Hi all, - As my Bio shows, I'm an Aussie but I love this forum. We don't have anything like this here.
So - I'm a 4+4 GS ... I was diagnosed in August 2023. PSMA showed no Mets. I started Eligard in Jan 2024. So far apart from fatigue and some Hot flashes I've been feeling OK. Travelled a lot and hope to do so in 2025.
In July I Had 23 sessions of VMAT on prostate and pelvic lymph nodes and 2 weeks later had HDR Brachy Boost therapy. This was an approach I decided to do after some intense research including from this forum. T_A also has provided me with some positive input as well.
Anyway, my PSA was around 8 when I was diagnosed, and prior to RT and BBT and after being on ADT for 6 months the PSA went down to 0.37 ... since RT & BBT my PSA is now 0.02.
Now then my question is this
I still have a prostate, so what are the readings that should worry me when I decide to give up ADT which I'm thinking of doing at the 14-month or latest 18 month timeline?
I have noted that everyone seems to get uptight at a reading of 0.2 but surely that isn't correct if you still have a wounded but still a living prostate?
Given my course of treatment and given I still have a prostate that will generate a certain amount of non-cancerous PSA ... what would be the more realistic PSA levels that I should be looking at for future monitoring?
Hey, thanks in advance for any replies. I hope you all have a great Christmas and a happy New Year.
Let's all hope that 2025 is a better year than the worrying 2024 that this world has had so far.
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Mike58
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The SoC cookbook holds 0.2 for those that had prostatectomy, not you. Your "magic" number is nadir + 2. You will not know your nadir until you are out of ADT and your Testosterone has assumed normal levels. Thus you will have to wait.
As you asked for any replies, if it is cancer at X + 2, how is it not cancer at lower values? In addition to PSA I find two types of imaging and liquid blood biopsy testing very helpful in striving to stay ahead of this beast.
So what you are saying T-A is that anything above 2.02 may be seen as concerning once I am off ADT? Which is interesting because I'm not sure that even 10 years ago I was as low as that. Was always around the 2.5 to 3.5 until July 2023 when it shot up over 3 months to 8.1
Wrong, definitely wrong, by the person that preaches: "no PSADT bellow 0.1"
Question to ChatGPT:
"After Radiotherapy for prostate cancer, BCR is commonly defined as PSA >= nadir + 2. If a patient, being on ADT gets a very low PSA count, say 0.02, can this be assumed as the nadir leading to defining BCR as 0.02 + 2 = 2.02, or should he has to wait until ADT washes completely out and then see what his nadir will be?"
ChatGPT responded:
"In the context of prostate cancer treatment with radiotherapy and androgen deprivation therapy (ADT), determining the nadir PSA (lowest PSA value) is essential for defining biochemical recurrence (BCR). However, it is important to consider how ADT influences PSA levels when interpreting the nadir and defining BCR.
Key Points:
ADT Effects on PSA:
ADT typically suppresses PSA levels to very low values, often below the natural baseline PSA level achievable through radiotherapy alone.
The PSA nadir reached while on ADT may not represent the true PSA nadir after the effects of ADT have worn off.
Defining BCR:
The standard definition of BCR after radiotherapy (with or without ADT) is a PSA rise of ≥2.0 ng/mL above the nadir.
For patients on ADT, clinical guidelines suggest that the PSA nadir should be established only after the effects of ADT have dissipated, typically 6–12 months after discontinuation of ADT.
Practical Implications:
If a patient achieves a PSA as low as 0.02 while on ADT, this value cannot reliably be used to establish the nadir for determining BCR.
The nadir for BCR determination should ideally be measured after ADT has fully "washed out," allowing the PSA to stabilize and reflect the underlying disease activity without ADT's suppressive influence.
Summary:
In the case of a patient on ADT with a PSA of 0.02, you should not consider this as the PSA nadir for defining BCR (i.e., BCR should not be defined as 0.02 + 2 = 2.02). Instead, the patient should wait until ADT has been discontinued for an adequate washout period (6–12 months) and then reassess the PSA to determine the true nadir. This approach ensures that BCR is accurately identified based on a PSA value not artificially influenced by ongoing ADT."
This suggest that, after you’ve stopped ADT x amounts of time afterwards PSA rises to a specific value, stays there for x amount of time. Then that should perhaps be considered the ’real’ Nadir.
But, if you’re on 0.02, then stops ADT and PSA slow and steady crawls up with no plateau whatsoever; why not use 0.02 as the Nadir and actually start to take some actions at 0.02 + 2 in PSA.
So, yes I may agree with you that, if you’re on ADT and PSA is 0.02; you’re on ADT and you stop ADT. After x amount of months your PSA goes up but then stays on this level for example one year (for example a plateau of 0.5) before it starts to climb again perhaps recurrence could be 0.5 + 2 and 0.02 +2
I mean, if you have a good doctor you probably will have dialouge long before 2.02 or 2.5 and he have ordered a PSMA Pet Scan to hopefully get a good diagnos if there is any actual hot spots to worry about
We have 6 monthly PSA blood tests as advised by our local Cancer Centre. If you can limit or cease intake of carcinogens, including alcohol etc. and are eating fresh, unprocessed food and are enjoying plenty of exercise, living stress free too, then hopefully your chances of controlling your chronic disease are good. Seven years on we are living a great life too. We are the fortunate ones. Glad you are enjoying travelling. See the world before we leave it is our credo.
Thanks Babychi, I wanted to lose some belly fat and so went on the KETO diet but leaning a little towards Carnivore. Seems to be working but my vice is that I like a glass or 2 of beautiful full blooded red Aussie wine with my meals. Hopefully that isn't going to cause me too much angst. By the way, I'm talking nice red wine, not the yellow tale rubbish that is dumped over in the USA.
Research what a plant based with fish diet can do for you, look up the " Blue Zone Diet" areas in the world where people live the longest - none of them eat carnivore diets - mediterranean diets that eat minimal amounts of red meat - heavy on plant based food - nuts - certain grains -certain fish - chicken. Or Asian diets - but none of them eat much meat that I have found. Highest life spans with least diesease on the planet.And the lipids in red meat - as I understand it - Prostate Cancer thrives on.
To each thier own - but plant based with fish for me for last 2 years since Bio- chemical reoccurance - never felt better - no more cholesterol issues - tremendous stamina - works best for me.
Yep, makes a lot of sense. I guess I was looking for a quick fix of losing belly fat and the Keto, part carnivore diet came up trumps for doing just that. I tend to be eating more pork than red meat anyway, and I haven't gone off the appropriate vegtables that are Keto friendly and from what i understand PC friendly (Broccoli, Brussel sprouts, etc) - I also do include fish as well. I am losing weight and am feeling quite good as well. Still love my red wine though. Thanks for you reply. Have a great Christmas.
Good job, sounds .ike you are on right path on your diet! God Bless you in your journey fighting this beast - best to you from Washington State USA, my wife would Love the Sunshine you get where you live, she hates the rain here! Rick
From my amateur knowledge the healthy part of the prostate can heal rather well after radiation and then PSA rises because of that. The higher PSA you had before was perhaps from malignant prostate cancer and now you’ve killed the or put them dormant but the healthy part recover and perhaps PSA to healthy level.
But like leach234 says, it’s not a fully functional prostate gland, but still there may be many areas of the that is healthy😉
most ROs like to see it around 1.0 or under. But there is enough variation that 2.0 + can not necessarily be a recurrence.
You are right, there is a lot of variance in what is normal. Some of it has to do, according to TA, with "benign PSA" and also susceptibility to prostatitis. Adding TRT can also cause it to rise. I think the key thing you are looking for is stable figures or slow rises. I had a conversation with the TRT guru himself, Morgentaler, and he said it is normal for men on TRT to have slow rises the rest of their life without necessarily being a recurrence. But sustained sharp rises indicates a recurrence. So it seems that would be the same for anybody that has an ample amount of Testosterone, once it returns. So it seems the answer is, if your PSA is .5 or above after a couple or three years, or sooner, take a PSMA scan every couple or three years. If you get to 5 years with nothing over .5, maybe you're cured (technically "durable remission").
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