PSA & Testosterone 3 months post RT

[SimMartin]

After MRI/biopsy was recommended AS for G7 in Jan 2020 and PSA 4.1, which stayed stable until mid 2021 - I opted for HIFU for in Decembers 2021 when my PSA reached 6 then 8. However it failed as PSA return to 6 by July 2022. Another MRI and biopsy surprises urologist aa reveals G9. Had PSMA which was Clear - and initially treated with 8 weeks of Bicalutimide and then Zoladex plus RT 20 x 3Gy (no pelvic RT).

3 months post RT and 5.5 months into Zoladex PSA 0.01 and testosterone 0.6 

I am assuming this is a good result so far ? And curious as to know if the HT merely keeps the PCa hormone sensitive cells in check (until the hormone resisted cells may eventually take over) or has it a more overall destructive mechanism with the 18-24 months standard protocol for intermediate to high risk. Equally, surely a very low testosterone level must have some relevance to treatment outcomes and so curious why not routinely requested with the PSA. 

Of course I am at this stage happy to have a relatively quick response to a nadir of 0.01 - 12 weeks post RT and 5.5 months on Zoladex.

I am just trying to understand the future risks profile and process. - is it too early to offer an indication that the oncologist choice to not include pelvic radiation due to clear PSMA (due partly also because of comorbidities) was a reasonable risk call as we know the PSMA doesn’t see micro mets. 

[MateoBeach]

You are asking all of the right questions. I would be nervous about not having the pelvic node fields also irradiated. With G9 that should be the standard. Nothing to do now but follow PSA from nadir, especially when the ADT is complete and testosterone recovers. If it rises then you could still catch it with a PSMA scan. We will hope not.