My husband has been on Eligard and Xtandi since 2021. He’d been undetectable until this past November when his psa rose to 0.004, detectable. But then he became undetectable once more until yesterday’s psa test when it became detectable again. His oncologist switched his Xtandi to another similar med because she noticed hand tremors. Can psa fluctuate while on meds or does it necessarily mean castrate resistance?
Can psa fluctuate while on adt? - Advanced Prostate...
Can psa fluctuate while on adt?
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artmus
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Please check the decimal position from your husband's November PSA test. If 0.004 is correct, this should not worry you. What was the result of yesterday's PSA test? Again, be precise with the decimal position.
It would be helpful if you filled in you husband's bio.
A PSA value of 0.004 is undetectable. Some doctors consider all PSA values below 0.07 ng/ml as undetectable.
I wouldn't count it as "fluctuation". The limit of detection of modern analyzers can be as low as 0.003 which subtracting the rounding error can be anything between 0.0025 and 0.0034. Plus 20 percent accuracy max error on the latter totals 0.0041. In short, it can be within the normal aberration of the measurement. 0.005 and up, can be chategorized as fluctuation.
Update bio please............ all info is voluntary. Thank you!
Good Luck, Good Health and Good Humor.
j-o-h-n
I will , very soon. I’m very busy and tired right now. New week things will calm down .
Of course...... It was just a reminder.... take your time..... I (we) understand....
Good Luck, Good Health and Good Humor.
j-o-h-n
Make sure and give yourself grace and mercy! As a caregiver myself I totally understand the constant aching in the stomach wondering what is going on! You have to take care of yourself as well!! Those number are absolutely awesome, have prayed for those in the past. So chin up breath and remember your never alone!!
Ultrasensitive PSA tests that have lowest values below 0.1 have no purpose other than to cause anxiety and should be abandoned, IMO.
IMO too.
Respectively, strongly disagree based on my experiences. As I share, post RP, I rely on <0.010 as best indictor and IMO reject the use of the misleading term 'undetectable'. After my salvage RT, at uPSA 0.11, imaging identified five suspicious pelvic lymph nodes; six were confirmed cancerous by ePLND including common iliac and para-aortic nodes. The cancer had to be there growing and spreading below 0.1. My RP nadir was 0.050 and cancer indeed had spread outside of the prostate gland.
Most regular PSA test to <0.01....quest PSA lower limit is <0.04. There is no need to have an ultra sensitive PSA test that tests lower. There are other sources of PSA than prostate tissue.
Are you saying there is no need to test to limits lower than <0.04?
In my many years of probably too many tests, I have to request ultrasensitive test for capability to report to <0.010 (or lower) and to thousands. I am not familiar with a "regular PSA".
Essentially yes, except the first PSA test after a RP a uPSA is warranted.
How differently we see this. I note per your bio your have had RP - again when IMO ultrasensitive is warranted and I strongly believe there is great value in tracking rise above 0.010.
My third treatment ePLND yielded a uPSA of <0.010; no ADT at that time. I then did one year only of bicalutamide for added insurance. Ten months after I stopped the bical the < dropped and during the next (also last) five years my PSA rose through 0.01X range into 0.02X range and has been holding 0.03X for past three years.
This frequent ultrasensitive testing causes me no anxieties. What would case me anxiety is waiting for a higher value and imaging that 'easily' identified multiple mets whilst giving the cancer time to grow and spread.
Knowing that sometimes prostate cancer changes and reduces or stops producing PSA completely, (giving the beast even more time), serum PSA testing is in this circumstance less useful as a good marker of cancer growth. This is why I also do serial liquid biopsies and imaging.
As I have noted elsewhere, my recent Pylarify PSMA, done at 0.033 identified a 2 cm liver lesion. Further investigation will help us determine if it is just a cyst, a 'false positive' or cancer. The concurrent GUARDANT360 liquid blood biopsy identified a TP53 mutation.
I don't worry about my PSA. That's the deal I have with my MO....I let him worry about the PSA. I am focused on my next hut to hut hiking trip.I just got back from 5 days in the Pyrenees and looking to do something in Croatia next year.
Of course I keep up with what my next treatment could be, that's why I visit this site but I don't let my cancer consume my life.
Sorry, miss typed. It’s 0.04 , not 0.004
Learning questions - How do you respond if PSA number was regular one ? Can psa fluctuate while on adt ?
In what setting?
I do understand here PSA number is in lower side. for example there is patients. He is taking Xtandi when he started his PSA was 10 than went to 6 and climbing to 10 . In this case of fluctuate number. does patients should wait for 3 months to see or consider that Xtandi is not working
It can take a couple of months for an ARSi to fully kick in. In the OP's case, the PSA is 0.04, not 10, so Xtandi is working.
Thank you It means we need to watch couple of PSA trends rather weekly or daily.
No- that won't show trends, only fluctuations. For recurrent men, waiting until PSA goes over 0.2 and confirming a month later has no risk. For men that have had salvage therapy, there is nothing worth doing until PSA reaches 1.0 or PSADT< 9 months. For men that are non-metastatic and PSA is increasing over 1 while on ADT, there are ARSIs that may be beneficial. For men with mCRPC, rPFS may be a better indicator that it's time to change therapies. That's why I asked the setting you were interested in.
That's blog post idea. I can help to manage if you want to post
I don't understand- what is a blog post idea? These things are well known.
By the way I have been on zytiga and press for to months but psa on my went die. From 55 to 38, so is this a sign already that I have missed the chance at it working do must live in to xtandi??
Exactly, that's what the group did that I go to. They can test into 3 digits but only report as >0.1 - when I asked why they said that if they were seeing numbers increasing below 0.1, they wouldn't do anything anyway so why report it and cause stress. They would wait till it got above 0.1 so they could do a PSMA test to find out what we are up against and treat it accordingly.
I agree total nonsense to worry at that level!!!
This is very interesting to me Tall_Allen. My MO and RO only use regular PSA tests and consider me to be undetectable as long as the test returns <0.1. I see almost everyone here talking about results from ultra sensitive PSA tests, but my docs told me that they feel it's not valuable and will just cause anxiety. Are you saying that you agree with this strategy, or is there a place for the ultrasensitive PSA test under some other set of circumstances?
I agree completely with your docs.
I understand the delusion that those who advocate uPSA tests suffer from, since I used to believe that myself 5 years ago before 3 clinical trials proved me wrong,
prostatecancer.news/2019/09...
I used to believe it was a good idea to get uPSA tests and treat as early as possible. There is nothing wrong with having a hypothesis that later proves to be incorrect. But after it is definitively proven, one has to acknowledge its truth. That's how science works.
Thanks very much for the reply. This is very interesting.
I’m sorry guys. I don’t know how to edit the post. It should have been 0.04.
Select More ->edit. You can edit any post you create.
When I was undetectable I always used an ultra sensitive test, Snuffy Myers was a proponent of them. I liked the way they were an early warning for changes that might be occurring so I can plan a course of action. That said if your husband has been undetectable and now is not it could be the beginning of resistance. You’ll need consecutive PSA tests to show this. If it has dropped back to undetectable I wouldn’t be concerned, I seem to recall mine doing that once or twice back then. If it begins to rise again however, once it reaches 0.2 you could consider a PSMA scan. In my case it showed a tumor on a rib that I had treated with SBRT, I’ve had this happen twice. Both times PSA fell back to nearly undetectable. Resistance isn’t necessarily an all or nothing thing, it could be an individual tumor causing it that has figured out a work around to ADT.
Ed
I can only relate my experience based on my clinical history.
When my new urologist switched me to USPSA in February 2019, it came in at .326, yikes! I asked for a subsequent test two weeks later and it was .24, two months after that, .06, then, .12, .06...it continued to fluctuate until 2021 when it began it continuous increase to .7.
That met our decision criteria, three or more consecutive increases, PSA between .5-1.0, so we imaged, located one PLN as active, did SBRT to the single PLN plus 12 months Orgovyx for micro-metastatic PCa .
We came off treatment in Apri, labs in July were good., next ones in October. We have the same decision criteria this time.
It may be useful to discuss with your medical team and decide on decision criteria on when to go back on treatment, the what and how long may depend on the when since treatment possibilities evolve rapidly.
Having decision criteria about what constitutes clinical data to go back on treatment may alleviate reaction to a single test. That brought me 4-1/2 years off treatment with likely no risk to the PCa spreading out of control.
As TA has said though, PSA is not always a viable measure of our PCa.
Again, my experience....
Kevin
Clinical history
The concept of undectable is misleading and has not caught up with the science. If you see the results then they are detectable.
My understanding (which could be incorrect) is that "undetectable" just means too low to be detected by the particular method used. In other words, my last ultrasensitive PSA from Labcorp of "<0.006" simply means that the lowest that particular test could measure is 0.006, and my result was too low to be detected. Could be zero, could be 0.005, but we'll never know. I'm okay with that!
Doesn't it seem like a misnomer when you're looking at a number and that number is considered undectable? Medicine has to catch up.
MSKCC in NYC doesn’t measure beyond (below) .05. All they say is “<.05”, apparently because they believe anything below that is insignificant.
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