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Continue hormone therapy? or not?
Prostate Cancer | Last Active: 4 days ago | Replies (27)Comment receiving replies
your case is very close to mine. I had the RP in April. my Gleason was 7. My urologist who specializes in prostate cancer said to see an oncologist when my PSA began rising rapidly. .1 >.18
Tue 0ncologist wants 2 years of ADT plus radiation. Lupron is the ADT with Zytiga. Both the oncologist and the radiologist said a low PSA is expected at this point but no indication of progress. The cancer can adapt to testosterone deprivation. Continuing ADT is something rather than nothing. I would ask both what's next? If not ADT, then what? If ADT, will that cure this? My PSA is .01. They want to go full speed ahead. I start radiation Wed. I don't know the endpoint.
Replies to "your case is very close to mine. I had the RP in April. my Gleason was..."
@lacraig1 I don’t think that ADT cures cancer, but rather inhibits cancer cells from growing and spreading. If you don’t have any prostate cells left, ADT is unnecessary. Unfortunately, prostate cancer cells can be microscopic and not detectable until they grow. I don’t think you know until the cancer either returns or it doesn’t. ADT can slow the process and can provide 20+ years of survival. I do intermittent ADT and not continuous ADT because I found the side effects awful and was on ADT for three years with “undetectable” PSA. I have now completed 15 months off ADT now with no detectable PSA. If my PSA becomes detectable, I will start ADT again and hopefully have a PSMA PET scan that can pinpoint the area that requires radiation. Bottom line, none of us know what will happen and we are all going to die at some point, so the most important thing is to maximize quality of life right now and practice gratitude. Really enjoy each moment. Right now. What are you waiting for?
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@lacraig1
I think I answered this in another message but if your PSA hits .2 the recommendation is that you get salvage radiation. ADT is quite often Used just before the radiation to try to shrink the tumors.
Since your PSA is so low, you can’t have a PSMA PET scan which would tell me whether or not you have had the cancer spread somewhere else in your body. The ADT may have stopped that, but they have found that even on ADT with an undetectable PSA you can get metastasis. I was on Zytiga for 2 1/2 years and my PSA stayed very low, but not undetectable, I got a metastasis on my spine and had it zapped. That was found out when I stopped 1 zytiga pill (out of 4) For 18 days and my PSA went from .2 to 1, So then the PET scan was now possible, and it found a metastasis.
Here’s what the standards are for getting salvaged radiation after a prostatectomy.
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.
This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/