PSA drop after ADT

[John347]

My PSA went from 14.9 ug/l in May to 5.9 ug/l in June to 0.24 ug/l when tested 2 days ago after Lupron injection 3 months ago. Naturally I'm very relieved over the drop.My oncologist has pretty much left the decision to me on the ADT duration. I had earlier voiced my reservation about ADT on account of the SE. I know that the ideal ADT duration mentioned in this forum is to have at least 18 months to 2 years. But isn't that for high risk multi-met patients?

I had one spot of suspected met in my ribs following PSMA pet scan and had 5 rounds SBRT for it. I was originally dx with PCa in April last year with Gleason 3+4.

With my history, am I considered to have high risk, advance PCa? Would a 6-month, 9-month or 1 year ADT be sufficient followed by PSA monitoring?

Thank you all for your advice.

[Magnus1964]

If a drug is working, why stop.

[John347 in reply to Magnus1964]

Thank you Magnus for your reply. I will be continuing with the ADT but the question is for how long.

[Magnus1964 in reply to John347]

Until it fails. When you get there significant rises in your PSA.

[Peeffervescence]

I’m high-risk, stage 4. I’ve had 4 noted mets in lymph nodes. I’m currently at undetectable with my PSA. Whenever I raise the question of stopping ADT with my MO they infer that I’ll be on ADT for the rest of my life, or until they stop working. I’ve been on Lupron and Nubeqa for just under a year. My SEs are relatively minor.

[Derf4223 in reply to Peeffervescence]

Peeff, you and I are in pretty much the same boat as regards high risk mPCa, light tumor load, oligometastatic. My initial PSA 25 put me in advanced high risk category. A PSMA-PET/CT scan showed 2 spine spots, not biopsy-confirmed and small. No lymph node involvement. Genetic testing showed no bad genes / mutations.

1 year since radiation therapy to prostate alone, firmagon before and lupron+abiraterone since, PSA has been and continues to be undetectable.

I also exercise daily -- 1 Hr resistance work, 1/2 Hr aerobics, 1 Hr walking vigorously. And take a slew of supplements and vitamins to offset my mostly vegan diet, sarcopenia and osteopenia. I'm also on Prolia. I take taurine, creatine, and HMB for muscle/strength growth needed to release myokines during exercise.

I take venlafaxine for hot flashes. Get a DEX scan ASAP for bone density. The best time to start an exercise regime is right after starting Abiraterone + Lupron. The second best time is now.

[John347 in reply to Derf4223]

Thank you Derf4223 for your reply. Reading your reply give me the impression that you are someone who takes great personal responsibility for your own health. That's something I can learn from especially regarding exercises and taking of supplements.

[Tall_Allen]

I don't know what advice you've taken from the forum - people say all sorts of things. It depends on whether your rib met is a true met or a false positive. Is there a CT correlate? What was the SUVmax?

[John347 in reply to Tall_Allen]

Thank you TA for your reply. No further tests were done to determine if that spot was a false positive. When I raised the possibility with my oncologist, he assured me the PSMA Pet scan is very sensitive and arranged SBRT for the met. The SUVmax was 6.2. He never explained to me what this figure means. Is it a measure of the likelihood that the spot is a true met?

Are you saying that a short ADT duration might be justified in my case? I don't want to be on ADT longer than is necessary for QOL reasons.

Thanks. John

[Tall_Allen in reply to John347]

6.2 is probably real - especially if there was a CT correlate. It means that your cancer is systemic and lifelong ADT will be necessary to keep it in check.