PSA numbers after radiation with no ADT

Age 69 during treatment last summer. Gleason 3+4 in 2 cores, but high Decipher.

Radiation Type: Photon Beam (VMRT)

Number of Sessions: 39

Last PSA before treatment: 4.63

1 months post Tx: 1.66

3 months post Tx: 1.30

7 months post Tx: 0.79

Why have RT with no ADT, it’s an invitation to cancer spreading. Be careful!

@ozelli
No ADT and received 30 rounds of radiation (proton). Was diagnozed initally at itermediate risk per biopsies. After had Decipher test was rated at low risk and NO need to have ADT. Both Mayo (Jacksonville), and UFHPTI confirmed no need to have ADT with my type of prostrate cancer, Decipher test at low risk, PSMA, and bone scans all negative. Having ADT has serious side affects and should be done if your radiologist/oncologist deems necessary and needed. You should rely on experienced highly professional medical institute what treatments are appropriate after long time research.

ADT does not kill prostrate cancer it reduces the source of feeding it (testostorone) and thus reducing growing.

Per you request:
Received 30 round of pencil beam proton radiation at UFHPTI. NO ADT.
Initial PSA wasa 3.75 but had been rising every time tested. Both MRI, biopsies confirmed prostrate cancer.
3 months after last treatment PSA 1.2
Next 3 months PSA .79
Next 3 month test PSA .60
Next test to be done in June/July.

I was told with my PSA original number anything below 2 after treatment was good at 3 month mark. Long range goal was to be below 1. But caveat that could take 1-2 years to get that low. As you can see already below that goal.

Without RP you are going to have PSA levels and they will rise and fall caused by other things than prostrate cancer. It is the long term testing numbers that are important. Be carefuly and follow your urologist, oncologist, radiologist advice on PSA testing like no bike riding 72 hours prior and other things that can affect the prostrate PSA testing. When you have had RP the PSA had completely different expectations and should be at untectable range.

I just received Prostrate Report: Pathologic Stage T1c Gleason Score 7(3+4) anyone close to this opted to Wait and Review

Bevana00007:

I was diagnosed with the same pathological stage (favorable intermediate risk), after my mpMRI fusion TRUS biopsy in October 2023 (see details in my profile).

I selected (and my urologist agreed) to pursue Active Surveillance, after receiving a Decipher Score on my 3+4 cores of 0.22 (low risk).

Getting a Decipher score is a MUST (IMO) if one is considering AS with this stage (F-IR) of PCa. “High Risk” Decipher Score would have changed my treatment decision.

AS is not the same as “watchful waiting”. If one selects this approach IMHO a program of vigorous exercise and modified diet to reach and maintain an “optimal BMI” (22-23) should be a high priority.

One must also be prepared to pursue other forms of treatment if follow up PSA and biopsies indicate progression.

In my case, my PSA dropped from 7.8 (pre-biopsy) to 5.9 (3 months after biopsy). I lost 25 lbs, during that time period, due to my exercise/diet problem which may have helped??? I’ll know more after my 6 month PSA and a follow up biopsy at 12-18 months after my initial biopsy.

In any case, others will select immediate treatment with this F-IR diagnosis, so every man must decide for themselves, hopefully with the help of a supportive and informative doctor.

All the best as you consider your treatment options.

Alan

Hi I’m 67 and have been on active surveillance for 4 years. My biopsies were always 3+3=6 one core over the years psa went from 4 to 5 with no major jumps. My last biopsy in November 2023 things changed they came back 3 of 14 were 3+4=7 and psa jumped to 6.01. I sent my biopsies to John’s Hopkins for a second opinion they rated all three as 3+3=6. After talking to my oncologist he ordered a Decipher test it came back as high. So I have decided to go ahead with 28 sessions of IMRT. It’s a tough decision but the Decipher score was really the tie breaker for me. If it had come back low I would have stayed on active surveillance. I know what you’re going through. You’re doing the right thing by asking questions. Good luck.

@handera
See you had similiar history. Was at intermediate then had Decipher and went to low risk. I agree the Decipher test is a must. It a much more accurate diagnosis of your cancer risks. I also had bone scan and PSMA which all showed no spread outside prostrate.

I had the proton radiation as it was recommended by both Mayo Clinic and UFHPTI as a cure (hate to use that word maybe best treatment outdome is better) and so far great PSA test.

It is interesting your loss of weight and lower PSA score. Maybe they should research that relationship.

As an referenced add-on to my comment, this 2019 study, including Huang and Cooperberg, (“Decipher identifies men with otherwise clinically favorable-intermediate risk disease who may not be good candidates for active surveillance”) is particularly applicable regarding how important a F-IR man’s Decipher Score is for considering an AS decision making.
https://www.nature.com/articles/s41391-019-0167-9
One conclusion quoted from the study:

“Men with NCCN F-IR PCa and a low or intermediate Decipher score had similar odds of AP (Adverse Pathology after RP) as men with NCCN VL/LR PCa. Therefore, incorporating Decipher into clinical decision-making, particularly for F-IR PCa, may be useful to safely expand the use of active surveillance.”

69 10.2 Gleason 3+4
10/5/2022 10.29
Treatment 2/15/23
3/31/2023 4.61
5/25/2023 2.99
9/12/2023 1.4
1/9/2024 1.4

Radiation Type: MRIdian Linac Mri Based Narrow margin Photon Machine
Number of sessions: 5 treatments

I had operation in 2021 , March . After operation PSA was 0.070 , then climbed slowly to about 0.14 . Had EBRT , 22 sessions- No ADT . Right after it dropped to 0.60 . Then fluctuated . Last 3 PSA's were 0.014 , then 0.11 , then 0.072 . The direction is good .