PSA Expectations after SRT with Concurrent ADT

[dans_journey]

Greetings!

I just wrapped up 7 weeks of salvage radiation therapy on 26 August that was done with concurrent androgen deprivation therapy, and I'm about to go for my first post-treatment PSA test. (We agreed the ADT would be a one-time, 6-month dose to assist with the SRT.)

I'm just not sure where to set my expectations for where the PSA should be at this point.

We're 4.5 months into the 6 month ADT treatment, so I'm guessing it will have knocked my PSA down some from its 0.36 ng/ml starting point, but not necessarily to undetectable. (If it did knock it to undetectable, great.) I also know it's far too early to claim the SRT had an impact on PSA. We'll have to wait a year or so to make that determination.

If you have any insights, I'd appreciate them. Thanks!

A quick summary:

JAN 2011 - Radical prostatectomy, neg margins, no ECE, LNI, SVI, 3+4

APR 2022 - PSA 0.36 ng/ml

MAY 2022 - Eligard injection, 45 mg (6-month dose)

JUL-AUG 2022 - Salvage radiation therapy

[Tall_Allen]

I'll bet on undetectable or close to. You're still on ADT.

[dans_journey in reply to Tall_Allen]

Thanks, Allen! I'm tempted to get a "Guess the PSA" pool going.... 😂 I'll post the results when I have them, probably by the end of the week.

[dans_journey in reply to Tall_Allen]

Hey, Allen. It came back at 0.05. I'll take it.

[Blackpatch]

Hi Dan - I've followed your blog since my BCR in May 2018. Your PSA will be zero for sure, given the time since the ADT treatment. I just reached 24 months undetectable PSA post-T recovery - I'm beginning to think it might actually have worked, maybe... the good news is that i stopped worrying about a year ago. i think that's the real goal for you..

[dans_journey in reply to Blackpatch]

Thanks for the feedback and for following my blog! I'm venturing into new territory here and it's good to have insights from others to help me manage expectations.

[MateoBeach]

Bigger question is: Did they include the full pelvic lymph node fields in the SRT, or just the prostate bed? Whether your PSA is undetectable while on the ADT or just close to it is not so important as what happens after ADT is gone and you have recovery of testosterone.

At that point you would like to see a downtrend of PSA towards undetectable as whatever remaining cancer that has been irradiated progressively die towards a nadir. It can take two years or so so must be patient. And a bump along the way is common and does not prove failure.

[dans_journey in reply to MateoBeach]

Thanks, Mateo. We radiated just the prostate bed.

One of the things that concerned me about the SRT with concurrent ADT approach was that we were messing with two variables simultaneously. Thanks for the reminder it can take nearly two years to see if the SRT did its job.

[norman44]

Dear Dan I only had the radiation treatment for 44 sessions started adt two months before radiation treatments. My PSA was almost 9 when i started ADT . after 2 years of ADT still PSA running at undetectable . Its been almost a year since my last 6 month shot of Eligard and still have hot flashes . Good luck.

[dans_journey in reply to norman44]

Hi Norman. Thanks for sharing your story. If your PSA went from 9 to undetectable, I would certainly expect that mine will have gone from 0.36 to undetectable.

I'm reluctant to mention this given your situation, but I have managed to dodge hot flashes so far. I've been able to maintain my weight and the only real side effect from the Eligard for me has been slight fatigue and some musculoskeletal aches.

Wishing you the best!

[Scout4answers in reply to dans_journey]

but I have managed to dodge hot flashes so far. I've been able to maintain my weight and the only real side effect from the Eligard for me has been slight fatigue and some musculoskeletal aches.

Do you Exercise?

[dans_journey in reply to Scout4answers]

Hey, Scout... No. I need to begin doing something. The fatigue from the radiation kicked my butt, but I'm turning the corner now that it's behind me and need to get active again, even if it's just walking to start out with.

[1waserefornow]

hope all goes well and the results are positive.

[dans_journey in reply to 1waserefornow]

Thanks! I'll have the blood draw for the PSA tomorrow and will post the results here later in the week.

[Laun]

after my external beam radiatin almost 25 years ago I had PSA running between 2-4. For years. Since you still have a pristate you can have a reading

[dans_journey in reply to Laun]

Hi Laun. Thanks for sharing. You may have missed in my original post that I had a radical prostatectomy in January 2011 to remove my prostate. Unfortunately, the surgery failed and the cancer returned, and that's why I'm doing SRT with ADT now.

[Ab75]

I finished srt jun 1st of last year, had one 3 month shot of eligard. PSA has been less than .02 ever since. I hope you have the same results.

[dans_journey in reply to Ab75]

Thanks for sharing your story! Let's hope my PSA follows suit.

[Lewis22]

Hi Dan! My PSA rose from 0.03 after surgery in 2020 to 0.5 ten months later. Started on 150mg of bicalutimide in August 2021, PSA reduced to 0.1 after a month. Completed 33 sessions of RT to fossa and lymph nodes in January 2022 and the last two PSA tests read <0.01. In July 2022, my oncologist suggested stopping bicalutimide which I agreed to. However, like you, I am concerned about “RT failure”, if my PSA is NOT <0.01 although I am aware that RT may take up to two years to kill off cancer cells. I share your apprehension and subsequent anxiety.

[dans_journey in reply to Lewis22]

Thanks for sharing your story. We just have to keep riding the roller coaster, I guess. All the best to you.

[dublin1717]

hi Dan

My husband finished his full pelvic lymph node SRT in august. Treatment started in June following a failed prostatectomy 2 yrs previous. He received a single 6 month Lupron injection in June and is on daily cosadex. His psa in June was 0.15 when they started the SRT and his first bloods 3 months in have come back at <0.03, another 3 months of meds and then hopefully we have kicked it down the road for many years. Let’s see what happens best wishes to you and be sure to let us know how your doing.

[dans_journey in reply to dublin1717]

Hi. Thanks for sharing your story. I'm glad to see things are working for your husband and wish for continued success!

[dans_journey]

Hi Everyone.

I received my PSA results this morning: 0.05 ng/ml. I used the same lab I always do, and their threshold for "undetectable" is <0.03 ng/ml.

I'm thankful for the huge decrease. It gets me back to where I was seven years ago when my PSA first became detectable. It's been 4.5 months since the Eligard injection (6 month dose) and only 2.5 weeks since the salvage radiation therapy ended.

Would I have liked it to have been undetectable? Of course, but this is definitely a move in the right direction, and we've established a starting point against which other PSA results can be measured.

Thanks again to everyone for your insights and kind words.

Chart reflecting my PSA values between February 2013 and September 2022

[dublin1717 in reply to dans_journey]

The fact that the radiation will continue to work for a while after this means that you’ll likely get a further reduction in PSA . Fingers crossed for you and congrats that’s a huge step in the right direction.