Does PSA settle after treatment?

[Doseydoe]

Before I was diagnosed, so long as my PSA was within the acceptable range, (59 yrs - less than 3.5) I was considered healthy. But now the goal is to maintain a really low PSA ( undetectable or less than 1) How will I ever know if it will naturally stabilise if I keep on ADT? Thoughts? DD 😎.

[GP24]

With a Gleason 9 it will never stabilise without ADT I am afraid. You could try intermittent ADT and restart at a PSA value of 5.0 or 10.0

[Tall_Allen]

As long as it stays undetectable on ADT, no further intervention is needed. When it increases in spite of ADT (and it will someday), you will consider a new therapy in addition. You will always stay on ADT.

[Doseydoe in reply to Tall_Allen]

So the idea is to use PSA as the guage of PCa progression. Do you agree with GP24 and possibly let PSA run until it hits 5.0 or 10.0?

[ARIES29 in reply to Doseydoe]

Reading here I think you will find 2 & above to be the PSA level when ADT should start.

[GP24 in reply to Doseydoe]

I was refering to this study: nejm.org/doi/10.1056/NEJMoa...

"During the nontreatment interval, the PSA level was monitored every 2 months until it reached 10 ng per milliliter"

[Tall_Allen in reply to GP24]

That's for iADT - not what the OP was asking about.

[anony2020 in reply to GP24]

So why if RT was never applied? ie only ADT + 2gen or ADT + 2 GEN plus chemo only? Just wondering.

[Tall_Allen in reply to Doseydoe]

Usually 2.0 or rapid PSADT.

[turkeyjoe1 in reply to Tall_Allen]

I am a Gleason 8, no mets per PSME scan. started at 60 PSA went to 106. I went on lupron, it went to 1.8 at 2-month check, 4 month check its .05. No RT as of yet. Is this normal? I cant make the 30 mile trip through massive snow Country here to get RT before March.

[Tall_Allen in reply to turkeyjoe1]

You should discuss adding abiraterone now and whole pelvic RT in the Spring.

[turkeyjoe1 in reply to Tall_Allen]

Thank you!

[turkeyjoe1 in reply to turkeyjoe1]

medscape.com/viewarticle/90...

[Tall_Allen in reply to turkeyjoe1]

Reduced dose with food is only a good idea to save money. The biologically effective dose (which is what may cause side effects) is the same, although not as reliably. Now that it is available as a low cost generic, there is no justification for it.

[Doseydoe in reply to Tall_Allen]

Ok, 2.0 PSA or rapid doubling time of last PSA result, thanks.

[austinsurvivor in reply to Doseydoe]

My MO lets me take ADT vacations periodically, but we agree on me going back on ADT when PSA get to 2.0 or above. Currently on ADT, hoping 2 more months of undetectable will get me a vaca. He says 3-4 months of undetectable is sufficient with my lymph node only mets (and small volume)

[Doseydoe in reply to austinsurvivor]

Sounds like you're responding well. I've had five Lupron shots (Eligard) and now 18 months since my last 3 month shot. My PSA remained at 0.01 or so for that time but then my PSA went from 0.02 to 0.14. I started taking 50mg of Bicalutamide (Casodex) a day for 5-6 days with one day off to give my liver a break. My last two PSA blood tests returned 0.19 and 0.24 respectfully. So over the last 6 months on Casodex, my PSA has increased by 0.10, am pretty happy with the outcome. My Testosterone continues to climb and I feel pretty good considering, so will stay the Bicalutamide course for a bit longer, cheers DD 😎

[cesces]

Pay more attention to PSA trajectory than PSA level.

Don't worry if it wanders around a little.

But perk up if you see it escalate 3 times in a row.

[Doseydoe in reply to cesces]

Will do, cheers DD 😎.

[NecessarilySo]

My test results say this:

PROSTATE SPECIFIC AG, SERUM My value:<0.1 ng/mL

Standard range: 0.0 - 4.0 ng/mL

Roche ECLIA methodology.

According to the American Urological Association, Serum PSA should

decrease and remain at undetectable levels after radical

prostatectomy. The AUA defines biochemical recurrence as an initial

PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory

PSA value 0.2 ng/mL or greater.

Values obtained with different assay methods or kits cannot be used

interchangeably. Results cannot be interpreted as absolute evidence

of the presence or absence of malignant disease.

This suggests to me that I should continue ADT until my PSA tests .2 or higher. If that happens, then I should consider other or additional treatment.

[SteveTheJ]

You don't know that. Read what others say and don't believe any one person because everyone is different. Diagnosed at age 59 with PSA 3.4 max, my PSA has been unmeasurable since I started therapy and now I'm in remission. YMMV

[tad4]

Continuous monitoring is what you must do and ask your team (Urologist, oncologist, etc). My PSA was 8.6 but the main thing is not the level but to look at the spikes on the graph over time. I was Gleason 9, had brachy and EBRT and been on ADT (Zolodex) implants every 3mths, now been 18mths, two more shots to go. My PSA has been consistent at .008 and T at less than 0.5 (so much for my non-existent sex life, lol). The question will be, do I take a ADT holiday after my last shot? That will depend on my discussions with my team. We all face the same music, we can't cure it, but we can manage it. Hopefully. Take care and stay vigilant.