Post SBRT and ADT PSA Results

thanks for sharing, always a good day when we get good labs.

You are beyond your RO. You need a (GU) Genito Urinary Oncologist, they specialize in prostate cancer, unlike medical oncologists. if you were going to a place like Mayo, you could get a good oncologist to handle your case and manage what you should do now.

Once your PSA rises three times after radiation, you need to start looking at other options. With such a major rises to .59 you almost definitely have had three rises if you’d had tests every month . A GU oncologist would definitely consider putting you on ADT right now as well as a second level drug like Zytiga.

You should be getting monthly blood tests now, your doubling rate is way too high. Your PSA more than tripled in three months, that calls for treatment.

See another doctor that specializes in prostate cancer or go to a mayo clinic or equivalent medical facility in your area.

Where you live can be a factor in finding a good doctor. If you need help come back here.

I just found out my UPSA is 0.06, 6 months from start of ORGOVIX (April 1st, 2024) and about 5 1/2 months from last SBRT treatment (April 18,2024). My Testosterone is 22. I have an appointment with Medical Oncologist next week. If he suggests, I can take a holiday from Orgovix, I might take it. But, on last visit I may have to be on it for 18 months.
If my RO and MO suggest differently, who should I go with?

What was your Gleason score. Months of ADT are based on Gleason usually. What was the SBRT for? Was it first treatment to your prostate, if so you probably want to go on ADT to prevent recurrence.

If you were just zapping a metastasis then it’s a totally different story, and you may want to wait.

I was diagnosed with Prostate cancer Gleason scores of 8 and 9 High-risk aggressive cancer but contained within the gland. My biopsy was in March 2024. SBRT treatment was at UCLA.
It was my first treatment. I am on Orgovyx right now.

When Gleason is reviewed the highest number is what counts. A Gleason 9 is supposed to have 24 months of ADT to try and prevent reoccurrence according to NCCN. You can do 18 months but it could leave you susceptible to reoccurrence sooner, though with the fact your cancer was isolated to the prostate the doctor may consider 18 months sufficient. Gleason 9 is very aggressive, you never know.

UCLA is an excellent place to go for treatment. If you want the best chance of a long life you should consider following their recommendations. The RO is not the one to decide. Your MO is the one you go to after radiation is complete, you may never need to interact with the RO again, unless you need a metastasis zapped.

I have been on ADT for 7 years, some of us can’t ever stop, 18 or 24 months can be done.

Good luck.

May I ask which adt agents you have used? 7yrs seems a good run

I was on Lupron for seven years and now on Orgovyx for 8 months. I am also on Darolutamide, and was on Zytiga for 2.5 years before that.

I have BRCA2 which prevents my DNA from correcting genetic mistakes. as a result if I stop treatment, my PSA rises quickly. Just dropping from four Zytiga pills to three caused my PSA rise from .2 to 1 in 18 days.

Different prostate cancer situations call for different treatments.

Thanks

Thank you jeffmarc for your response.
During my last appointment, my MO said I should probably stay on Orgovix for 18 months. He didn't think it will help much to stay longer. At that time my PSA was 0.1 not 0.10. I didn't know I have to ask for Ultrasensitive psa until my RO said that to me.
I will see what my MO will say next week with my PSA 0.06. I intend to stay on Orgovix as long as necessary and to err on staying longer!