1. < Prostate Cancer

Numbers After SRT/ADT

Posted by heavyphil @heavyphil, Apr 24 12:55am

I just received my post treatment results after SRT with 6 months of Orgovyx.

PSA < 0.05. Had been 0.18
before treatment.
T = 688. Was 610 before ADT

The 25 sessions of IGRT ended on 12/09/24 and ADT ended 2/07/25.
I am shocked at the recovery of T since it was only a whopping 3 after one month of Orgovyx. From all I read and from comments of others who had taken it, I thought it would only be about half this number.
While I am glad of its recovery, I must admit a bit of trepidation at its strong presence; I’m hoping it will not fuel any dying embers and get the ball rolling once again. As usual I have difficulty taking the “W” and going home…
Meeting with PA in 2 weeks to discuss the results. Best,
Phil

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heavyphil | @heavyphil | 1 day ago
In reply to @jeffmarc "If you started off with radiation, not surgery then the rule is you do not do..." + (show)
@jeffmarc

If you started off with radiation, not surgery then the rule is you do not do anything until your PSA rises 2 over the minimum that it ever reaches. If surgery is done then salvage radiation is recommended when the PSA rises to .2. With salvage radiation normal time to worry is after the PSA has risen three times in a row.

If you we're a Gleason seven then Six months of ADT makes sense. I can’t understand why he says you’re over treated. If you were only a Gleason 6 then maybe he was right. You want your PSA to be undetectable and your testosterone to be extremely low, So you can stop taking ADT and see if things go back to normal once your testosterone starts rising.

I sure would want to have PSA test every three months for the first year.

Jump to this post

Chippy and Jeff, the newer ‘guidelines’ say that men with rising PSA after surgery, whose PSA IS LESS THAN 0.7 should not get ADT. This is based on a large retrospective study which found that the harm is greater than the good.
However, I disagreed with this when diagnosed by my first RO since I felt that my surgical pathology of Gleason 4+3 Unfavorable made it more aggressive.
So I got a second opinion from Sloan and they agreed that, study or no study, they were using ADT. So I am sure plenty of Uro’s are saying that overtreatment is being rendered in many cases since we all usually go running for SRT at 0.2. Best,
Phil

REPLY
2 replies
heavyphil | @heavyphil | 1 day ago
In reply to @jkoop "I’ve asked about using a different agent for the scan, but they said PSMA is the..." + (show)
@jkoop

I’ve asked about using a different agent for the scan, but they said PSMA is the best available. I’ll ask again. Do you wait until PSA gets higher until you get another scan or let them blast away in the hopes they kill cancer cells? Thanks for your input, I really appreciate it.

Jump to this post

I started at 0.18 so no way I would wait until it got much higher than 0.2. Blasting, carpet bombing, burning the village to save it, etc….whatever we like to call it, what choice do we really have??
Besides, it’s not that bad once you’ve trained your gut to perform on very low fiber diet.
Phil

REPLY
1 reply
ecurb | @ecurb | 1 day ago
In reply to @jeffmarc "If you started off with radiation, not surgery then the rule is you do not do..." + (show)
@jeffmarc

If you started off with radiation, not surgery then the rule is you do not do anything until your PSA rises 2 over the minimum that it ever reaches. If surgery is done then salvage radiation is recommended when the PSA rises to .2. With salvage radiation normal time to worry is after the PSA has risen three times in a row.

If you we're a Gleason seven then Six months of ADT makes sense. I can’t understand why he says you’re over treated. If you were only a Gleason 6 then maybe he was right. You want your PSA to be undetectable and your testosterone to be extremely low, So you can stop taking ADT and see if things go back to normal once your testosterone starts rising.

I sure would want to have PSA test every three months for the first year.

Jump to this post

That’s exactly what my MO is doing in my case. ADT stopped in Jan.2025 April checked < .01. See ya in July .

REPLY
jeffMar | @jeffmarc | 1 day ago
In reply to @jkoop "Thanks again Mark, you’ve been a great help in my situation. I guess my next question..." + (show)
@jkoop

Thanks again Mark, you’ve been a great help in my situation. I guess my next question for me is, do the salvage radiation or wait for the PSMA-PET. I’ve not heard of anything to terrible with the radiation treatments other then it’s 6 weeks long other than for me it’s an hour to the clinic. My urologist is thinking at .45 the window for a possible cure is closing if I don’t do the radiation soon as possible. I’d rather do the pill form of ADT, can I request that? Radio Oncologist seemed to be okay with waiting for another PSMA PET. Decisions decisions!

Jump to this post

You do want to get the PSMA pet test soon, two weeks maximum. If you have to wait longer than it may not be the right time.

The double time of your PSA is very important You only told us the current PSA what was it the previous month or quarter, or the month/quarter before that, How quick is it doubling? If it’s Doubling in two months, then you need to get radiation immediately. If it’s taking 9 months, different timeline, maybe different choices.

Please look at the information below, You are at a pretty critical point so you may want to get that Radiation going ASAP.

From Ascopubs about what PSA to do salvage radiation.

≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

REPLY
1 reply
surftohealth88 | @surftohealth88 | 1 day ago
In reply to @heavyphil "Chippy and Jeff, the newer ‘guidelines’ say that men with rising PSA after surgery, whose PSA..." + (show)
@heavyphil

Chippy and Jeff, the newer ‘guidelines’ say that men with rising PSA after surgery, whose PSA IS LESS THAN 0.7 should not get ADT. This is based on a large retrospective study which found that the harm is greater than the good.
However, I disagreed with this when diagnosed by my first RO since I felt that my surgical pathology of Gleason 4+3 Unfavorable made it more aggressive.
So I got a second opinion from Sloan and they agreed that, study or no study, they were using ADT. So I am sure plenty of Uro’s are saying that overtreatment is being rendered in many cases since we all usually go running for SRT at 0.2. Best,
Phil

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Phil - are you saying you wish you had ADT immediately after surgery regardless of PSA or as soon as PSA went to 0.2 ? Sorry to interrupt this thread , I am now trying to learn about salvage treatments since with our luck and cribriform it is high probability that my husband will need it.

REPLY
1 reply
jeffMar | @jeffmarc | 1 day ago
In reply to @heavyphil "Chippy and Jeff, the newer ‘guidelines’ say that men with rising PSA after surgery, whose PSA..." + (show)
@heavyphil

Chippy and Jeff, the newer ‘guidelines’ say that men with rising PSA after surgery, whose PSA IS LESS THAN 0.7 should not get ADT. This is based on a large retrospective study which found that the harm is greater than the good.
However, I disagreed with this when diagnosed by my first RO since I felt that my surgical pathology of Gleason 4+3 Unfavorable made it more aggressive.
So I got a second opinion from Sloan and they agreed that, study or no study, they were using ADT. So I am sure plenty of Uro’s are saying that overtreatment is being rendered in many cases since we all usually go running for SRT at 0.2. Best,
Phil

Jump to this post

Interesting point of view. Fact is, If you have a problem, your PSA is gonna hit .7 pretty quickly. I know for me, just cutting back Zytiga from four pills to three caused my PSA to rise from .2 to 1 in 18 days. I went right back on four pills. Another example, in 2017 I got my six month Lupron shot late by two weeks, Same day I had a PSA test, My PSA had risen from undetectable to .6 that month, I was undetectable for the next two years. If you have a problem, it can go up quickly. I was a Gleason 4+3.

Have to admit It’s a good idea and must be backed up by a lot of data. According to AUANews however exceptions include “Other high-risk features include grade groups 4-5, PSA doubling time (PSADT) ≤ 6 months, persistently detectable postoperative PSA, and/or seminal vesicle involvement.”

The kicker for me is seminal vesicle involvement. Where we thought it was a problem, but to include that in exceptions, but not cribriform is interesting, and a little scary for some.

If they’re not waiting for .7 they are over treating a lot of people. I know that up till now that .7 has not been the rule. But I suspect there’s a good number of doctors that didn’t do ADT after surgery if it was just a Gleason seven. That’s what happened to me, though that was a long time ago.

REPLY
1 reply
jkoop | @jkoop | 1 day ago
In reply to @jeffmarc "You do want to get the PSMA pet test soon, two weeks maximum. If you have..." + (show)
@jeffmarc

You do want to get the PSMA pet test soon, two weeks maximum. If you have to wait longer than it may not be the right time.

The double time of your PSA is very important You only told us the current PSA what was it the previous month or quarter, or the month/quarter before that, How quick is it doubling? If it’s Doubling in two months, then you need to get radiation immediately. If it’s taking 9 months, different timeline, maybe different choices.

Please look at the information below, You are at a pretty critical point so you may want to get that Radiation going ASAP.

From Ascopubs about what PSA to do salvage radiation.

≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

Jump to this post

PSA seems to be consistent rises, 3 months ago it was .31 the prior 3 it was .21. And. The three before that was 0.018. Well that’s disappointing, they seemed to be waiting for PSA to go down after rib radiation. If I understand doubling time it’s about 9. months?

REPLY
jkoop | @jkoop | 1 day ago
In reply to @heavyphil "I started at 0.18 so no way I would wait until it got much higher than..." + (show)
@heavyphil

I started at 0.18 so no way I would wait until it got much higher than 0.2. Blasting, carpet bombing, burning the village to save it, etc….whatever we like to call it, what choice do we really have??
Besides, it’s not that bad once you’ve trained your gut to perform on very low fiber diet.
Phil

Jump to this post

Well I’m past that at .45. I don’t hear to many having any luck with finding the cancer with PSMA PET and hitting it with SBRT?

REPLY
2 replies
jeffMar | @jeffmarc | 1 day ago

If you are getting a scan soon after the PSMA scan then it would have to be one of those other types. Normally, you would get those for cases where your metastasis are not producing PSMA. You can also get them to find metastasis that are smaller than can be seen on the PSMA scan. At one conference, they said that the smallest size is 2.7 mm but then yesterday UCSF had a conference where they said you really had a problem seeing them if they were under 5 mm.

REPLY
1 reply
jeffMar | @jeffmarc | 1 day ago
In reply to @jkoop "Well I’m past that at .45. I don’t hear to many having any luck with finding..." + (show)
@jkoop

Well I’m past that at .45. I don’t hear to many having any luck with finding the cancer with PSMA PET and hitting it with SBRT?

Jump to this post

If you’d like to hear about that, go to YouTube and look up the PCRI conference at the end of March. The last hour and a half or so has Moyad talking to Scholz about a lot of things. Dr. Scholz was pretty confident that SBRT was the way to go. Instead of salvage radiation. You want some more information. Listen to that part of the discussion, you can just skip forward to it.

According to AUAjournals Adding short-term androgen deprivation therapy (ADT) to SRT (salvage RT) can increase the 10-year progression-free survival rate to 64% compared to 49% for SRT alone.

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