ASCO Gu 2025: real world data confirms that undetectable PSA nadir is a strong predictor of outcomes

[Maxone73]

Real world seems to confirm clinical trial data in this case!

A real-world study from the IRONMAN registry confirms that achieving an undetectable PSA nadir (<0.2 ng/mL) within the first year of treatment is linked to better long-term outcomes in metastatic hormone-sensitive prostate cancer (mHSPC). Among 1,377 patients, those treated with ADT + ARPI had the highest PSA suppression rates (51% at 6 months, 63% at 12 months), outperforming ADT alone (27% and 38%) and ADT + docetaxel (26% and 32%).

After a median follow-up of 18 months, 21% of patients experienced disease relapse, with lower relapse rates in those who reached PSA nadir <0.2 ng/mL at 6 months.

prostatewarriors.com/2025/0...

[Scout4answers]

awesome. Can we buy these as a supplement or do we need to buy them individually?

[Maxone73 in reply to Scout4answers]

Mmmm...I think you missed the right post!

[Scout4answers in reply to Maxone73]

Yes

[janebob99]

Excellent! Thanks for the posting.

[pakb]

My husband is an outlier in this. He's never been below .8 PSA. started at >677 (urologist gave him bicalutimide for 2 weeks prior to doing 1st PSA- crazy, I know). After lupron and 6 rounds chemo got down to 25. Then took 6 years to get down to .8. Fluctuated for those 6 years- sometimes up a point or bit then back down. Mostly has hovered between 1 and 2 the last 2 years. He went to lupron and abiraterone +prednisone after chemo and has been on that for 7 years. Spot radiation to previous metastasis site on spine that re-lit up 2x in last 3 years. No symptoms since chemo at diagnosis.

[Maxone73 in reply to pakb]

I think that if you have a slow but steady decrease in PSA during the years could be even better!

[dhccpa]

I was diagnosed as metastatic in 2018 and have spent 6.5 years on Lupron alone, no ARPI. No RP or radiation at that time.

Nadir was 0.5 in April 2021 (one reading, but I've had 7-8 readings of 0.6).

I just finished radiation to prostate and pelvis on 1/22 and PSA was 0.56 on 2/6 (down from high of 2.72 on 10/5/2024).

I've never been clear on how low PSA could go on just Lupron with a functioning prostate. Any idea?

[Maxone73 in reply to dhccpa]

Very hard to answer!

[Orange95 in reply to dhccpa]

My husband’s readings PSA 56June/24 pretreatment, first Lupron end of June, PSA 0,3 September/24 second Lupron, PSA 0,09 December/24. Completed 20 RT sessions in December. Next PSA test next week. Also the plan to add ARPI

[dhccpa in reply to Orange95]

That's low if prostate functioning and just Lupron. December reading after at least some or all radiation?

[Orange95 in reply to dhccpa]

that was at the beginning of RT, after 2 sessions.

[Orange95 in reply to dhccpa]

Just came back from our appointment husband's PSA 0.01. Going to add apalutamide in couple of days after blood work pre apalutamide results are in.

[dhccpa in reply to Orange95]

That's great

[Orange95 in reply to dhccpa]

Those tests always make me worry crazy. So glad got great results. Thank you

[dhccpa]

Yes, you're right.

[Maxone73 in reply to dhccpa]

With adt + arpi and a prostate i am at 0.01 currently

[dhccpa in reply to Maxone73]

I'm anxious for this recent radiation to play out. It's very early yet, but I was encouraged by the reading. Of course, one hopes the radiation was done as effectively as possible.

[dhccpa]

I do encourage everyone, including those going to "center of excellence," to bring these results to your doctors and get their reactions and report back. I've done it with my three, none of whom could be fairly called a prostate cancer expert. They seem scared to death, but that didn't surprise me.

Probably best to emphasize that you're not demanding estrogen therapy at present, just following these breaking developments and wanting to encourage them to follow them also.

Just a suggestion for anyone interested in this therapy.

[Adendino]

I'm not sure how this study plays into the various types of PSA testing. My husband's doc uses ultrasensitive PSA tests and after EMRT + ADT + Abiraterone for 2 yrs he got down to .02, but it didn't have the < sign because the test was so sensitive so he technically wasn't undetectable.

[Maxone73 in reply to Adendino]

"undetectable PSA nadir (<0.2 ng/mL)" so for the parameters used for this study your husband is undetectable since he is 10 times lower than that 😀