PSA .03 after Radiation and ADT

[Wynnsts]

Visited my RO this week and my PSA was .03 after radiation to 3 lymph nodes and a spot on the iliac bone. He wants to stop Eligard for 6 months to determine, not sure what. Guessing to see if the cancer is gone but my understanding that once it has metastasized you’ll never really be cured, you just continue to try to live long enough to die of something else, I’m ok with that. August 2015 RT, then salvage radiation in 2019, then SBRT in 2021 so I’m about to be 7 years in this fight and only 75 years old. Do I seem correct in my thinking, I’m comfortable ADT and I will meet again. Just putting things on paper but thoughts are always appreciated.🌴

[Tall_Allen]

I agree with you. He is making the mistake of thinking that "treating PSA" is the same as treating the cancer. Maybe that spot radiation slowed the cancer down for a while - IMO it was worth trying. But your basic maintenance therapy is ADT - if it isn't bothersome, why mess with it? Maybe email him this article:

prostatecancer.news/2020/07...

[Wynnsts in reply to Tall_Allen]

Thanks TA, I know this group has the best and latest information available for Advanced Prostate Treatment/Care any where in the world! People like yourself who know what the latest in care before many caregivers. We have info coming in from throughout the world constantly. Our members have been through so much but continue to share until the Good Lord calls us home. Thanks Again, I always value your advice.

[Karmaji in reply to Tall_Allen]

For TA....I would like to have your opinion regarding advanced biomarkers.Efficient use of CTC blood tests...My ONCO says even if there is indication of cancer thru CTC, he wont know what to do...makes me laugh?

Then we have more advanced Biomarkers test advanced by Prof. Patrizia Brechot, univ Descartes Paris. ISET by Rarecells and safetestsforlife.org

Why we do not go for these biomarkers...simple blood tests...

Any ramark ?

[Tall_Allen in reply to Karmaji]

I don't know what to do with them either. They haven't been validated and I especially wouldn't know what they mean after MDT.

[Vangogh1961 in reply to Tall_Allen]

Thanks for the post. I guess I'm trying to rectify the use of MCP and Broccomax, when he advocates no supplements. Your opinion is appreciated as always.

[Tall_Allen in reply to Vangogh1961]

I haven't heard that MCP or sulforaphane affects PSA tests.

[Vangogh1961 in reply to Tall_Allen]

Ok. I misread that sentence in the article. I thought he was advocating no supplements, and I take both, but now see he's addressing those that may make the PSA inaccurate.

[KocoPr in reply to Vangogh1961]

Lol, I thought I knew every supplement but can someone tell me what MCP is?

Nevermond just found the MCP thread. Very informative.

[Vangogh1961 in reply to KocoPr]

healthunlocked.com/advanced...

[Shooter1]

Stick with treatments and hope for as much quality life as you can get before it pops back up again....

[Wynnsts in reply to Shooter1]

Thanks Shooter, that’s my plan! I appreciate your input!!

[fireandice123]

I had similar treatment- ADT and RT. My MO and RO made me wait 18 months after RT before trying a vacation. It’s been about an 8 month vacation so far and I’ll get a good indication in a couple of weeks as to where I am when I have a PSMA scan. (Insurance finally approved it!!)

[Wynnsts in reply to fireandice123]

Thank you for your reply, I’ll be very interested in seeing how your scan goes. Where are you having the PSMA done? I certainly pray the results will be positive.

[fireandice123 in reply to Wynnsts]

I’m having it at the Univ of Vermont Medical Center

[Wynnsts in reply to fireandice123]

I’ll look around south Florida and see what’s available. I go to Moffitt Cancer Center and last I checked it wasn’t available there, but I didn’t ask on my visit this week. Thanks again! A trip to Vermont would be nice this summer.

[Hidden in reply to Wynnsts]

If you have a .03 PSA, do you really think a PSMA is going to show anything?

[Wynnsts in reply to Hidden]

Sorry I missed this. No Sir I do not, but when it rises again, and it will, knowing where it is available near me will help.

[Kowalla in reply to Wynnsts]

husband had PSMA Pylarify scan done at Mayo Jax last month. A little closer to south Florida.....

[Wynnsts in reply to Kowalla]

Thanks so much for this information, when it begins to rise again I’ll try to get in Mayo Jacksonville. God’s speed to your husband and yourself!!

[ctflatlander in reply to fireandice123]

Fire, I have somewhat similar condition, although never been on a vacation since 2017. See my profile. I have recurrence lesion on T3 but RO doesn't want to do it again. I'm going for scans in June and a Dexa this week. I live in NE Kingdom and travel to Burlington to bike the bike path up to Hero. Friends over in East Middlebury. Success on your scans. Bob

[Hidden in reply to fireandice123]

What is a scan going to show if your PSA is undetectable? Probably nothing other than red herrings. Am I wrong?

[fireandice123 in reply to Hidden]

My PSA isn’t undetectable. It’s 0.9 up from a nadir of 0.1. The question is whether the rise is due to what’s left of my healthy prostate cells firing back up since my T level is back normal and releasing PSA or is my cancer firing back up? Or is there cancer popping up in someplace new? For me the appeal of the PSMA scan is that it’s PC specific and can spot much smaller amounts of cancer than either CT or bone scans can pick up.

Also, in reality having a PSMA scan with an undetectable PSA is probably a moot point unless you’re paying for it yourself since insurance almost certainly will not approve it. I had to jump through hoops to get it approved with a PSA of 0.9.

[Hidden in reply to fireandice123]

oh. i thought your PSA was .03. Wait, I intended that for the OP. His is undetectable. So why would a PSMA scan help him. Perhaps some other blood tests.

[6357axbz in reply to Hidden]

Good question

[Magnus1964]

If the treatment is working, stay the course. Don't stop the eligard.

[GP24]

My experience is that ROs often recommend against ADT after metastases directed radiation. This way they can determine the result of the radiation quickly. However, this is not the objective of the patient. He wants the combination of ADT plus radiation to work as long as possible. Do not stop with ADT.

[Hailwood]

I agree with TA, continue with the ADT.

[Rocketman1960]

After lowering the tumor burden on the body I would encourage you to stay the course with ADT also. Keep riding that horse.

[Hidden]

First I wish success to you in fighting this terrible disease. Based on your posting, you were metastatic in 2015 and had three different treatments of radiation by a Radiation Oncologist with injections of Lupron or Eligard. There is more than one way to kill the little bastards. So I’ll ask a series of questions to think about based on my thinking and action when I went metastatic in 2004.

How did your metastasis happen? What does your Medical Oncologist, hopefully one who specializes in Genitourologic Cancers; particularly Prostate Cancer say? Do you know the term micro-metastasis; and have you discussed with your treating Physician? What co-morbidity factors exist that might interfere with your treatment? Have you had nuclear bone scans along with soft tissue CT scans? If so, how many and what does a comparison show?

I have written a lot in this group and other groups about my treatment path; however I recognize that is an ultra standard of care beyond what is offered today. I was most fortunate to be included in an academia and research clinic trial immediately after being diagnosed with T4N0M1b prostate cancer a

year after primary treatment of Brachytherapy and 25 sessions of IMRT.

I am also biased with regard to treatment and standard of care protocols. My blood work results amounted to four pages with various bio-markers; most important, PSA and Testosterone and nuclear bone scans and CT scans. In February 2010, my MO convinced me to stop Lupron/Eligard with what do you have to lose. “I am convinced that you are cured. If PSA rises, we will re-start Lupron and move on.” A year later, 2011, in an effort to restart the production of testosterone, he had me start testosterone gel. PSA was still <0.1 and T at 5.0.

Until December 2021, I maintained PSA at <0.1 and T ranging from 350 to 500 each quarter depending when I applied the topical gel. I was asked to stop the gel. In January 2022, my PSA was <0.1 and T at 33.

At this point, I started to have ultra sensitive PSA tests along with 0.4 ml of Testosterone Cyprionate injected twice a week. Blood work is done three days post injection. Note: my Medical Oncologist, Gastroenterologist, and Cardiologist all concur.

Since January, I have had three rounds of bloodwork...... results are: PSA at 0.014 and T at 1400. I have lost 4 inches of visceral fat in the abdomen, 2 inches of fat in the thighs, 3 inches in the waist along with 30 pounds. My Testosterone and Estradiol are now balanced.

I have never had any of the “silver bullets” tested and approved nor any of the new scans developed since 2004. They were always in the MO’s holster if needed. After 26 sets of scans and 124 sets of bloodwork, I have no doubts that my Research Professor Medical Oncologist was correct in 2009 when he said, “ I can not find any cancer in your body.”

I said that I was biased. There is no doubt that my treatment helps to validate Dr. Amato’s working hypothesis (published in 2005), “ We suspect that the transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. Thus we view the androgen-independent component as analogous to “microscopic residue” or “micro-metastatic” disease for which adjuvant chemotherapy has shown to be effective in other contexts.”

Eight years later, in 2013, Dr. Amato published another paper along the same lines. Available at pubmed.ncbi.nlm.nih.gov/236...

I am most fortunate to be in the group of 9 with a complete response.

Keep killing the little bastards,

Gourd Dancer

[Hidden]

There seems to be confusion as to whether metastasis to a limited number of areas can be "cured" or even put into long term remission. I would like to understand whether this is a widely held belief.

[6357axbz in reply to Hidden]

My understanding is Stage IV PCa with distant (not in the immediate perimeter of the prostate gland) is incurable.

[Hidden in reply to 6357axbz]

But the Iliac crest would not be distant, would it? Isn't it possible this man is cured or at least in a long term remission?

[6357axbz in reply to Hidden]

Don’t know. If it’s in the bone I think it’s “distant”. Long term remission is a possibility for any of us with incurable Stage IV mPCa

[Lrv44221]

I understand what you are dealing with. My husband has been dealing with prostate cancer that has met to other areas. ( 6 years)He deals with it the way he chooses and I think what ever you decide is the right choice.

[Wynnsts in reply to Lrv44221]

Thanks Lrv44221. I do like and appreciate your reply, yes I think anyone dealing with a potentially life threatening condition should reserve first right of refusal. While I think we should always consider the thoughts of our loved ones, as we all suffer the side effects of treatments, the final decision lies between the patient and the Lord! God bless you and your husband as you travel down PC Lane!

[Lrv44221]

Thank You