Can you use Lupron to postpone PSMA?

You might stay off Lupron wait 7months. PSMA/PET is expensive and medcare will cover 80%.
If you decide on the PSMA it is better to be off antiandrogen treatment because it can reduce detection of cancer cells.
Your provider may suggest that you should have the PSMA now and decide by the results if you should resume Lupron. You might counter with the 7 month proposal.
The PSA rise seems insignificant to me, a lay person.
You had somatic genetic testing and the mutations didn't indicate whether you were more likely to metastasize?
I would want the PSMA in seven months, regardless of the PSA.
Another year of Lupron wouldn't be foolish with regard to the cancer. I suspect your urologist won't advise it with your PSA numbers.

Few people take Lupron for years unless (1) it’s part of their advanced prostate cancer treatment plan or (2) they’re out of other options. The side-effects of Lupron are quite unpleasant and eventually the prostate cancers may become hormone resistant and find an alternative food source.

With only prior radiation (no surgery), and 3 years of Lupron:

> what is your testosterone level now? (2 years ago your PSA was 0.06 ng/mL because the Lupron was suppressing your testosterone. 1 year ago your PSA was 0.1 ng/mL because the Lupron may or may not have been still suppressing your testosterone. At 0.634 ng/mL, Lupron should be out of your system. Is your testosterone back to pre-Lupron levels?)

> if you’ve been tracking PSA & testosterone regularly (every 3 - 4 months post-treatment like most do), you’ll know when the testosterone left your system, and can calculate your PSA Doubling Time since then. A PSADT of < 10 months is of concern; a PSADT of < 3 months needs looking into.

Once you’re confident that the Lupron is out of your system, your PSA at that point is referred to as the “PSA nadir.” For only having initial radiation, recurrence is defined as a PSA of nadir + 2.0 ng/mL.

Now, no one wants their PSA to reach nadir + 2.0 ng/mL, because we all know that recurrence can occur well before that. On the other hand, you were on Lupron for so long, that you want to make sure that your PSA has settled in at its new normal. They often look for 3 successive PSA increases after nadir before being concerned enough to take any action.

If you had a prostatectomy, a PSA of 0.634 ng/mL would be of great concern. But, 4 years after only radiation treatments, not as much concern. If it were me, I would wait for 3 PSA increases after nadir (as long as that’s well below 2.0 ng/mL + nadir) to begin following up. (On the other hand, if they’re ok with throwing in a PSMA PET scan for free, I wouldn’t turn it down). And, you don’t want to be on Lupron unless you need to be.

The problem with PSMA PET scans is that at a PSA of 0.6 ng/mL, they’ll miss about 30% of prostate cancers. What you don’t want is to get a PSMA PET scan too early, get a false negative, and then head down the wrong path.

So, whether or not it would be a foolish decision to start Lupron temporarily depends on many factors.

How does approaching Medicare age play into your decision??

> If you get Original Medicare (and if they do cover the PSMA PET scan), your Supplement Plan will cover the remaining 20% that Original Medicare doesn’t. If you get a Medicare Advantage plan, the coverage varies plan-to-plan.

Thank you very much for all that info. It makes sense. The hard part is waiting. Though I've been on this journey for 4 years now, I still panic when the PSA jumps.

There was an area that the oncologist were uncertain about. Was it cancer or not. The plan was to take an antiandrogen for 3 months. If after 3 months of the antiandrogen the PSMA/PET saw nothing in that area, they would know that it was cancer. If that area remained lit up on the PSMA/PET they would know that it was not cancer.
As it happened the tumor shrank by about half, but the questionable area lit up on the PSMA. The oncology radiologist knew then that he would not treat the area.
Inversely for you, taking Lupron before the PSMA could hide the presence of cancer.
The PSMA/PET cash price is over 5,000$.

You might check out this video put out by Dr. Scholz with the PCRI.