Define Nadir

[Jimhoy]

Please..... simple answers only!! I get it that you guys are all wicked smot, and I do appreciate that..... but I seriously can’t handle much above a 5th grade level!!! Well, maybe a dumb 6th grader!!!

I read that you need to reach a nadir (lowest constant PSA numbers) number to effective monitor any PC treatment success. Need to understand the simple logic about this.

Had my annual Urology followup appointment last week and got no answers as I was fluffed off onto this PA. I asked this exact question after discussing IN LENGTH my cognitive decline (put mildly) but I left there retaining nothing. She talked and talked all around it making no sense to me (not her fault...mine) but I’m pretty sure she didn’t really answer me, just made another appointment with the Dr himself in Dec.

So please, please, please, In simple terms and without links, that to me now are mind numbing.........what do I look for going forward?!

So.... since the end of my +/-20mo ADT stint, my numbers are;

Last 3mo Eligard on Nov 13, 2018 / T=18 & PSA=<0.1

June 2019 / T=19 & PSA=<0.1

Nov 2019 / T=107 & PSA=0.1

Mar 2020 / T=317 & PSA=0.2

June 2020 / T=346 & PSA=0.4

Sept 2020 / T=407 & PSA=0.4

What would I prefer to see from here on. Next bloodwork scheduled late Nov 2020.

Thanks in advance

Jc

And yes.... I have a brain MRI and another Neuropsychology exam being scheduled. This really does suck!!!

[Tall_Allen]

"Nadir" means the lowest value. So your nadir PSA was <0.1.

[Jimhoy in reply to Tall_Allen]

That is what confuses me! That was drug induced (still ADT)! Kind of expected natural numbers balancing off once treatment was over / suspended!

Thanks

Jc

[Tall_Allen in reply to Jimhoy]

So "biochemical recurrence" after radiation with ADT is nadir+2.0. For you, that would be 0.0+2.0= 2.0. That means you wouldn't even suspect a recurrence unless your PSA reaches 2.0.

[Jimhoy in reply to Tall_Allen]

Got it... 2 is easy to remember!!!!

Thanks again,

Jc

[SeosamhM]

A lowest point value ("nadir") is important to use as a baseline to compare future value changes to. We all assume that the nadir value and the time we tested at that value to be the time that treatment or treatment combination was most effective.

Changes to the value might mean changes in treatment effectiveness and that a new treatment combination may be in order. Your trend shows that T is rising and so is your PSA - this does not necessarily mean that cancer is active, but you, your caregivers, and your doctors need to discuss what these number changes mean and what comes next: Wait and watch, new scan, new treatment, etc.

Good luck. You aren't dumb. - Joe M.

[Jimhoy in reply to SeosamhM]

Same response as TallAllan....

Thanks Jc

Dumb..... brother, you don’t know the half of it!!!!! Not trying to bitch here but when you’re naturally dumb, you don’t know it!! When you become dumb... man do you know it!!!!! Thanks for the vote of confidence though!

💡💡💡Maybe I was a genius before and now I’m just normal!!! Boy do I feel sorry for normal people now 🤪😛😜!!!!!

[dadzone43]

Lowest point Jim0hoy

[Jimhoy in reply to dadzone43]

Thanks, as stated above, thought it would be once off the treatment. Makes sense to me now to use as an indicator for the ongoing treatment and not so much past treatments’ success or not!!!!

Jc

[pjd55d]

yes - my eyes glaze over when the numbers and initials start too

I pretty much have trained my Doctors to respond to my constant " what does that mean ? simple english please !" and they do - I have a graduate degree but this lingo is beyond me and they do love to rattle on

BTW some PA's are quite talented and are better listeners than Doctors - I am very blessed with good talented healthcare workers

hang in there

[Jimhoy in reply to pjd55d]

I used to be a really smart fella.... ADT was a shovel smack to the back of the head, now I’m just a real fart smella!!!

It took some doing to get my Dr to fully buy into the cognitive / executive issues associated with ADT or from the drugs used to chemically castrate you. No one will touch the argument of which.... yet... I stir the pot once and a while!! We know 1000’s of men are treated with ADT but only a few lucky bastards (like me), are blessed with the psycho issues!!! So, I have no doubt that she (PA) is sharp. She just (inadvertently I’m sure) left me in her dust! My Doc’s now know to take it down a few notches (as you noted).

Thanks

Jc

[doc1947g in reply to Jimhoy]

Me, I have trouble concentrating, remembering and aggressivity(opposite of what I am).

Including hot flashes that have decreased a bit. And tingling in my left extremities (hand & foot).

[RonnyBaby]

The others have covered the topic well, I M O.

I would add one thing that might be of interest to you.

The amount of time you STAY at that level is also a factor to consider, in terms of effectiveness of the treatment(s) AND it serves as a baseline to see IF the disease has progressed ABOVE that 'nadir' or lowest point you achieved (still castrate sensitive).

If you take an ADT vacation ( a break from ADT treatment IF the numbers warrant it),you would expect some recovery of 'T' (testosterone).

That number, 'T' would recover, assuming you are still able to produce 'T'.

IF you are on ADT for a significant period of time (greater than 24+ consecutive months),

SOME men may not ever produce enough 'normal' 'T' in the future - a potential side effect of long term ADT use.

What I've stated may help you understand the significance of nadir and why it is important to note.

Wishing you well on your journey .....

[Cheez986]

I wish i knew more about it. Only that I’m on my 2nd 6 month stint with Eligard., and I don’t like it one bit. Not sure what NADIR is, don’t know if I’m considered favorable, unfavorable, despicable, or just outright objectionable. I have not been educated on what it means to be castrate sensitive. I completed radiation, had another 6 month shot of eligard. When I asked the doctors, what is next, they said, “that you no longer worry about death from prostate cancer”. Ok, so I also asked if I should be on cialis or something since nothing is working. They said as long as I’m on Eligard it wouldn’t do any good. I have pulled myself away from the downward spiral of depression, and panic attacks have vanished for awhile, but I’m perched at the edge of disaster like a hobo watching me eat a ham sandwich. Having been educated beyond my intelligence, I have gone beyond my ability to understand what is going on. Many 2nd,3rd,4th opinions, so much confusion. I do not trust the process, I suppose that is all I have gotten from my journey. That, and the discovery that I am a stupid idiot. The more I discover or read the more confused I get. Seems that there should be a verification process for every treatment modality, a prequalification screening, or at least required imaging before and after a treatment like radiation or brachytherapy, for example. Oh yeah, and I say too much.

Wishing you all the best in health and happiness

[Jimhoy in reply to Cheez986]

Cheez Louise

Looks like you kept a sense of humor.... thats a good start!!

Why not put some med info on you profile. Not me.... but there are guys (and a few gals) here that can answer your questions before you ask it!!!

I’ve got way too many thoughts spinning around in my head (from reading your post) so I’m going to try and slow that down and them and get back to you!

Jc

[treedown in reply to Cheez986]

Nicely said, it's amazing how such eloquent writers feel so stupid

[pjd55d]

I used to tell people that I was crazy - not stoopid

now I am stoopid AND have no sex life ... grrrrrrrrrrrrrrrrrrrrrrrrrrrr

bitchin about it feels good

P

[treedown]

You may feel dumb but your sense of humor seems to have remained intact! Best of luck to you.

[ASAdvocate]

Have you had a curative treatment such as radiation or surgery? I only saw reference to ADT. I'm not sure that the nadir +2 guideline applies to ADT-only treatment.

[Jimhoy in reply to ASAdvocate]

Yes, EBRT x 44. First 1/2 to pelvic and 1/2 1/2 directly to gland. Had a typo in my profile... fixed now!!

Jc