July 2024 I had a CT scan that showed a tumor is my let lung. My PSA at the time was 1.06. My Oncologist ordered PSMA pet which showed that the tumor was a metastatic prostate tumor. I did 5 sessions of SBRT to the tumor that got rid it and dropped my PSA to <.06.
My PSA on 4/6/2025 jumped to 0.1. My oncologist wants me to do a PSA test at the end of June and if it gets close to 1.0 I'll do a PSMA pet and possibly do another whack a mole like I did before.
I'm wondering if it is time to start ADT having avoided it for far.
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old64horn
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I would not start with ADT before 2.0 ng/ml. Some doctors would wait until it gets over 10.0 ng/ml. If you want to start early I would take Casodex because it does not lower testosterone.
I did whack a mole but new mets showed up in about a year after the treatment. So now I take Bicalutamide after another whack a mole treatment to stop the micromets from growing and it worked fine for three years now. Bicalutamide is sufficient if you have no visible mets, you do not need to take lupron.
A systemic disease demands systemic treatment. You are only "treating PSA" by playing whack-a-mole. Treating PSA-only is dangerous because you are giving microscopic metastases time to spread. Even if you use only ADT-lite with an anti-androgen alone for a couple of years, it is better than doing nothing.
The most superficially persuasive study mentioned in your link - TOAD - ( because it purports to test the theory that delayed ADT is worse), actually found no difference for the subset of people who were ADT naive. In other words, the results of the study showing a difference came entirely from people who had already received ADT in the past, and got it again, upon "recurrence". In that group of people it was dramatically important to not delay. But in the other group, this graph tells the story.
survival graph of people who had never received ADT.
Hiu, street-air. I'm not sure that I understand your response. Are you saying that in actuality, it's better NOT to delay ADT? The graph that you attached seems to indicate that. Please clarify. Thank you.
The title of the graph was people in a study who “did not (previously) receive adt” ever and the two lines are people who got adt immediately on recurrence vs people who got adt delayed after recurrence. In this graph, there was no survival advantage. A small number died of metastatic disease in both groups. Overall in the study, there was an advantage, when looking at people who had experienced adt before - eg with primary treatment. Then reoccured later. TA believes the weight of evidence is to start adt asap, not muck around, and he obviously has read widely on this.
You should read the OP again. He was metastatic already - TOAD had nothing to do with men in his situation. His situation is that he had metastatic-directed SBRT and his doctor was avoiding ADT because of it.
The valid conclusion from the combined analysis of TOAD and TROG 03.06 is that "It also showed there was no major detriment to global health-related quality of life by starting ADT earlier."
I was just picking up on the article on your page that presents TOAD as one of several studies proving you should never “treat psa”. It seemed like a wonderful clear study from the title, but when I looked at the actual data in it, it fell apart at least in terms of supporting why being urgent with adt provided a survival advantage for the group of people people who had avoided adt. The ones who died in both arms, early adt or delayed adt, surely all had metastatic pc, too. anyway, never mind.
ok. I did read the article, and then went down the rabbit hold of the TOAD paper. I dont have a straw man conclusion, it just struck me that what seems like a clear statement turns complicated when looking beneath the headline.
Thank you for everything you do for those of us with PC. I've taken Orgovyx, Zitega and Prednisone daily for 21 months and started 26 rounds of radiation at the same time.. My PSA is currently 0.03 down from 2.5. I've had discussions with my Med Oncologist about a possible medicine 'vacation' if my PSA reaches, and stays at 0.01 for 7 or 8 months. Given your comments about continuing treatments to do everything possible to prevent future spreading of the disease, would you ever be in favor of a med-vacation? Thank you.
My husband had the same thing happen, but after SBRT for his lung when his PSA started to creep up he went on Monotherapy instead of ADT. We chose this route due to his heart disease. Monotherapy has less side effects and is much easier to tolerate.
My husband was dx low volume also according to the CHARTEED trial. He has been on monotherapy Xtandi now Nubeqa but now 1 new node has showed up and now meeting with RO to discuss SBRT. MO is thinking it may be enough to beat it down. Husband has decided quality of life is more important than quantity. He refuses ADT. Monotherapy nubeqa has been nearly free from any side effects for him.. His MO says his cancer is aggressive but doesn't behave that way I hope it stays that way indefinitely!!! I hope the same for you as well!
My doctor understands my situation. He knows how tough it will be on me to be on ADT while also fighting bladder cancer. So far, I'm in remission fro bladder cancer and my prostate cancer despite the high gleason has been creeping slowly.
Glad to hear about the remission for the bladder cancer. Also sounds like your PCa doesn't behave aggressively either. With new treatments coming and all these advancements it can stay controlled for many more years..
"... metastatic prostate tumor... wondering if it is time to start ADT having avoided it for far."
In my opinion, you should have started ADT as soon as you were diagnosed with metastatic in 2024. And you must start it now or the spread will be worse. I regret that I delayed ADT for 3 years until I had mets, as it might have prevented or slowed them. At age 82, I have been on Orgovyx and Abiraterone for over a year now, and there is nothing to them.
which does less damage to the body on balance? My MSK RO suggests that the future holds more promise for creative uses of radiation ( not the biggest surprise from an RO)…..what do you all think?
many will disagree for this opinion so I will put it this way. I am 74 years old and all about quality of life. If I could play wackamole I would. While adt may improve your survival chances with prostate cancer, I would think at 83 years old my doctors would also be considering the effect of adt on my overall health.
Now, that being said, I think a second opinion may be a good choice.
old64horn. I fail to understand why , particularly at age 83 , you are even considering ADT .
ADT over age 70 is NOT RECOMMENDED , except in advanced stage PC . - the side effects can be worse than the disease Weight loss , bone loss and heart issues .etc.
As a matter of fact with the advances in recent years with the use of MRI , PSMA PET SCANS AND VASTLY IMPROVED RADIATION GUIDANCE SYSTEMS ( RayPilot Tumor Tracking ) etc . TARGETING THE TUMOR . ADT is being recommended less . Google : Dr. Mark Scholz U TUBE VIDEO - Intermediate Risk PC - Do you need ADT .
I would broach the subject of Monotherapy SBRT , with your doctors , as a salvage treatment. And get a 2nd or even a 3rd opinion .
Finally 5 Fraction SBRT is now offered in 2 and 3 fractions worldwide . In Ireland , UK , Canada , USA , Australia etc . etc. Read the TOFFEE STUDY 3 Fractions vs 5 Fractions . Also view the exercise video By Dr. Geo who interviews Dr. Robert Newton from Australia " The Science of Exercise as Medicine for Prostate Cancer " , he also address the side effects of ADT . I am in my 86 year and plan , at all costs . to avoid ADT .
Finally . We often hear the old adage : " You will die with cancer - Not from cancer " . The death certificate will read : Death from cardiovascular disease " . But in fact the ADT side effect caused the heart attack .
I have been delaying ADT since 2017 when my PSA became detectable. It was rising very slowly until it reached 1.06 at which time I had a OSMA pet scan that showed the tumor in my left lung, 5 sessions of SBRT took care of the tumor and my PSA dropped to <.06. six month after SBRT my PSA now is 0.1.
Another reason for avoiding ADT is the fact that I'm also dealing with bladder cancer. I had a cystectomy in Jan 2023 and have been ding CT scans to monitor any recurrence of bladder cancer
Hi, I’m 82 with metastatic castrate resistant prostate cancer in my lungs. Years of ADT, Docetaxel, radiation to mediastinal lymph nodes, radiation to nodules in my lungs, surgery removing half of one lung & Lu177 treatments. Yes, I’ve been though the wars. A PSA at 0.06 which little meaning at this time. You may want to consider Lu177 to treat your lung Mets. The treatment in my experience has few side effects and may in fact be effective to control your PCa since your cancer is PSMA avid. Best to you.
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mcrpc , stage iv with aggressive treatments
PSMA Scan to be scheduled - thank you Tall Allen
Post treatment post ADT time to PSMA test
Tripple therapy - ADT+Lynparza+Xtandi
Just had Psma-pet scan... Confused
