PSA after radiation and Hormone therapy prognosis

[Mgtd]

meetings.asco.org/abstracts...

I have be searching for some data on the impact of radiation and short term hormone therapy on Intermediate cancer. If anyone else has some additional data or experiences please post

Background.

I finishing up 25 doses of radiation to the prostrate and pelvic area as a precaution and 6 months of hormone treatment (1 month prior and 5 months post). My GP ran a PSA test at my annual physical last week. The PSA <0.10 I will meet with my MO and RO in early January for my official 6 month follow up and their analysis of the blood work they ordered.

Nothing truly definitive but a reasonable indication that things are heading in the correct direction. Only time will really tell.

Enjoy your new year and may it bring good news.

[Justfor_]

For your PSA value to make sense the Testosterone value should be measured along.

[Don_1213 in reply to Justfor_]

Exactly what my medical oncologist (rather well known) said to me after the urologists kept ordering PSA tests without T reads. Right now I bet MGTD (nice car..) is castrate..

[Hidden]

Seems like the latest studies say <.06 is best. But most places just test for <.1 so I don't know how you're supposed to know that. I know I took some ultalab tests on my own that went down to <.02 after all that, with testosterone in the 90 ng level, so i felt pretty good about that. when my Testosterone went up so did PSA, then seems to be going back down, so I really don't know if there are any studies that establish a firm graph.

I did see this guy's graph, that I thought was interesting. It's without ADT though. But seems like it would be the same once Testosterone comes back.

protons101.substack.com/p/p...

[Mgtd in reply to Hidden]

Thanks read both articles. Really interesting. Bottom line seemed to be that the longer it takes to nadir the better the outcomes. I also found that ROs need to really use higher dose escalation to achieve better results. I also like his thoughts on reducing dependence on ADT to cover up for poor radiation applications.

Really enlightening and perhaps just a tad too late since I already had my radiation therapy.

[Don_1213 in reply to Hidden]

What an interesting article - and makes it clear - lower faster = better prognosis long term.

I'll quote his summary: I published my goalposts of <1 at 1 yrs and <0.5 at 2 yrs about 4 months ago. To date, I stand by that analysis - a massive improvement upon 2 weeks (sarcasm). And this brings us back to the subtitle: We've done a poor job simplifying endpoints. No wonder our own community is somewhat confused as to what is the best answer is on a quick first impression click. Read those two articles back to back and you too might land on the best answer being in fact: “none of the above due to statistical concerns”.

Me, I’m from Arkansas and like to keep things simple - lower is better. Nothing is magical. Really low really early relates to really good long term cure.

This is a super easy article to understand, and worth reading for anyone whose primary treatment was radiation. It makes me very happy actually (was <.1 under ADT, have been around 0.20 (+/- 0.02) off-ADT for the past 3 years. Low early is really a good thing.

@Anomalous - thanks much for that article. I subscribed to that substack.. I think it will be the source of some interesting discussions.

[Hidden in reply to Don_1213]

The fact that he is talking about patients that had no ADT is significant, though, I think. which to me means that we can be optimistic about lower earlier nadirs with ADT (where other studies seem to indicate below .06 is significant in ADT cases) but the rubber hits the road when testosterone comes back. Which therefore means the graph is only applicable for periods of time after that.

So we have to take his <1 at 1 year and <.5 at 2 years as after testosterone come back, seems to me, or maybe from the date of RT so long as there is not a sustained rise after the return of testosterone.

Seems the Sprat study had a notable fulcrum period, again, I'm assuming with no ADT:

I’ll summarize the paper: Patients with a PSA of less than 0.4 at 4 years have a really low failure rate, like super low. The paper reports a magical type separation: in 637 patients they report that IF the PSA reached <0.4 at 4 years, the chance of recurrence was 1.7%. But if it was 0.4 or higher, the rate was 27%.

But he notes that a study about the same time by the same people didn't have that 4 year cutoff jump. So...what will be will be. Still, I think being within that blue line in the graph, all other things being equal, is a good sign. And certainly for you with around .2, 4 years out from the end of ADT, very good.

[Don_1213 in reply to Hidden]

I noted the no ADT part, and took that into account. Under ADT my PSA was continually undetectable, it was only as T started returning, and I got off finasteride that I had a measureable PSA. When I was on finasteride and off ADT - my PSA was either undetectable <0.1 or 0.1. The "jump" to 0.2 wasn't any surprise to me, I fully expected that to happen. What was a surprise to me - my medical oncologist seemed surprised about it.

And yeah - based on that paper (and others I've seen) -- it appears that my PCa is in remission, and hopefully long-term remission. I'll never say never - but something else will probably get me before PCa.