Testosterone levels are rising after cessation of ADT

That is a very good outcome at least for now if you ask me. Your T recovers to levels at which you can rebuild muscle mass which is important to metabolic health.

I'm not a biochemist or similar but my understanding is that long term ADT can cause some cancer cells to perish and others to be damaged or place them into a state of inactivity. How many millions of cancer cells survived your treatment to some degree and are "sleeper cells?" It takes a lot of them to get the PSA meter to budge.

I'm about to enter the first ADT-free phase of my treatment after 2 years of intensified therapy. Trying to figure out everything I can do to improve the ability of my immune system to keep any residual cancer in check in the presence of T. I haven't seen a lot of literature on this particular scenario.

I found this interesting.

I discussed with my medical team, they did not disagree.

Kevin

I am stage 4a, grade 5, have had surgery, radiation and am currently 18 months into ADT therapy.
My PSA is undetectable still, my but testerone has jumped up to normal levels while still undergoing ADT injestions.
Wondering if I am now jumping into castration resistance phase.

Castration-resistant prostate cancer (CRPC) is defined as:
PSA or cancer progression despite testosterone being kept at castrate levels (usually < 50 ng/dL).
So if your testosterone has climbed back into the normal range, by definition your cancer is not considered castration resistant. It simply means the ADT isn’t suppressing testosterone as intended, or that you’re in an “off-cycle” if you’re on intermittent ADT.
The key thing is that your PSA is still undetectable. That shows your cancer is currently under control. If it were truly castration resistant, we’d expect PSA to start rising while testosterone stayed low.
It would be a good idea to review this with your oncologist:
Double-check your testosterone and PSA with repeat labs.
Clarify whether your treatment plan is continuous or intermittent ADT.
Make sure your medications and dosing are working as intended.
For now, an undetectable PSA is excellent news. The fact that your testosterone is higher doesn’t mean castration resistance — it just means the picture needs a little more clarification with your care team.

It sure sounds like you’re in good shape. You say you have what could be a serious case of prostate cancer and even with no drugs, your PSA stays undetectable.

Your testosterone rising is a positive thing that is in no way a problem unless your PSA starts rising.

Hopefully you’re getting your PSA checked at least every three months.

You say you are high risk, but you don’t include any information about your biopsy or treatment, Without that information, it’s hard to say what your likely chances are of a long-term remission.

Before surgery I was a Gleason 7 with high risk perineural invasion detected
After surgery pathology was
Stage 4a grade 5 (Gleason 9)
Two lymph nodes involved one with extra nodular extension detected
Did 40 rounds radiation and on ADT now in month 18

My ADT is continuous

I’m no expert but how can your T be approaching normal levels if you’ve been on ADT for 18 months? What does your Doc say?

Here's my clinical history. In both cases, T rose to 300+ after three months and 400+ after six months after completing treatment.

In the first case, the PFS was roughly five years. In the 2nd, we are at 17 months, and PSA is stable at .03.

I am not naive enough to believe I am "cured...!" For high risk Advanced PCa I believe medical research has brought about ways to manage through imaging and treatment, but cure, no.

So, enjoy your T, continue to actively monitor through labs and consults. Think about and discuss with your medical team what clinical criteria would warrant going back on treatment and until then...

Kevin

I was on Lupron(adt) for 2 years... I also was on casadex for 2 years. I had radiation therapy first.
I did not have my prostate removed.
Gradually after 18 months of no ADT my testosterone levels returned to normal.
My psa has risen slowly to .09 but my oncologist says that is to be expected as testosterone levels return .
I have been assured that I have no biochemical recurrence at this time.
I am 4 years after my initial diagnosis . Hope this helps