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Hormone Levels after 90+ days Lupron

Posted by azp52 @azp52, Mar 16 11:40am

Background: @ age 62 Radical Prostatectomy May 2020. Post RP pathology report stated high risk, confirmed 4+3 Gleason, positive margins, Perineural invasion, as well as invasion into the neck of the bladder. No salvage radiation post surgery. Three years post RP rise in PSA to 0.78. PSMA scan Sept. 2024 positive lymph node metastasis in pelvic wall. Started Lupron Nov. 2024. Tested PSA and hormone levels March 2025. PSA now at .08 however, the testosterone level is at 241 ng/dL - a low 'normal' range. I've read where the target level is < 50 ng/dL. Could this be a sign of some resistance to the Lupron? Thank you in advance.

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jeffMar | @jeffmarc | Mar 16 12:16pm

Normally, they would start salvage radiation at .2 PSA after a prostatectomy. If you wait, a lot longer then the cancer can get out of the prostate bed, which could make the salvage radiation insufficient. Can they zap the cancerous lymph node with SBRT radiation, and also give you salvage radiation. Or is that lymph node in the salvage radiation area?

Lupron is Apparently not working since your testosterone level is so high. It should be below 20 right now. This may mean you are castrate resistant, not castrate sensitive.

Normally, with what you describe, they would add a second drug, an ARSI like abiraterone, which can bring most peoples testosterone down very low, even if castrate resistant. Another alternative if abiraterone doesn’t work a lutamide actually makes the testosterone ineffective. There are Three main lutamines, apalutamide, Darolutamide and Enzalutamide. Darolutamide has the least side effects.

I’m telling you about this so that you are prepared when you speak to your doctor and know what the possible options are.

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azp52 | @azp52 | Mar 16 3:28pm
In reply to @jeffmarc "Normally, they would start salvage radiation at .2 PSA after a prostatectomy. If you wait, a..." + (show)
@jeffmarc

Normally, they would start salvage radiation at .2 PSA after a prostatectomy. If you wait, a lot longer then the cancer can get out of the prostate bed, which could make the salvage radiation insufficient. Can they zap the cancerous lymph node with SBRT radiation, and also give you salvage radiation. Or is that lymph node in the salvage radiation area?

Lupron is Apparently not working since your testosterone level is so high. It should be below 20 right now. This may mean you are castrate resistant, not castrate sensitive.

Normally, with what you describe, they would add a second drug, an ARSI like abiraterone, which can bring most peoples testosterone down very low, even if castrate resistant. Another alternative if abiraterone doesn’t work a lutamide actually makes the testosterone ineffective. There are Three main lutamines, apalutamide, Darolutamide and Enzalutamide. Darolutamide has the least side effects.

I’m telling you about this so that you are prepared when you speak to your doctor and know what the possible options are.

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Thank you very much for the information. Yeah, I got behind the curve ball in checking my PSA levels after the 2nd year post RP . The third year other health issues consumed me and I went a year without checking. Of course it decided to take off that 3rd year. I'll see my doc in a few weeks. Your information allows me to go with some knowledge. Again, thank you. I hope you are doing well.

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