Bit of a complicated question, but I'll ask since I'm scheduled to start an "ADT vacation" next month. Is an increase in PSA from <0.01 to <0.014 significant?
Sorry in advance if I'm worrying about nothing and to all those here dealing with harder fights.
So here's my deal. Today's PSA was <0.014, up slightly from <0.01 for the last year. I am grateful the result is very low, but it is up unless there is random noise in the tests. Is the small increase meaningful? I should add that a recent PSMA PET was all-clear.
As context, I'm just finishing 12 months ADT+Nubeqa and last fall I finished 6 months docetaxel and SBRT to a suspect vertebrae and rib. PSA was 0.8 with 4-month doubling at BCR when I started all the above.
Meeting my primary oncologist to confirm plans, and then I have a followup with Dr Sholtz at PCRI. Planning to ask both about the "vacation", what to do if/when PSA rises further, and what's new for consideration (BAT, Xofigo, etc) presuming the fight is still far from over.
I know time and more tests will tell, but as always I welcome any input. Thanks all.
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I know where your coming from but I knowing what I know now I would not be worried by that. A jump to .028. thank .060 and then to .12 might get me to the start thinking about it but even then there isn't much to do but wait until it shows on a scan or start back on ADT right then. If you going on a vacation at what point will you want to restart ADT. That's the question you need to answer in my opinion.
Ok, read my biography and you will have an idea. With my Gleason scale of 9,there is a likelihood that my PSA will rise from the current .008 because I have now begun a vacation from ADT. My last implant was Feb 2023, so I don't expect any change for at least 6 months. Monitor your PSA and if and when it gets to 0.35, then get a PSMA PET-CT scan. Getting the scan earlier with a lower PSA will most likely reveal nothing. My Urologist believes 0.3 to 0.35 is the threshold for the scan. The unknown is when your PSA is going to rise. With GS of 7, you might be ok for yrs. My thoughts only based on my team.
For years I was on what they call "intermittent" hormone therapy. I had 3 shots in 90 days, 30 days apart, then waited for PSA rise before continuing. My RO waited for the PSA to rise to 4 before scheduling another series. Twice, the "vacation" lasted about a year after the previous shot. I then vacationed for four years, during which my PSA rose to 35. I resumed hormone therapy and PSA returned to <0.1 for the past three years.
For me, I was undetectable for 6 years despite being diagnosed Stage 4 with a Gleason of 9. I had the opportunity to take a vacation but all my doctors said if it’s working don’t fix it, I listened to them and felt it made sense, why gamble with the reprieve I was given? I decided to keep my foot on its throat and continue ADT. That’s my experience, just sharing.
Although a vacation sounds nice, I'm afraid that the disease won't take any time off and will have a chance to spread. Unfortunately, I think that there are no breaks on our train ride, so personally, I'd stay the course and would find other ways to enjoy the ride. I'm sure you want the adventure of life to last as long as possible. Best
That sounds like good news to me. And, as the daughter of a father that is 16+ years at 87 with cancer...and on the SPLASH trial...here is what I can tell you that i have learned from my father, and from Dr. Geo Espinosa.
(I urge ALL men and caregivers in this group to check him out. He's a caring human/MD/Holistic practitioner for male health issues/and writes a VERY optimistic blog and has a podcast about dealing with PSA #'s, stress, living etc...)
"A chronic state of stress and worry will harm you, and debilitate you faster than a slight raise in a PSA" - Dr.Geo
My dad does not spend much time talking about his cancer. He DOES talk about what he looks forward to doing the next day or week, or year.
On days that he is nauseas and "can't do much" he draws, builds lego, and watches golf or nature shows".
On days that he feels good , or "OK" which is more days than not( between bouts of gagging and slight vomiting in the morning) - he focuses on his NEW JOB.
He's a retired architect that has designed major retail malls in the US...and has been HIRED to draw up the plans and meet with the new architects at his firm that he retired from over 12 years ago. JPRA (my dad is James Patrick Ryan (associates) ... has done malls that maybe you have been to??
Mall at MIllenia - Orlando, FL
Somerset Collection in Troy, Michigan - the one he is doing the plans for the renovation
The Shops at Waterside - Naples, FL
The Gardens - Jupiter, FL
If you get a chance to ever go to these beautifully designed places, you'll feel a calm and see the beauty that is associated with everything my father has designed in the US. (more in other countries)
I pray that all of you here, caretakers and patients, find something to focus on - that brings you joy...and manifest more of that in your life.
Sending you prayers of healing and many happy moments,
I have only been a part of this community for about a year, but what I have learned throughout this ordeal is to focus on trends, not absolute numbers. Numbers will fluctuate and you will have stress over those numbers, but try to stay calm and focused on the big picture (PSA doubling time, etc.) and not on one number. A positive attitude is much healthier than the worry resulting from one data point. I wish you the best!
My impression is you don't take a vacation unless the side effects are so onerous it makes daily life difficult. I think your PSA is too low to worry about.
I hope the vacation works for you. My choice has been to remain with the "hot goalie" (ice hockey reference), and ride the horse until I need another one. I like seeing T less than 0.5 and PSA less than 0.02 every 3 months, but I see a lot of people considering a holiday from meds. I hope it works.
First, you are undetectable with first and second line ADT and spot Radiation after a Prostatectomy in 2018. Undetectable is anything <0.1. Ultra-sensitive testing will not lead to any treatment choices.
Second, you have systemic disease. I do not know anything about second and third line ADT. Back in 2004, systemic treatment meant chemotherapy to tackle the unseen and undetected micro-metastasis traveling in the vascular and lymphatic system looking for a place to land and multiple. That’s why whack a mole radiation to prevent spread is doomed to fail. Granted one can continue with this method for years until the tumor burden become to invasive. However, this is a valid personal decision. I just disagree with the methodology.
Third, and again this is a personal decision, I do not believe in vacations. In my mind all it does is give the cancer a chance to continue its growth.
I am not in the medical profession; just a guy who reads and listens to the pros; one who was metastatic in April 2004 and micro-metastatic in March/April 2003 on original diagnosis of Prostate Cancer. We all make varying decisions on how to fight this bastard. Best Wishes...... GD
I've had stage 4 metastatic prostate cancer for almost 14 years and have enjoyed 5 or 6 vacations that the shortest one was 10 months and longest was 30 months. Felt so much better during those vacations. I usually go back on hormone treatment when psa gets up to 1 or at most 2. I've gone to Dr. Sholz and Dr Lam (prefer Lam) for 10 years. The studies concerning taking vacations or not only showed a couple month difference in life span. Even though testosterone may not get back to previous levels not having the side effects from hormone block is great.
Looks like the tests were done at different labs. Both PSA readings were below the testing limits of the testor, so it's really an inconclusive result as to whether there is an increase or not.
Duan, my favorite time of the day. Waking up with that wonderful wife beside me in a cozy bed.... it's such a joy and brings tears to my eyes when I realize I fell asleep in my girl friend's apartment........so now what do I tell my wife?
imo go for it, there are major advancements coming in the near future that will hopefully stop this horrible disease dead in its tracks n you can always go back on adt with any kind of significant rise in psa…😁
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ADT Vacation?
First post-ADT vacation PSA test
Update after a year on vacation
