PSADT under vacation from BICALUTAMIDE < 1month, please advice

[Odon]

Hi everyone, I was in ADT bicalutamide 150 mg for 16 months, my MO wanted to have vacation. But in 1 month my PSA increased from 0.050 to 0.130. He wants to continue the vacation at least 3 months. I am very concerned . What is your advice? vieuw my profile. Thanks.

[Tall_Allen]

I think you made a mistake going after pelvic lymph nodes one at a time. You need radiation to the entire area + 3 years of Lupron + 2 years of abiraterone. You have to find a radiation oncologist who will treat you properly.

prostatecancer.news/2021/05...

[Odon in reply to Tall_Allen]

Thank you, TA.

It doesn't matter if I had SBRT in 2017? Can I have whole pelvic radiation because of it?

[Tall_Allen in reply to Odon]

Yes. According to your profile, only two lymph nodes were irradiated, out of maybe 70 in the pelvic area. He can exclude the area that was previously irradiated.

[Odon in reply to Tall_Allen]

Thank you TA

[Justfor_]

The short PSADT is normal. Bicalutamide doesn't kill all and every cancerous cells. Some of them are put in a dormant state for lack of androgen supply. When stop taking it, they will reactivate and start producing PSA. Picture it as letting loose a compressed spring. It will instantaneously get back to its uncompressed shape/size. This is what your doc is after.

[Odon in reply to Justfor_]

Thank you

[MateoBeach]

T_A is right that you need full pelvic LN fields irradiated. And short term ADT, though I am unconvinced that 2 years+ is needed when your PSA is so low. 6 months might be sufficient with the SRT.

As for the bicalutamide, it does not lower but actually raises testosterone levels while blocking the AR receptors. So your increase in PSA may be a rebound from unblocked AR and high testosterone. Suggest you recheck PSA along with testosterone levels within a month while you are pursuing the salvage pelvic RT plans. Might not be so bad. Paul

[Odon in reply to MateoBeach]

Thank you

[TJGuy]

Initially coming off ADT your PSA can increase as your PC wakes up. After a number of what appears to be rapid doubling times from waking up, the doubling usually lengthens out. This in combination with the fact your looking a very low levels to begin with.Your low number induced doubling time are not something of great concern.

You should expect doubling times to look better as your PSA increases.