How reliable is PSA in measuring the control of my cancer?

The hormone therapy has brought your PSA down and may have actually shrunk the metastasis as well. I know at least a couple of people that have had lung metastasis that could not be found any longer after being on ADT for a while. Doesn’t mean they went away completely, they just became so small they couldn’t be seen any more.

When they found a metastasis in my spine, they wanted an MRI to see where the metastasis was exactly. I then had three sessions of SBRT radiation on it, to eliminate it.

You could ask about getting an MRI on your spine to see if that shows anything, The hormone therapy may be hiding something that’s there, and it could be zapped if the MRI shows where it’s at now. Having a metastasis on the spine can weaken the area it is in.

Your PSA is probably too low to see metastasis now, an MRI can usually still see what’s there.

@jeffmarc
What type of hormones are typically given to us? I have adenocarcinoma, score of 6, PSA around 6. thanks
Sam

@drcopp Adrenocarcinoma responds better to treatment than (much rarer) squamous/small-cell prostate cancer, and PSA is a reliable marker for it, so that's "good" news, as far as it goes.

There are two types of hormone therapy:

Androgen-deprivation therapy (ADT), which severely restricts the production of testosterone. Examples: Lupron, Firmagon, Orgovyx. (Testosterone is the main "on" switch for prostate cancer cells to start multiplying.)

Androgen-reception signalling inhibitors (ARSI), which prevent the cancer cells from "seeing" any testosterone that does slip through. Examples: Erleada, Xtandi, Nubeqa, or the older Zytiga.

It used to be that for metastatic prostate cancer, they held the ARSI back until the ADT stopped working, but after a series of studies showed huge improvements in overall survival and time to castrate-resistance from starting ARSI at the beginning of treatment, it's becoming more common to offer both right at the start now.

@drcopp
I suppose you mean your Gleason score is a six.

If your Gleason score is only a six, then prostate cancer treatment is not normally recommended. If your PSA has been rising at a good rate, then an MRI can show whether or not there is any tumor inside your prostate. That’s the best way to find out what’s going on.

You can also get a PSE test, which will tell you or whether or not there is actually prostate cancer in your system. If it shows there is then you need to get a biopsy.

If someone has given hormone treatment, they are given ADT. The most common ADT drugs are Lupron and Orgovyx. ADT also includes Firmagon,, Eligard, Prostap, Camcevi, Lucrin, Zoladex, Trelstar, Pamorelin, and Decapeptyl They can cause numerous side effects. Actually due to a lack of testosterone.

@jeffmarc Thanks Jeff,much appreciated.
~Wayne

@jeffmarc
Thanks for the info. , Jeff. I'm glad that I found this group.
I'm heading in for my PSA blood draw tomorrow and then will see my Urologist for my yearly follow up mid-November. I have had 2 biopsies over the past 4-5 years, on a monitoring plan so far. Probably will do another biopsy by Dec., as it will have been 2 years since the last one.

Your question was about the reliability of PSA testing in monitoring the control of your cancer.
It is very reliable, especially in light of the fact that ADT has dropped your PSA by a large amount.
Subsequent PSA’s taken every 3 months will show how effective the ADT is in continuing to control the cancer. Of course, you will probably have some sort of SBRT to zap those areas on your PET scan.

@heavyphil, Phil, thanks for the info on SBRT. I wasn't familiar with that procedure. I'll mention it to my oncologist when I see her next month.
~Wayne