ADT for almost 2 years

[Paulo1968]

Hi everyone,

It is the first time I post in this network and I still feel a bit strange and with my heart beating stronger ... sorry for this!

Well, I have gone through surgery, radiotherapy, ADT, since my diagnosis in February 2018. It will be 2 years in February next since I started ADT and PSA has always been <0.01, but a couple of day ago it came at 0.03. I wrote to my doctor and she answered right away saying that we have to wait for a next result and then we see.

In the event that it grows again, does that mean a recurrency again and that I am Castration-resistant? If so is this the end of the line?

Some more data: On January 2022 I did a PET scan when PSA was rising, after radiotherapy having failed. It was 0.7 then. In spite of having a cleaned exam, I started ADT in February 2022. Some months after I developed anemia, and the hematologist prescribed several TACs. I also did a colonoscopy and endoscopy ... So, no sign of cancer anywhere, but they said I had an auto-imune disease - Croombs disease. I read here that anemia can be one of the consequences of ADT. Is that so?

Thanks in advance,

Paulo

[GP24]

Hi Paulo,

the official definition for castrate-resistant is 2.0 ng/ml and rising. So you have plenty of time to wait for that. It will not be the end of the line then, you can get chemo or Pluvicto then.

Yes, anemia is a common side effect of ADT.

GP

[Paulo1968 in reply to GP24]

Thanks for you answer GP24.

But is this PSA=2 level also relevant for someone who had done surgery and removed his prostate gland?

[GP24 in reply to Paulo1968]

I understand your doubts but it now is. The definition is under review but currently it is 2.0 ng/ml. You have a Gleason 8, so you are high risk. Your doctor should recommend to add Abiraterone, Enzalutamid or Apalutamide to your ADT.

[MoonRocket in reply to GP24]

I believe the OP is correct. If RP is involved, then BCR is a PSA above 0.2 when not on any systemic treatment. CR would be 3 consecutive increases of PSA while T is under 50 ng/dl. I would also caveat that the PSA should also be above 0.1, but that is my humble opinion.

[MoonRocket]

.03 is still undetectable and keep mind there are other sources of PSA besides the prostate. Salivary glands being one of them. PSA is not static either. It fluctuates day to day, month to month. I would not be concerned until you see .1, then you can start looking for your next treatment options.

[Tall_Allen]

It is still too low to worry about. Let's see what the next few PSAs say. If PSA>0.2, you can add enzalutamide, apalutamide, or darolutamide.

[Velohomme]

The next treatment (when needed) in your situation would typically be a secondary hormone treatment such as abiraterone, or one of the “ides” (e.g., enzaludimide). Depending on your response you might have a lot more time on hormone treatment.

[Paulo1968 in reply to Velohomme]

Thanks, that is reassuring!

[j-o-h-n]

Relax............ you're reading between the lines...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/05/2023 10:43 PM EST

[Gatodd]

I did HDR brachy, followed by 29 sessions of radiation plus ADT and Abiraterone. The muscle mass loss and increased fatigue

[Gatodd]

Sorry, premature send.

I did HDR brachy, followed by 29 sessions of radiation plus ADT and Abiraterone. For me, the muscle mass loss and increased fatigue was rapid. However, I just started working out like a college athlete. It slows down the effects. And makes me feel better. There were days I thought I just can’t exercise. Those are the days you need to do something, even if it’s a short walk. Despite working out, I reduced the amount on lifts for the first 6-9 months. That was tough for me, the competitor.

But it’s all manageable. With exercise, I still play golf, hike with the family, play with the grandkids, paddle board and do most things that I like to do. I just do them for shorter durations and nap occasionally.

Best of luck to you.

[EdBar]

If it continues to rise then yes, it’s very likely that you have become resistant. I was in the same boat after having undetectable PSA for around 6 years it became detectable again. Once it reached 0.2 my MO, Dr.Sartor ordered a PSMA scan. It showed a spot on a rib that I had radiated. PSA fell back to almost undetectable until a couple months ago and it began rising again. So another scan, another spot and radiation scheduled for next week. I’ll keep playing whack a mole as long as I can. Beyond that there’s other treatments so it’s not the end of the line.

Are you on any second line ADT? Enzalutamide or Abiraterone? That would likely be the next step if you’re not. And yes, ADT can cause anemia, my doctor recommended a high quality iron supplement that helped quite a bit. You just have to be sure that you check your iron levels periodically to make sure your iron level doesn’t get too high which can cause problems.

Ed

[TN1932 in reply to EdBar]

What brand of iron supplement that your dr recommended? My dad's been on vacation for 9 months, but that doesn't seem to help his anemia. his hemoglobin drops in last 2,3 tests.

[EdBar in reply to TN1932]

I’ve been using this… just be sure to test iron levels every 4-6 months. And it’ll take 2-3 months to see improvement. I take it in the evening after dinner.

Iron supplement

[Paulo1968]

Hi Edbar. No I am on a primary line ADT.

[EdBar in reply to Paulo1968]

Enzi or Abi would likely be next if PSA continues to rise.