I was diagnosed with Pca in 2012 (age 52) with PSA 5.4. RP in July 2012 with G9, pT3b. After prostate bed radiation (Sep-Oct 2012), my PSA decreased to undetectable (<0.008) until 2018. From 2018 to July 2020, PSA was below 0.1. In the past 2 years, my PSA gradually increased to 0.4 in July 2022.
I did a PSMA scan in July 2022, one left lymph node with SUV 3.2 was found and I did a 35 sessions radiation (from early Aug to end Sep) on my left pelvic lymph nodes with 70Gy. My 1st PSA test (early Dec 2022) went down to 0.17. I have not started ADT together with pelvic radiation as my Urologist felt that ADT won’t have much benefits to me at this moment as my Gleason score is 9. He seems that he wants to monitor my PSA instead. However, my MO suggested me to start ADT after radiation. I am yet to make a decision due to different views from them.
Should I start ADT or keep closely monitoring my PSA like before? Grateful if you could give me some advice. Many thanks!
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Wloi
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It appears you have 2 different doctors with differing opinions. My suggestion would be to choose the doctor you trust the most. Then proceed with that doctor’s treatment path. TBH, your PSA is REALLY low. Anything 4. I would ask the urologist for empirical evidence proving that ADT does not help with a Gleason score of 9. You have to do your own homework. Best of luck.
Just for your info my diagnosis was similar to yours but was n1. I had ADT prior to radiation and in one month it went from 10.28 to 0.75. PSA continued a slow decline post HDR Brachytherapy and EBRT Currently 0.08. My profile gives details on my journey. As they say your mileage may vary.
Perhaps the PSMA report only shows my left pelvic metastasized so only side being radiated. And my left seminal vertical was found with cancer cells in 2012 so MO believed left pelvic was affected.
Lymphatics are networked and cancer cells don't care if they are on the left or right side. A tumor has to be at least 4 mm to show up on the best PET scan. Your MO has very strange beliefs, and no evidence to support his beliefs.
My history is similar in the fact that I had radiation in 2012 & it reduced the PSA from 9 to 1.6 but 2 years later started to climb again & have been on ADT on & off ever since.
As people here can contest ADT will give you many years.
Why NOT go on ADT? From my experience so far, the side-effects are manageable and offer big upside. Btw, just read that mortality rates for PCa patients on ADT are much improved (35%) by taking statins. I was on fence about statins but that information decided me and I just began.
my journey was similar to yours. I had two oncologists who disagreed on treatment, one a young world renowned PO, the other my MO for 30 years that has kept me alive from metastatic rectal cancer. When my PSA doubled from 3.5 to 7.1 in 3 months, I started Lupron. Next visit, My PO told me he quit following me, I was shocked!
My MO told me he has some successful cases that patients cured the disease with radiation and ADT but urologist has patients continue to fight against the cancers after radiation and ADT. Perhaps, that is why they have different views. I feel that Urologist like to monitor PSA figure and take action when PSA rises while MO wants to kill the cancer cells whatever he can.
read the PEACE1 study. We happen to go to a doc who believes in hitting it hard. Yours do not seem to. While the ADT could slow it down and worth the try it will just put things off. I may have missed it, but you need a pet scan to see what you are dealing with. Our doc started with chemo, then onward with excellent resukts
I have had a similar experience as you....good news is after all this time it seems to have not migrated out of pelvic region. PSA is good and once PC has left prostate (i.e. to lump nodes) gleason score is meaningless relative to aggressiveness. After having a Pelvic Lymp Node dissection my PSA was rising rapidly...because of prior radiation and past surgeries, the only treatment option was hormone therapy. My MO put me on Orgovyx--one pill a day. PSA went from 12.4 to 0.39 in 28 days after starting and I have been undetectable for the past 10 months. Orgovyx has a Patient Support Program that greatly reduces cost to you.
I had same situation, exactly. Low but rising PSA in 2019. PSMA scan showed 2 pelvic LNs on left side only. RO and another RO consultant, both in USA, said RT to left pelvis only despite my questions and doubts. Mistake! Two years later in 2021 repeat PSMA showed new avid node on right side and one above pelvis. So now I’m metastatic.
Do at least 6 months of ADT now as evidence shows it provides better chances than salvage radiation without it. Then you can decide whether to continue for the full 24 months. Would ditch that urologist who is not up to standards.
My MO only looks at the PSMA report to design the radiation treatement so only left pelvis was radiated. My urologist seems pessimistic to the long term result of this radiation as he mentioned that my Gleason is very high which is hard to cure. I plan to do the ADT after New Year. Thanks.
My diagnosis is similar. DX 2017 PSA 51 (age 69). Had RP 2018. FINAL PATH (Stage IV pT3, pN1) T3b, GS 9, 70G, Pc 40%. 3 Lymph Nodes & tried to get into bladder.
Started Lupron for 2.5 yrs. Maintained <0.1 PSA.
2018 IMRT/IGRT 25@45Gys), 37@66Gys). Went high to get more Lymph Nodes.
After 2.5 yrs. went off Lupron, PSA <0.1 ((MISTAKE))?
After 1.5 yrs. (2021) PSA rose to 0.4, T 330. Axumin Scan showed lesion, only on T-ll. Considered Oligometastatic. Had it CyberKniffed.
3 mons. later PSA shot to 7.3, mets through out skeleton, large ones on T-4, T-8.
Went back on Lupron & added Apalutamide, Xgeva.
After 1 mon. PSA 0.7, T 42.
2nd mon. PSA 0.3, T43.
3rd mon. PSA 0.2, T 39.
4th mon. (8/20/22) PSA 0.2, T 12.
9/16/22, PSA 0.1, T 19.
10/19 PSA 0.1, T 42. Received 2nd 6 Mon. Lupron Injection, Mon. Xgeva
Will continue monitoring PSA, T, every 3 mon. Lupron every 6 mon., Erleada daily & Xgeva every 3 mon.; annual scan. SE's mainly "warm flashes", some muscle loss.
Wloi, I had GS 4+3 and recurrent PSA a weeks post RT of 0.13...I went on ADT for 6 months, then had sRT (salvage), then was placed on 24 months of ADT as I was high risk...I had a Decipher genomic test of my tumor that was off the charts (0.97 out of 1.0) and had pattern 5 noted at the margins...so I was high risk and my URO recommended ADT. I have now 15 months into that 24 month period...ADT has some serious side effects but it kills androgen sensitive cells...it can lead to castrate resistance and there is great debate about this...it does appear that if you stay on long enough this could happen. But from what I read if you are high risk then ADT is beneficial. But prepare for it and know its side effects. Here some articles that I used. TNX Rick
Thanks for sharing which is very useful to me. Your diagnosis is similar to me. Ten years ago, I was told my Pca was stage 1 as there was no finding from PET scan/CT scan and MRI. However, after surgery my doc told me that the margins had a few cancer cells and Gleason score was 9. As a result, I was Pca Stage 3. I had radiation on my prostate bed right after surgery but I didn't have ADT.
Now, the reason I am considering ADT in January is to see if it can cure my disease. I also watch some videos about the side effects and I am quite worry about that as I used to do a lot of exercises. I don't know if 24 months are long to lead to castrate resistance as it seems that standard protocol is 24 months for high risk person.
I agree on the doc you trust. That said I dropped my Uro and deal only with my MO. Just started my 8th yr of G9 incurable. All good with Lupron/Nubeqa.
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My first post. Rising PSA After Surgery. 
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When should I start ADT treatment?
