PSA over 5000

[wpopomaronis]

I’m involved with a number of clinical trials. Does anyone else have a PSA over 5000

[Tall_Allen]

I've seen one guy with 10,000

[Hidden]

There was a guy on the forum: Ctarleton that started off with a PSA over 5000 and he lived quite while after diagnosis, not sure, but I think more than 8 years.

healthunlocked.com/user/cta...

PSA at diagnosis is not prognostic for overall survival. The most aggressive prostate cancers tend to be the ones with low PSAs.

[LearnAll]

It is not important how high PSA starts at...what is most important HOW LOW PSA Falls after ADT. Lower the PSA falls, better the survival.

[Scout4answers in reply to LearnAll]

I have heard this said before, Can you put some numbers on this probability of longer survival. Any studies as proof?

[LearnAll in reply to Scout4answers]

There are many research articles over last 2-3 decades both from US and also from Japan, Korea and China...about issue of PSA Nadir and length of survival. I will have to dig into my old, thick files ..but not in mood today as chilled beer is making the atmosphere of starting the celebration of long weekend of memorial day.One study is by Maha Hussain et el.

Lower the lowest point after ADT and longer the time to reach Nadir PSA both indicate longer life. Also, after ADT how far low total Testosterone falls also indicates longer survival.

[Schwah in reply to LearnAll]

I’ve heard that before. Any clue what’s considered a fast and what’s a slow length of time to hit nadir?

Schwah

[LearnAll in reply to Schwah]

Time to Nadir PSA means how many months it takes to reach the Nadir PSA after starting ADT. What Nadir PSA means is that it is the LOWEST point PSA reaches after being on ADT. Any Nadir PSA 0.2 or lower is considered "undetectable" which also means "the best possible Nadir PSA."

Best survival is reported to be in men who take at least 9 months to reach Nadir PSA.

Various studies put best TTM at anywhere from 9 months to 12 months.

It seems counterintuitive that slower the PSA falls after ADT..better the survival...So I went into deeper physiological mechanism to understand why it is so.

I found out that in every Prostate tumor there are tumor associated Fibroblasts . These cells are responsible for slow decline in PSA after start of ADT. Detailed mechanism is too complex for this setting. Bottomeline is if one achieves 0.2 or lower Nadir PSA with time to Nadir above 9 months..the expected survival is is at least 5 to 7 years (may be more) But as always, there are other factors to take into consideration.

[Schwah in reply to LearnAll]

Thanks for the detailed reply. However, weren’t most of those “time to nadir” studies done when SOC was just one adt drug? I have not seen any new studies since the recent changes in SOC came about wherein most patients are now using multiple drugs (adt + zytega or adt plus Xandi or adt plus chemo etc) which might be expected to lower PSA more quickly?

Schwah

[LearnAll in reply to Schwah]

Yes. Most of the studies about Nadir PSA and survival were studies done with Lupron monotherapy. I was wondering exactly what you are thinking. Now, with multiple drugs upfront, does those conclusions even matter ? Because with multi drug regimen, pretty much everyone can reach Nadir 0.2 or lower.However, time to nadir still remains valid IMO. In my case, it took almost 12 months to achieve Nadir PSA of 0.19. (with total 9 months of Lupron+Zytiga)

[Hidden in reply to LearnAll]

12. Independent association between time to prostate-specific antigen (PSA) nadir and PSA progression-free survival in patients with docetaxel-naïve, metastatic castration-resistant prostate cancer receiving abiraterone acetate, but not enzalutamide - PubMed

pubmed.ncbi.nlm.nih.gov/281...

[LearnAll in reply to Hidden]

From this study, seems like longer time to Nadir PSA still indicate better outcome.

[Hidden in reply to LearnAll]

Yeah. The reasons weren't immediately obvious to me but after being presented with data they became clear.

[j-o-h-n in reply to LearnAll]

So maybe you can dig into your old refrigerator and tell us how many chilled beers it takes in making you see double? Enjoy the Holiday!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/28/2022 2:26 PM DST

[timotur in reply to Scout4answers]

pubmed.ncbi.nlm.nih.gov/186...

[dhccpa in reply to timotur]

That's local PCa only?

[timotur in reply to dhccpa]

This study was local- advanced, up to T3.

[Hidden in reply to Scout4answers]

10. Detectable Prostate-Specific Antigen Nadir During Androgen-Deprivation Therapy Predicts Adverse Prostate Cancer-Specific Outcomes: Results from the SEARCH Database - PMCncbi.nlm.nih.gov/pmc/articl...

11. The Importance of Time to Prostate-Specific Antigen (PSA) Nadir after Primary Androgen Deprivation Therapy in Hormone-Naïve Prostate Cancer Patients - PMC

ncbi.nlm.nih.gov/pmc/articl...

I think it depends on the stage and other therapies. Perhaps anti-androgen use also. For example, after RP if PSA is undetectable within 2 weeks that is a good sign.

[Juju1979]

Mine was 4950. On ADT treatment it came down to 0.38 as of last month and is still dropping. That is over a 1 year period.

[Woodstock82]

In June 2019 my PSA was 11,201.69. Lupron and six infusions of docetaxel brought it down to a nadir of 1.54 in February 2020. By September 2020 it had doubled, whereupon I was considered castrate-resistant and enrolled in the CHAARTED2 clinical trial, which got me started on daily abiraterone and a set of six infusions of cabazitaxel. I got very good results from that. The periodic Lupron injections and daily doses of abiraterone are still ongoing. As of May 2022 my PSA is 0.01.