PSA Result

[dac500]

I had my PSA lab today with the result of 0.453. I have been on ADT vacation since November 2019 (last 3 month Lupron shot September 2019). The PSA and Testosterone results every three months:

November 2019 PSA 0.06

March 1, 2020 PSA 0.07 T <20

June 1 2020 PSA 0.135 T = 128

August 28 2020 PSA 0.453 T(waiting)

Note that I have been treated for lymph node metastasis since November 2018 with Lupron + Casodex.

Between June and August my PSADT is under 2 months.

I have to decide when to restart ADT. I am concerned about the rate of PSA rise. Should Zytiga be added?

[Tall_Allen]

I can't recall - why was it that you did not have your pelvic LNs irradiated? Or did you? Or were the LNs you're referring to outside of the pelvic area?

[dac500 in reply to Tall_Allen]

Yes there were some abdominal lymph nodes involved as well.

[dac500 in reply to Tall_Allen]

Here is the PET/CT result:

- Abdomen and Pelvis: status post-brachytherapy, without definitive abnormal DCFPyL-avid foci at the prostate or seminal vesicles. There

are several foci of abnormal intense DCFPyL uptake at the pelvis,

fusing to small sub-centimeter lymph nodes; representatives nodes are seen in a 7 mm right perirectal lymph node (SUVmax 60.3), in right internal iliac/pre-sacral nodes, measuring up to 9 mm (SUVmax 46.1), two adjacent nodes below the aorta bifurcation measuring 4 and 5 mm, with SUVmax up to 49.2, a 6 mm right common iliac node (SUVmax 56.1) and a mildly DCFPyL-avid 3 mm left pelvic wall node (SUVmax 4.7). Several intense DCFPyL-avid retroperitoneal nodes, as seen in a 6 mm upper retrocaval node (SUVmax 37.6) and in a 5 mm lower retrocaval node (SUVmax 75.4). Mild uptake in few small bilateral inguinal

nodes, non-specific. No DCFPyL-avid mesenteric nodes. Physiologic distribution of the radiotracer within the liver, bowel, and urinary system. Scattered atherosclerotic calcifications in the aortoiliac vasculature.

[Tall_Allen in reply to dac500]

Gotcha. When to end the vacation really depends on you. There are no rules about it. With T still low, are you feeling the relief you'd hoped for? The double edged sword is that you feel better with the rising T, but it causes PSA to increase rapidly, creating anxiety.

[dac500 in reply to Tall_Allen]

Now I have my Testosterone. It is has gone up to only 147 from 114 three months ago, while PSA has gone up from 0.135 to 0.453. This implies PSADT is 1.7 months. I had my last Lupron a year ago. My quality of life has not changed much. I still have hot flushes.

[cesces in reply to dac500]

"I still have hot flushes"

Tall Allen, what do you think about adding some estrogen patches, then watching for a few more months?