Rising PSA after being off ADT for 16 months

[JolleySprings]

My hubby’s PSA has risen from .02 to 1.7 in exactly one year. The rise began 16 months after being off Lupron/Casodex. He had RP in 2017 with all clear margins etc at time of surgery. 6 months later PSA began to climb. One lymph was lit up on Auxium scan which led to Cryotherapy at Mayo Clinic. 3 months later PSA climbs again and that’s when ADT was begun. ADT was stopped at 6 months as Oncologist Wanted to try Intermittent therapy. PSA was undetectable for 16 months. Now PSA is rising using Ultra sensitive tests. He had PSMA scan done at UCSF in Aug at PSA of .7 … showed nothing. Just last week he had Auxium scan at PSA of 1.4 and it showed nothing. Having group conference with two oncologist on Friday. Thoughts? One oncologist wants to wait until visible lesion and do targeted therapy. The other leans toward restarting ADT. Thoughts? Thank you!!!

[Hidden]

If a lymph node is spotted on a scan, whole pelvic radiation is required. You cannot pick off cancer one spot at a time.

[Hidden]

That's what I was thinking. Its in the nodes, just not showing up yet on a scan. But what do I know. Seems like Mayo would be leaning for whole pelvic, just like I had.

[JolleySprings in reply to Hidden]

Thank you for responding. I guess I failed to mention that IMPORTANT detail. He DID have SBRT … 39 rounds After the Cryo … and he began ADT during Radiation. Dr. Aggarwal at UCSF says that the PSMA scans have been a game changer for Radiation treatment: thus the precision radiation on spots that show up. It just seems so strange nothing has shown up on either of these scans. His very first Auxium scan in 2018 picked up a node in the seminal vesicle area with a PSA of .2 It picked up nothing on this scan with a PSA of 1.6 🤷‍♀️🤷‍♀️

[Tall_Allen in reply to JolleySprings]

Rahul Aggarwal is not a radiation oncologist.

[Tall_Allen]

IMO mistake to treat individual lymph nodes. I don't know why some doctors believe that what can be detected by a scan is all there is. ADT (probably with abiraterone) should have been continued for 2-3 years after whole pelvic salvage radiation. I hope it still works for him.

[JolleySprings]

Per Dr. Aggarwal and his Oncologist here in Dallas…apparently believe in intermittent ADT … for QOL purposes. When PSA begins to rise again hit again with another round of ADT … From what I understand…some studies are showing survival rates are similar. The ADT zapped my husband so badly he wants more QOL over blah quantity. It frightens me. Also the burden it puts on organs of the body. Soooo much to consider! Thank you for your response and thoughts!

[Spyder54]

You are being honest with your emotions. That is important. Intermittent ADT works for some Men. BAT (Bi Polar Androgen Therapy) works for some men. Quality of life is more important than survival for some men. All men present, and respond differently. This disease is insidious, relentless in always dividing and multiplying. Your husband has a shot at cure. Many of us here do not. Use your best judgement with your chosen medical team, listen to Tall Allen, run it all by your Medical team, and go out enjoy life. Notice the sunrises, and sunsets. We are all passing thru this journey we call life.

The only right decision, is the decision you and your family make. No wrong.

My best to you and yours,

Mike

[JolleySprings in reply to Spyder54]

Thank you for such a kind response!

[JolleySprings]

Thank you! Your plan sounds very sound and productive!

[slpdvmmd]

Agarwal who I spoke to directly described his clinical trial as evaluating PSMA located nodes with treatment by apalutamide and cyberknife versus apalutamide alone. He, as well another prominent researcher I spoke to said there is not "definitive" data that shows nodal treatment is not beneficial. Part of the argument presented to me for this study was the nodes identified may have different somatic genetics and are thought to serve as an independent site of metastasis generation. Just my interpretation of the conversations as a patient and soon to be retired surgeon.