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elimination of testosterone through ADT and aggressive behavior
I wanted to solicit your thoughts on something that has been on my mind regarding my treatment. I started Firmagon 2months ago, PSA went from 26.7 to6.7. Had Brachytherapy last Tuesday, EBRT to follow. Don't know current PSA levels - I assume they'd be lower.
Given that my prostate cancer developed in a naturally low-testosterone environment, I was wondering whether complete androgen deprivation through ADT could push the tumor to become more aggressive in its attempt to survive. Specifically, could eliminating testosterone encourage the cancer to adapt by finding alternative growth pathways, such as increasing androgen receptor sensitivity or relying on other metabolic sources?
I ask because, after two Firmagon injections, my PSA has only dropped to 6.7, which seems slower than expected. Could this be related to the tumor already being adapted to a low-testosterone state, or is it within a reasonable range at this stage of treatment? Would this have any implications for how we monitor PSA trends or consider additional therapies down the line?
I appreciate your time and any insights you can share. Looking forward to our next appointment.
Thank you again, as always, for the audience's advice and wisdom. Patience is not a strong point for me.
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Jeffmarc is the MAN, that can answer your questions- he ll show up shortly- always does. I m not qualified.
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2 ReactionsI know you’re real anxious about this since you aren’t waiting for your next PSA test to see if things have improved. If you’ve had a prostatectomy, then your PSA is usually gonna drop below .1 pretty quickly. If you just have radiation, then it can take a long time (3 years in some cases) for your PSA to actually settle down to its minimum, And that may not be undetectable. The question is, does it continue to rise after it has reached its bottom. It’s way too early to come to any conclusions yet.
If someone has become castrate resistance, they can defeat the ADT and your PSA will continue to Rise as a result. That’s just not gonna happen after two shots of firmagon. It takes prostate cancer a while to defeat that drug. If your PSA does not drop pretty much continuously, then maybe you have metastasis or Min metastasis somewhere else. That’s one of the things they were doing with these two treatments you’re getting.
Anxiety is a real issue, You’re having a lot of it and you just have to let things develop. You have a good chance of nothing coming back, that can’t be treated, for many years.
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8 ReactionsThank you. Perhaps it’s the anxiety factor that I need to manage and let the dice fall where they do. Admittedly, I have been concerned about this for a while and questioned the approach (I thought, not aggressive enough). Just had HDR brachytherapy last Tuesday. Thanks a million for your advice and wisdom.
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3 ReactionsAgreeing with other comments, I interpret your PSA decrease after only only two months to your PCa being very responsive to the Firmagon treatments.
If you’ve already searched through all of studies about prior low free testosterone, subsequent PCa, and asssiciates outcomes, you will know that the outcome correlations are primarily associated with initial Gleason score, decipher, and other PCa characteristics that are determined by the biopsy results and any initial scans (metastasis). I am not aware of any study that showed a correlation between pre PCa diagnosis free testosterone levels and the effectiveness of post PCa diagnosis ADT effectiveness. And, most importantly, the vast majority of these studies are using patient data before this generation of treatments were being used.
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4 ReactionsThank you for your insight. It’s my anxiety…
Anxiety is the worst part of this disease! You have a huge decrease in your PSA, so why even think that you are ADT resistant? If your PSA had gone up, now that would be a different story, but it did not. It’s way down. But you have a more aggressive cancer so it is going to take a lot more to knock it down - either many more months of ADT alone - or what you are currently undergoing - HDR +EBRT.
You probably will not be having any more PSA’s during EBRT and for some months afterward, so put that number out of your mind for now. Just the HDR brachytherapy alone probably already greatly destroyed your cancer’s ability to grow; the EBRT will finish the job and catch any strays that may be on the periphery.
You voiced this concern initially about your low testosterone environment and I think it was pretty well sussed out that we really don’t know what every strain of PCa requires in terms of T in order to proliferate. Maybe more aggressive means it grows in lower T levels? Perhaps - but by no means does that make it want to grow in castrate levels of T or even become castrate resistant - that’s a jump you cannot make.
Just continue on the path you and your doctors have chosen…or in the words of Confucius: “When rape is inevitable…just lay back and enjoy…”🥠🥠
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9 ReactionsIt’s anxiety and not knowing what’s normal and what’s not. Professionally, I am used for an input and then expect an immediate response. If there’s no response after the input, I know I’m in for some interesting moments. It’s a professional liability I guess…
What were your Total and Free Testosterone levels before you started the treatment?
But you DO have an immediate response: your PSA is down 75% after just 2 months; mine went from .18 to .05 - pretty much the same ratio as yours before starting radiation.
Haven’t had any bloodwork yet so we’ll see in about a month.🤞🤞
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3 ReactionsIt’s the 25% that worry me. Those are the cells, probably, that represent the next stage.