS I would like to add that the norm for adjuvavt ADT to RT foresees a 2 to 3 months advanced start of the former before the latter. Your father has already passed the mid of the RT thing that makes me wonder if there is still the claimed benefit of it.

[TheTopBanana in reply to Hidden]

Ah interesting! But do you mean benefit from ADT or RT? I’ve read that ADT usually goes before MDT, in this case his doctor wanted to see the effect on PSA from the MDT and not add anything else. The Firmagon is something we got because we asked for it.

[Hidden in reply to TheTopBanana]

Right, the norm is to start ADT 2-3 months in advance. If it has partly or any influence now that RT is half done vs some weeks later after another PSA that will confirm the decline and establish a trend, I really don't know a d probably no one does.

[Hidden in reply to TheTopBanana]

A PSA Halving Time of less than 2 months marks an excellent performance. I think it calls for a celebration, not additional worries.

[Rocketman1960 in reply to TheTopBanana]

No! Drive the T down!

[TheTopBanana in reply to Rocketman1960]

Rocketman1960 tell me more?

[Hidden in reply to TheTopBanana]

Good that he saw the light.! Please excuse me? But I think that your wanted to say ADT = firmagon . That was my first shot . It brought my PSA down then I went onto Lupron .. Great job being the caring daughter..Take care of the TopBanana and also yourself . Love him up ! Thank you for sharing . It’s wonderful for me to see someone like you stepping up and advocating for their father. God Bless your family !🙏😷

[dmt1121]

I just want to say that you are a courageous and loving daughter that any father would be so thankful for. Be sure to take care of yourself too.

I pray that you find the treatments that will work for your dad. I wish you all the hugs and laughs that you can have together!

I know you will stay the course but also remember to take some deep cleansing breaths to relax and center yourself.........

[TheTopBanana in reply to dmt1121]

Thank you, that is very kind of you to say!!

[maley2711]

Is it possible that you should search for a new Doc who you believe is more knowledgeable ? someone who is more specialized in prostate cancer treatments?

[TheTopBanana in reply to maley2711]

Yes we need to find someone else, I agree..

[j-o-h-n]

You're on top of the situation....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 07/08/2020 2:24 PM DST

[maley2711]

Good! I believe it would be a mistake to rely on amateur opinions in making your future decisions..these forums, serve as good sounding boards, but are not equal to true professional expertise....stressing EXPERTISE...ie unbiased advice!!! Not easy to find..but worth the effort?