Husband still not undetectable after restarting ADT...should we be worried?

[SuppWife]

My husband's T is at 2.5 and PSA is at 0.27 after 5 months on Firmagon (last month it was at 0.16). Should we be worried about castrate resistance at this point?

His urologist said not to add another med before another PSA check bc PSA may have bumped bc of AUS surgery he had four weeks ago. He has two known spots where seminal vesicles were per Axumin scan. He will be starting salvage proton beam radiation in about two weeks.

I'm wondering if addressing DHT might be useful. Urologist does not test for DHT, but in June we had it tested and it was 5.9 (T was 25).

Can DHT be effectively reduced using supplements like saw palmetto and pumpkin seed oil? Patrick? Nalakrats? Anyone?

Any thoughts will be appreciated.

Thank you

[Magnus1964]

He is not castrate resistant until he fails all ADT drugs.

[SuppWife in reply to Magnus1964]

Thank you for your reply.

[noahware]

Is there a reason to not use one of the 5α-Reductase inhibitors, like finasteride (proscar)? If urologist said not to add another med before another PSA check, that probably goes for supplements that would impact PSA, too. But after next PSA, maybe ask urologist about Proscar.

[SuppWife in reply to noahware]

I will talk to them. Good point about the supplements, particularly with radiation coming up. I’ll clear that with the radiation oncologist. Thank you for your reply.

[SuppWife]

Thank you Nal. Advanced Prostate Cancer is the only board I’ve posted on and had this post there first but moved it. Next time I will keep my posts on that board. It’s where all the folks I “know” are.

Thanks for your reply. It’s been hard to get docs to give us prescriptions we suggest (like metformin) and when I asked about DHT I got shot down by the urologist. I will ask the advanced PC doc in the practice when we see him next about Proscar and Avodart.

My husband’s E2/estradiol was at 20 when measured a month ago.

Thanks again.

[SuppWife]

Thanks so much, Nal.

I wish so badly I could find a good alternative/integrative provider like you have. I have not found one.

I really need a team leader among my husband’s docs. It’s hard to know who to ask about adding drugs like Proscar and/or Avodart and metformin.

Another complication is our face to face with the PA/urologist happens the day of the monthly blood draw rather than the day we get results. That is frustrating.

[SuppWife]

We are in the southeast. I’ve checked that site but have not been able to narrow one down yet. I will call the number in CA to ask for help finding one with cancer focus and ideally PCa experience.

Thanks very much, Nal 😊

[NPfisherman]

Hi SuppWife,

Read your profile before responding, I would advise going ahead with the radiation therapy you mentioned in your profile. It should be adjuvant and cover the whole pelvic region IMHO. This may drive his PSA back to undetectable. His PSA was 2 at his axumin scan and that was a good number for the scan--increased accuracy. Continue the Firmagon and see how it goes. I was diagnosed after PSA recurrence and they found one lesion on my clavicle at PSA near 3. I had SBRT to the one lesion and ADT plus Abiraterone and "undetectable" since. Getting SBRT to the one pelvic lesion is another possibility plus pelvic radiation at a later point perhaps (I am not an RO).... Talk to an experienced RO. I used Dr Burton at UPMC who was involved in the stage II trials for oligometastatic PCa patients. Your husband falls into that category. Dr Tran at Hopkins did the ORIOLE trial. This study below will give us some idea if ADT plus SBRT is more effective that SBRT alone- results due in February 2021.

clinicaltrials.gov/ct2/show...

Best of luck....

Don Pescado

[SuppWife in reply to NPfisherman]

Thanks so much for your reply, Don. The plan is pelvic radiation with extra focus on the spots of uptake. There is a small amount of uptake in one pelvic node and then the two spots low in the prostate bed. The RO was very encouraging after seeing the Axumin scan results, so we are hopeful. Initially we were told not to do it by the same RO bc husband’s PSA was very high after surgery, but that was before sensitive scans were done. We are going with proton beam. Thanks so much for your help. 🙏🏻

[NPfisherman in reply to SuppWife]

You're welcome....Best of luck.... I take it they plan on leaving him on ADT post radiation for a total of 18-24 months....

Don Pescado

[SuppWife in reply to NPfisherman]

I believe that’s the plan. He really enjoyed his break and if it weren’t for the break from ADT the scan and shot at radiation wouldn’t have happened but we know now he needs to stay on it longer this time.