What to do next?

[dac500]

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?

[StayingOptimistic]

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]

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]

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]

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 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.

[StayingOptimistic 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 in reply to StayingOptimistic]

I thought it was less than 50T

[StayingOptimistic in reply to Lawrencee]

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

[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]

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

[dac500]

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.

[StayingOptimistic]

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

[dac500]

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.

[StayingOptimistic]

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

[dac500 in reply to StayingOptimistic]

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

[StayingOptimistic 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 in reply to dac500]

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

[StayingOptimistic]

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

[dac500 in reply to StayingOptimistic]

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

[StayingOptimistic 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.