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The paradox of testosterone and ADT
Prostate Cancer | Last Active: Apr 26 11:59am | Replies (92)Comment receiving replies
Interesting hypothesis. I posted earlier about low (ish) PSA of 0.33 seventeen yrs post RARP and no further tx. At PSA0.33, PET showed 3 nodules + ‘micronodules’ on lungs but no where else. High burdrn? Testosterone 745 pre ADT. I keep wondering if this ca has already transitioned to neutoendocrine and thus not dependant on T, or wouldnt PSA be higher? Hate to start ADT when the cancer isnt dependant on the T. I have asked why not further test the biopsy for androgen receptivity to be sure, but sounds like no further testing is being done. What are anyone’s thoughts on my thinking - am I way off or missing something? It seems like this cancer has had 17+ years to mutate already.
Replies to "Interesting hypothesis. I posted earlier about low (ish) PSA of 0.33 seventeen yrs post RARP and..."
Having the cancer come back after 17 years is not unique. At the advanced prostate cancer Ancan.com Weekly online meetings, we frequently see people who have gone many years without any issues after surgery, and the cancer comes back. Recently had somebody who Had it come back after 30 years.
Why is there no test for ADT receptivity, It really isn’t needed since within a month of taking it. The PSA drops dramatically within two months. It usually drops to undetectable. That also stops the growth of any metastasis that have shown up, And frequently shrinks the size of them. Another thing that is done when it comes back is to include a second drug like Zytiga or one of the lutamides.
Lung metastasis seem to be the hardest to treat. I know a few people with them that have tried many different treatments, but they are still there, though in some cases, they reduced in size.
You might Talk to your doctor about having Pluvicto. It can greatly reduced the size of metastasis all over the body, Though it only works really good with 1/3 of the people and OK with 1/3. They have approved doing it before chemo.
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Seventeen years is a long time - anything can happen. But it’s not like your husband was on ADT all those years so why the castrate resistance?
True, it can happen all on its own but I’d be interested to see if the PSA drops - if and when- your husband is placed on ADT. If it does, he’s probably not castrate resistant.