Apalutamude offered by MO at .05 psa

[Chasu]

My head is spinning here. I had EBRT 4 years ago along with ADT luprolide ( 6months) I have been undetectable until suoer sensitive tests indicate psa of .1, then , .03 - .06 it actually came down some. My testosterone ranges from 20 ish. I am very hypogonadic. But, I did try Androgel which caused ( imho) the surge in psa. Now he has offered apalutamide. With my T so low, di I need that stuff? My uro says they shoot for 20 T with ADT.

[Tall_Allen]

Weren't you cured?

[Chasu in reply to Tall_Allen]

Thankyou. Evidently not according to my MO.

[Tall_Allen in reply to Chasu]

What is his evidence that you were not cured? PET scan?

[Chasu in reply to Tall_Allen]

Any opi ion on apalutamide?

[Tall_Allen in reply to Chasu]

I think taking it if you are already cured is a terrible idea.

[Chasu]

Ive never had a pet scan. Insurance won't pay until .2 psa

[Chasu in reply to Chasu]

Any detected psa seems to be interpreted by my docters as not cured. So no one has ever made that pronouncement to me. I thank you for your replies. I feel a bit " unenlightened " at 78 years. QOL is poor with low T.

[Mike58]

That doesn't seem right. I wrote a post about when to start worrying about a higher than normal PSA reading after radiation and HDR Brachy plus ADT for 14 months.

Here is my question and the answers healthunlocked.com/prostate...

If you still have even a slightly operational prostate as you do, then you are going to get a PSA reading after you come off ADT.

Seems to me that the panic button has been sounded way to early if you only have a 0.05 reading.

[Aardvark4]

Do NOT be rushed into unnecessary treatment with readings that may well normal. You could even investigate the possibility of T supplentation after 4 years off ADT. Get a socond opinion

[Chasu in reply to Aardvark4]

Thanks! I have done androgel which bumped my psa to .1 then quit taking it and it receded to .03. Did it as an experiment for 3 days and psa went back up to .06. It's now .05 after quitting again for a month. At this point. I will decline apalutamide for now and ask for 3 months testing and consultation

[Hawk56]

Hmm, may be time to throw the BS penalty flag on your MO.

PSA results that you indicate may not be a "call to arms...!" For my medical team and I we have decision criteria about when to decide whether or not to go back on treatment:

Three or more PSA tests spaced three months apart which show a continuous increase.

PSA between .5-1.0 where a PSMA PET scan has a reasonable chance of locating where the recurrence is.

Then, informed by current clinical data, results from imaging and my past clinical history (see the attached chart) we decide on whether to treat, when, with what and for how long.

I'm 68, diagnosed almost 11 years ago, clinical history says high risk - GS8. GG4, 18 months to BCR and rapid PSADTs and PSAVs. Given my PCa, we do treat "early."

I've done ADT twice, both times my T has recovered. As my chart shows, my PSA results have varied while off treatment but having mutually agreed to decision criteria let's us avoid overreaction.

You're 78. I would be happy to get there, shooting for 83....

I would consider "challenging" your MO to explain his reasoning., what he sees as the risk in continuing off treatment and actively monitoring through labs and consults to a PSA where imaging may be a choice and inform a treatment decision.

At my last consult with my MO he looked at my PSA results of .03 and said he had no issues and did I want to do labs and consult in four vice three months. I said three, we wished each others a happy holiday season and said see you next year..

For me, the clinical data you present does not support the MOs recommendation. Perhaps a 2nd opinion? If your MOs feelings are hurt by that, well, move on, this is not about egos, it's about your life, the longevity and quality.

There are those on this forum who do jump on minute changes, they are not wrong. I am not wrong either in allowing my PSA to increase to .5-1. Which way you want to go is a decision you'll have to make in concert with your medical team.

Kevin

Clinical history.

[j-o-h-n]

Where are you located and where are you being treated? Maybe a good idea to have a consultation with a new Crew. Post here after consultation.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Mgtd in reply to j-o-h-n]

I agree. Suggest Motley Crew rather new Crew. You may like their beat better! They can be found wherever records are sold.

[j-o-h-n in reply to Mgtd]

LOL 👍...... To Chasu, beware of a New Crew that may Screw you. Adiu.

Good Luck, Good Health and Good Humor.

j-o-h-n

[SillyUserName2]

You might be better off taking Eligard. If you take an antiandrogen while making T, you might become estrogen dominant. This happened to me while on bicalutamide. I grew a set of disgusting breasts fairly quickly. Herbs/supplements such as glutathione and iodine, quercetin, etc, will help you keep your muscle mass and energy up. I am on Eligard and abiraterone and have more muscle strength, stamina and energy than when I had T.