What to do next?: At the end of a... - Advanced Prostate...

Advanced Prostate Cancer

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What to do next?

dac500 profile image
26 Replies

At the end of a Lupron break in June my PSA was 1.1 and CT scan showed a new lymph node. I was put on six months of Lupron starting with a month of Casodex. The Casodex brought my PSA down to 0.452. After three months the Lupron brought my PSA down to 0.286. Three months later today, my PSA has slightly increased to 0.321. My T has been <20 during the last 6 months while on Lupron.

I think my MO would recommend do nothing and watch for the next months how PSA does and what another CT scan shows. I am of opinion that I should get another Lupron shot and watch what PSA does during the next 3 months.

What do you think?

26 Replies
Ahk1 profile image
Ahk1

I am approaching your situation. The problem is no one knows. Reading tons and tons of other patients experiences and all of them with no steady or straight answer. Everyone is different, guidelines does not clearly explain. I don’t know what to do. It’s really frustrating. I am back again in the grey zone. I am very disappointed

Tall_Allen profile image
Tall_Allen

There are no standard protocols for iADT. I think it's a good idea to discuss with your oncologist which benchmark you would feel comfortable with using. There is no point in doing iADT if you aren't getting QOL improvement and normal T levels from your vacations.

tango65 profile image
tango65

It seems to me that your PSA is stable since 0.286 and 0.321 are basically the same value (0.3).

Since you have mPC I would discuss to continue with the treatment and see what happens with the PSA.

ARIES29 profile image
ARIES29

I am in that boat also, now on zoladex with PSA of 1. However Every time I take a vacation the PSA slowly rises so it is still there waiting.

I think the MO would rather I stay on ADT forever or until castrate resistant anyway.

You would have to stop the treatment & monitor the PSA levels to find out like I did.

dac500 profile image
dac500 in reply to ARIES29

During ADT vacation, PSA is expected to rise. In my case, the PSA did not decrease during the last three months while I was actively on Lupron, it increased slightly from 0.286 to 0.321. I had the last 3 month Lupron shot on October 17, 2022. My testosterone has been <20 since July 2022. It is expected to stay close to 20 for the next three months, even if I don't get another shot on Monday.

Ahk1 profile image
Ahk1 in reply to dac500

if next psa has risen while your T is less than 20, then this considered castrate resistant. Either you are on ADT or not. But probably this will only happen if you are on adt to bring your T<20. I might be wrong but this is the definition of castration resistant.

Lawrencee profile image
Lawrencee in reply to Ahk1

I thought it was less than 50T

Ahk1 profile image
Ahk1 in reply to Lawrencee

yes, you are right. But < 20 is more favorable

Mcrpca profile image
Mcrpca

My husband was diagnosed October 2001, RP in 12/2001 but was lymph node positive. He had 9 months of Lupron & Casodex after which his PSA maintained undetectable until 2018. Seventeen years of active surveillance and have never regretted a minute of it. Good luck to you.

efsculpt profile image
efsculpt

Next time, what about Lupron/Zytiga/Prednizone and bring your Testosterone down to 3?

Yingsang profile image
Yingsang

What was your PSA at the beginning of the Vacation[Break], and why were you not monitoring monthly?

dac500 profile image
dac500 in reply to Yingsang

At the beginning of the last vacation, my PSA was 0.104 on 9/3/21. During the vacation it rose 0.188 on 12/2/21, 0.338 on 1/14/22, 0.514 on 3/2/22, and 1.1 on 6/1/22. My MO thinks checking every 3 months is OK.

On 6/1/22, CT scan found a new enlarged lymph node and two previous nodes increasing in size. So, I was put on six months of Lupron starting with one month of Casodex 50 mg. The Casodex brought my PSA down to 0.42. During the first three months of Lupron, PSA went down to 0.286. At the end of the second three months of Lupron PSA was found to increase slightly to 0.321 and a CT scan found all three enlarged lymph nodes to decrease slightly. The dilemma is PSA did not decrease but the lymph nodes size decreased. Let us what the MO suggests on Monday. I think I am most likely to abide by the MO's decision.

Yingsang profile image
Yingsang in reply to dac500

IMO your PSA was too high to have started a Vacation. And I am against PSA's that are taken every 3 months when taking vacations. I would insist of 30 day PSA's so you can take action, when PSA's rise. Again IMO, you should have gone back on the Casodex/Lupron, as soon as you had a 0.05 increase in PSA after starting your vacation. Which means your vacation would have been very short.

Ahk1 profile image
Ahk1 in reply to Yingsang

you mean, the psa is .05 or the increase in psa is up by .05?

Yingsang profile image
Yingsang in reply to Ahk1

I really mean if you have lets say a PSA of 0.02 starting your vacation. That if you have 3 consecutive monthly PSA's increases of 0.01--so that in 90 days you are now at 0.05, this would indicate a BCR is happening, or will happen in the future . Sorry I was not very clear when responding to dac500. Thus reaching 0.05 would be a time to take action, or you could wait to 0.07, but this is where you may be playing with fire. As it could take another month to get back on ADT.

I learned this from my Husband who read an article on this subject, from a big European Study.

Ahk1 profile image
Ahk1 in reply to Yingsang

thank you very much for explaining. So, to clarify, you would suggest resuming ADT when psa reaches .07?

dac500 profile image
dac500 in reply to Ahk1

PSA of 0.07 is undetectable. Why would you resume ADT when PSA is undetectable?

Ahk1 profile image
Ahk1 in reply to dac500

because I have been on vacation since 10/2021 and now my T has recovered to normal level. Psa has been .02 until 9/2022 and had reached .07 today. So, I think it’s a BCR. It’s very clear it’s on the rise. that is the reason I am thinking of going back on ADT. I might be totally wrong but I am very confused as to what to do next. Thanks

gsun profile image
gsun in reply to dac500

PSA of <.008 is undetectable. You are one zero out.

Yingsang profile image
Yingsang in reply to Ahk1

Yea I am aware that 0.07 is still undetectable, and 0.11 is not. Why risk getting over the line. When a man has 3 rises of 0.01 while undetectable in 3 months or has a doubling in 3 months in the undetectable range, a BCR is around the corner. I learned that expression growing up in NYC. Now as a Medical Practitioner, I know the SOC that most MO's use, is to have you let the PSA run up so it can be seen on a scan. Depending on what scan/sensitivity and the MO's thinking they will scan when it is 0.5 to 2.0. The idea is to see the cancer so it can be radiated. What is not seen is what scares me and others. I am not willing to have my Husband's PSA get that high if I have tools[drugs] to keep it the PSA from getting above 0.10. And when down again under 0.03 for a few months, start another vacation.

Ahk1 profile image
Ahk1 in reply to Yingsang

I mean while on vacation, when psa goes from .02 to .07, then start ADT again?

dac500 profile image
dac500 in reply to Ahk1

You are talking about BCR and I am talking about metastatic cancer. We are not on the same page.

Ahk1 profile image
Ahk1 in reply to dac500

I am too have Mets to LN in the pelvic and abdomen,found by a psma scan on 9/2020. That was the reason why I started the ADT on 10/2020 for one year.

Yingsang profile image
Yingsang in reply to Ahk1

Yes that is what I suggest. That is what I do for my husband Jeff.

dac500 profile image
dac500 in reply to Yingsang

PSA of 0.104 is practically undetectable. That was the right time to start a vacation. Many people would say you should restart Lupron when PSA reaches 2.0 or PSA velocity is high.

Yingsang profile image
Yingsang

I use a different formula! But it requires a starting PSA below 0.10.

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