A brief Recap….Stage 4, Gleeson 8, mets to lymph nodes and one to the common iliac a little distance away, RP in Dec 2019, ADT started in Jan 2020 (Zolodex and Bicalutinide) and in continuation thereafter, 33 sessions adjuvant IGRT to whole pelvis finished in Jun 2020.
PSA has been largely non detectable so far. However, when using different labs the results have been awry. One lab using Immunometric Immunoassay has consistently shown the PSA as less than 0.01 from beginning, while another lab using CMIA OR Chemical Luminescence Immuno Assay started off by results as less than 0.008 from Mar 2020 till Feb 2021 when it reflected =0.01. In Oct 2021 showed result as 0.03 and in Dec 2021 as 0.01 again.
Second Pet Scan in Sep 2020 and third Pet Scan in Jul 2021 showed no mets.
Met my Radiation Oncologist yesterday who gave the following suggestions/ observations:
1.I should not be concerned with the fluctuating PSA until it reaches 0.1 and anything below is as good as undetectable even for those who have had RP.
2.Since I have been on ADT for two years, with undetectable PSA I should consider taking an ADT vacation with six weekly PSA monitoring.
3.Since I am complaining of a constant stiff neck and occasional back pain I should get a cervical MRI and a PSMA PET Scan to eliminate any scope of mets despite undetectable PSA
I have not really been able to understand the variation in lab results for PSA and am wondering whether it’s a good idea to take the ADT vacation or should I continue ADT for another 3 or 6 months before taking a call. I also haven’t understood the need for another PSMA PET Scan since the last one was just 5 months ago. I recall TA mentioning that mets causing bone pain will show up in a bone scan.
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Tally111
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As for : 1, 2, and 3? Yes, yes and yes. (From this corner.) what happens when you are off ADT and testosterone returns will be important. May want an MRI for the neck to identify non cancer related causes. PSMA will very likely be negative at such low PSA. But may show how the pelvic nodes responded.
I take all PSA reads with a grain of salt now. I had two MD's who wanted PSA readings, and I went to Quest's local phlebotomist to get the blood drawn.
Instead of just adding the one MD's prescription to the others (so they'd both get results from the same test) she actually took 2 samples and submitted both for testing. One came back 0.19 and the other came back 0.22.
Same day, same lab did the tests, different results. Reading too much into lab results can lead to erroneous conclusions IMHO. Different results from different labs - no surprise to me there.
TWO years on ADT and non-detectable for months + / initially node positive @ G8 ...
I was similar at Dx (actually a bit more advanced) and surgery was not an option due to regional spread.
I had radiation, ADT . then an ADT holiday and then a BCR (recurrence) - all of this in about 5 1/2 years timeline.
Today I've moved on to Bicalutamide mono-therapy (150 mg daily) and had a PSA drop from 11.0+ to todays readings (< 0.04) and still dropping about 50 % every 3 months. The drop total from 11 plus to near zero took about 1 year.
I should point out that Bicalutamide is not SOC and many won't get a long(er) term favourable result. In fact MY scans show a reduction of cancerous activities in my entire body - a diminishing trend that continues + a BIG surprise to the doctors.
I've had CT, bone and PSMA scans - and will get more as part of an ongoing trial.
Bicalutamide has very 'minor' side effects - compared to the other ADT 'agents' in use today.
That's why I asked for it - hoping that I was one who could get great results..
Assuming you feel like it's time to see what your REAL status is, after a 'T' recovery and ADT withdrawal.
The result MIGHT be great or disappointing - be prepared for either but why would you continue ADT IF you didn't need to ??
You won't know unless you take that leap of faith.
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PSA Roller Coaster ride!
PSA numbers for start/stop Intermittent ADT?
PSA rising slowly since Nov 2022
PSA rise after stopping ADT with a prostate. 
Is it reasonable to pursue ultrasensitive PSA test that is more precise than undetectable at <0.05?
