Sources of PSA During ADT Break

[dac500]

I asked this question several years back and TA gave me an answer, which I cannot find. So, I am asking the question again.

My prostate cancer took an unusual path since brachytherapy in 2011 for Gleason 3 + 3 low volume cancer. First I had a local recurrence in 2016 and lymph node (pelvic and abdominal) metastasis in 2018. Since then I have been on intermittent Lupron ( 3 month shorts). Currently, I am on my second break from June 2021 (last three month short in March 2021).

My PSA has risen from 0.10 at the start of the break to 0.51 now with recent testosterone of 72. Since I still have a prostate (radiation treated), a question has puzzled me during the first and the current break. How much of the increase in PSA with rising testosterone during a break can come from the prostate? My PSA nadir was 0.1 eighteen months after the seed implant.

[Tall_Allen]

0.1, if you were off of ADT then.

[dac500 in reply to Tall_Allen]

I didn't have any ADT until recurrence in 2016.

[bluesnjazz]

Hello, dac500. Your situation is similar to mine, so let me summarize where I am and where I've been, hoping it might help you know where to go. In 2005 discovered PCa, PSA 5+ stage 1, no tumors, cells only in one quarter of the organ. Treated it for a year with nothing more than a restrictive diet and cancer-fighting supplements, but finally had brachy in late 2006 when my PSA climbed over 6 (a big mistake, I now think; wish I would have continued with watchful waiting and my alternate treatments). Three years later, PSA hit .003 so I thought I was home free.

But then a PSA check in 2014 found it over 7. Biopsy showed nothing in the organ yet scans showed nothing elsewhere so doc said micro metastasis. Again tried getting rid of those rebel cells with restrictive diet, supplements, and vitamins, which held it down for a while; but in Jan, 2016, it hit 45 and a tumor showed up in a lymph gland near the prostate. Started double ADT (Lupron & Casodex) and continued for only 6 months during which time, my PSA dropped 70-90% every month, all the way down to .03 and the tumor disappeared.

Stopped the horrors of that treatment and my PSA stayed down for nearly a year after, then back up to about 5. Refused to restart the Lupron with its hellish side effects, so did Casodex only off and on (usually about one month on, one month or more off) for nearly 2 years till it stopped working, then started Lupron again, but only 1-monthers 2-3 times a year. During those 3 or so years, my PSA yo-yoed between near-zero when on the stuff for a month or two and 16 when off for a couple of months. But no further sign of a tumor with semi-annual scans.

Then, in 2020, after half a year break from treatment, my PSA shot up to 47, but again scans showed nothing suspicious inside. After reading about the differences between agonists (Lupron, e.g.) and antagonists (degarelix and relugolix), which are faster action and have no bad effects on the heart, I asked my doc for an injection of degarelix. Four months later, my PSA had dropped to .89. I refuse to put any hormone meds in my body from late spring to early fall because the hot flashes absolutely devastate me, so again my PSA skyrocketed so got another shot of degarelix in October last year and January and March of this year. PSA at my checkup this month was about 5, and again, scans showed nothing amiss.

Hope this helps you. Don't hesitate to respond with questions, if you have any.

[dac500 in reply to bluesnjazz]

Even though both of us had brachytherapy for cancer that was confined to one quarter of of the prostate, our disease progression was quite different. In your case, PSA was all over the place shooting up to 47. In my case, PSA at diagnosis was 3.4 and 4.48 when multiple lymph nodes in pelvic and abdomen were found with cancer as confirmed by PET/CT scan and biopsy of a lymph node. I also had an extra-capsular recurrence treated with cyberknife and ADT. I am on intermittent ADT (Lupron + Casodex for one year at the start of treatment for my metastasis) for three and half years.

What I don't understand is why in your case with a PSA of 47 multiple metastasis were not found. The highest PSA I ever had was 4.48 at the start of my treatment for metastasis in November 2018. Before starting my treatment in 2018 my PSADT was less than three months. This was also true during the two breaks I had. My goal is to keep my cancer under control. The side effects of ADT doesn't bother me too much, even though the hot flushes are intense. At the moment, I am waiting to restart.

I will have Xray, CT scan, and bone scan in June and probably restart ADT.

[bluesnjazz]

For sure, our disease progression has been dramatically different. Of course, everyman is affected differently by the same meds. I, as well as my doctors, have often been shocked at how dramatically my PSA both drops on ADT and climbs while off it. Maybe I'm just lucky, but I believe my own alternate treatments of restrictive diets (very little red meat and dairy products, no sugar, lots of cancer-fighting vegetables), cancer-fighting supplements, exercise, and yoga practice has helped fight this beast. From the original discovery in 2005, I've done massive amounts of research on not only what medical treatments are available, but alternative ones, as well. And based on much of that research, it's clear beyond doubt that diet and exercise are extremely important.

I lift weights 2-3 times a week, run about the same, do yoga every morning after arising plus take a class weekly.

As for your much lower PSA, I have a good friend in Singapore who's had PCa in his gland for years, on watchful waiting, yet his PSA never went much over 2! When it finally did climb a little higher, he had brachy several years ago and is still tumor free and PSA low.

As for my current treatment, I switched to degarelix year before last, and even though there's a week of misery after they inject the liquid into my belly, the hot flashes have been far more irregular and less intense than those on either Lupron or Casodex, and the biggest thing is no more heart palpitations. It also brings down your testosterone much mor quickly and allows it to be restored more quickly after the medicine is gone. Degarelix is a different type of ADT called (GnRH) antagonist, while Lupron and others are called agonists. If you live in the U.S., another of the same type of med is called relugolix and is in pill form so there's no suffering from a wad of liquid in your belly.

Hope this info helps you. Feel free to ask questions or return comments.