In January I will be 6 months post radiation to the prostrate and complete pelvic area. I was on Lupron for 6 months - 1 month prior and 5 months post radiation. I also was on Casodex for one month prior to the start of Lupron to lessen the flare.
At 3 months post radiation PSA and Testosterone were not detectable. It is my understanding that the lingering effect of Lupron on reducing PSA could last up to at least double the time you were on Lupron.
I am trying to research how the PSA number at 6 months can potentially forecast the effectiveness of the treatment when combining Lupron with radiation treatment. Can you lead me to any studies that deal with this and the PSA used to forecast the effectiveness of the treatment.
Additionally my prior PSA tests at 3 months showed < .5 which I was told equated to not detectable. How do I get a specific number to do an analysis of the PSA according to those studies that were done in the past.
Thanks in advance.
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Mgtd
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I was reading a report in Cancer 2013 Jun1: 119(11): 1999-2004 titled PSA response after Short Term Hormonal Therapy plus External Beam Raidiotheraphy and Outcome in Patients Treated on RTOG 9413.
Conclusion of this hypothesis generating study suggested that PSA <=0.3 ng/dl after a short course ADT and EBRT could stop ADT earlier then the 2 to 3 years.
In addition in the article they stated that D’Amico used the Prentice criteria to demonstrate that PSA level higher then .5 ng/ml after 6 months of ADT and EBRT and PSA nadir higher then 0.5 ng/ml were surrogate endpoints for prostate cancer specific mortality.
I was wondering if this still applies. I was hoping to use these in deciding whether to continue Lupron for another 6 months.
While your T is so low, you will not have measurable PSA. It is not predictive of what your PSA will be when your cancer is no longer suppressed by low T.
PSA will not be telling you anything while you are on ADT and until testosterone recovery. More significant is: What was your PSA before the radiation and ADT? If it was above 2.0 then you should probably be on longer adjuvant ADT, 2 or even 3 years if you can tolerate it. If it was low pre-treatment (< 1.0) then perhaps the six months is sufficient. This is a fuzzy area IMO.
I understand that the Lupron needs to get out of my system before any valid measurements are possible. I agree the time on hormone treatment can be kind of a crap shoot. That is why I was looking for some guidance PSA wish to help me make a forecast rather then wait to the Nadir.
I had a pretty easy time while on Lupron but I was religious about my aerobic/walking and resistance training. Actually I still doing both. That was a positive of being diagnosed with the cancer. I feel great now that the effects of that and the radiation are behind me.
That seems a pretty good breakdown to date on a very complex subject. You are intermediate risk. Six months appears much better than none. Generally for higher-intermediate risk longer ADT such as 24 months appears better for MPFS anyway. So it comes down to tolerability of longer duration ADT and the harms to general health and well being that comes with it. Adding an ARSI such as enzalutamide or Abiraterone probably improves outcomes further as it has been shown to do with BCR and more advanced stages. But this has not been incorporated into SOC for adjuvant ADT with RT, to my knowledge. I think it comes down to personal choice and tolerance vs some perhaps small marginal benefit. I chose 6 months with my SBRT for what tha's worth. T_A parses the available evidence very well in his blog.
My testosterone never really came back. Within a year I had sarcopenia and had a spinal nerve compression requiring surgery. I decided to go on high dose testosterone replacement at that time. That dove-tailed into my ongoing BAT program which has been wonderful for me. Now I just do one month of ADT with Orgovyx and Darolutamide after every three month cycle of high-dose testosterone.
YMMV - I had a 6 month Lupron shot Oct ‘22 with radiation to prostate bed ending Jan “23. My testosterone did not recover fully until July “23. PSA was <0.01 during this time, but now appears detectable after my testosterone recovered.
What is your current T level? And what scale for PSA are we referring to (ng/ml?) - I know there are other ones in use in countries besides the USA..
I'm a bit surprised at "< .5 which I was told equated to not detectable" since mine is ~0.22 ng/ml and it's considered a detectable (but acceptable for the treatment I received) PSA level.
Don I use the American standard. Honestly I do not have a hard copy of that PSA test so my memory of <.5 maybe off but their statement that it was undetectable is valid. For some reason perhaps the level of the machines’s test accuracy is what drove the .5. I will check that out when I go back in January or stop up there next time I am in town.
Thanks. I will keep that number in mind. My GP ordered both PSA and testosterone labs for my annual in early December. I will be curious to see what they read on the test. I started at close to 700 on testosterone prior to Lupron and supposedly exercise is supposed to build testosterone but that does not take into account effects the Lupron.
I started on casodex and lupron, my PSA was 259. It came down rapidly to two. I stayed on that protocol until after about 14 months when my PSA started to rise. I went through six sessions of chemo. I then was enrolled in a clinical trial and my PSA has been<.2 for the last 20 months. I am 75and feeling lucky.
Those numbers sound much more reasonable. My PSA was undetectable the entire time I was on Lupron (with a low-non-existent T level). When I came off Lupron and my T started recovering it moved up to 0.1 or so. When I stopped finasteride (taken for pee issues) - it doubled almost immediately to around 0.21 (+/-0.02) and has remained there for over 18 months. The doubling was expected since finasteride is known to halve the PSA readings.. so the doubling wasn't a surprise or a cause for worry (it would have been a surprise if it hadn't actually..)
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