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Is PSA rise inevitable after hormone therapy?
Prostate Cancer | Last Active: Oct 22 11:18am | Replies (57)Comment receiving replies
@ajpernsteiner I would like to learn from your experience how you approached your oncologist. did you have PSA tests every three months after taking a break on Orgovyx?
I am surprised that you had bone lesions after the break. Can the lesions not be radiated? Did Xtandi work?
I ask because I was on Orgovyx for six months, starting from two weeks before my SBRT for Gleason 7 (3+4), Stage 2, unfavorable intermediate, positive on 8 of 14 cores, no metastasis. I am off Orgovyx for a week now. I am hoping for the best, but I'm not ruling out that there was undetectable metastasis before my treatment, and that I may have a recurrence in the future.
My second post-SBRT PSA test is this coming week and radiation oncologist consultation the week after. Maybe you can provide some tips on what questions to ask my oncologist. Before my treatment began, she said I might be on Orgoyx 8 months to a year, maybe longer, it depends. But after she reviewed my first PSA test result down to 0.36 from 7.9 and 10.5 at diagnosis, she said 6 months was enough.
I was glad to stop after 6 months, knowing that some of us who had radiation opted out of ADT and did well; one saw his PSA continuously declining the last 26 months post-radiation which is a very good trend. I hope mine does not begin to rise too soon.
Replies to "@ajpernsteiner I would like to learn from your experience how you approached your oncologist. did you..."
@vircet Hello, It began when my PSA went from 2.4 to 4.3 in one year. I got a biopsy asap. I was diagnosed Gleason 10, cores were 80% positive for cancer. I was 79, so radiation plus adt. I had 45 radiation treatments, and after those and being on orgovyx, my psa was 0.04 it stayed that way for 18 months....or considered non detectable. I stayed on Orgovyx for 18 monhts. My urologist had said at the beginning with the agressive nature and gleason 10, there is a likely chance of cancer cells "out there". I had a bone scan, but not a PET scan. I decided to try a vacation at 18 months in. In hind sight, would not have, but too late for that. My psa did raise, with in 3 months, within 6 months it was up to 1.5 At that point a PSMA was ordered. I was back on orgovyx immediately. I had 3 mets. Cyberknife to the one on the spine, radiated the other 2.... I then was put on Erleada, but with it plus adt my psa began to double. Then I had another PSMA scan, and lit up all over. Xtandi did not work, Erleada did not work, doublng continued. By the time I got to Pluvicto, I was up to 134PSA. I just completed my 3rd pluvicto. My psa has come down to 93....I have almost zero side effects from it. I am also on Orgovyx. As to questions for your oncologist. Is there a way to have a PET scan BEFORE getting off ADT? Even better a PSMA? Have you had the gene testing, and all the bio marker tests. PSA tests should be often at first, never go longer than 3 months. If possible a 2nd opinion. Other than that, I work out at the gym, I manage properties, I do not have pain, and any questions out there on Pluvicto, I can tell you all about it. Best of Luck
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@vircet
Not sure you are aware of the following
An early and influential study that showed prostate cancer progression can occur even with an undetectable PSA was published in the journal Cancer in 2007 by researchers at The University of Texas M. D. Anderson Cancer Center. The study was titled "Prostate cancer progression in the presence of undetectable or low prostate-specific antigen levels".
So even though your PSA was not rising during hormone treatment, you still may have metastasis that will cause your PSA to rise, once you stop hormones.
If I were to stop all prostate cancer drugs, I would want PSA tests for the first two or three months, monthly, to make sure nothing is coming back quickly. After that, you could have three months test for a while. After my salvage radiation, at which time I had a 6 Month Lupron shot, it took 2 1/2 years before my PSA started rising, but it did start rising again.
If you have a real clean biopsy That can help, but you did have a large percentage of cores with cancer. In that case, if you had a prostatectomy, it’s likely they would’ve found higher Gleason scores. Doesn’t always happen, but it happens quite frequently, Happened to me, went from 3+4 to 4+3.. I know people with 3+4 that it became an eight or nine Gleason after surgery.