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PSA now .04. What might be next steps?
Prostate Cancer | Last Active: Feb 20 7:11pm | Replies (19)Comment receiving replies
ok, now that I read his clinical data from your profile...
My husband, 64 yr. old, has metastatic PC. Rising PSA noticed in 2024. Diagnosed in early 2025,
PSA of 10. Gleason 9, PSMA pet scan showed large tumor in prostate and two positive pelvic nodes.
Prostatectomy June 2025 at UCLA Westwood. Three of seven pelvic lymph nodes removed were positive.
PSA after surgery was 1.9 and continued to rise up to 4.7.
My thoughts - Unsure why when three of the lymph nodes positive, a PSA of 1.9, GS 9 and GG 5 his medical team didn't recommend adjuvant therapy immediately, but, water under the bridge..
Placed on doublet ADT in September, with plan for follow-up radiation. PSA down to .7 in November.
My Thoughts - This sounds right though not sure why was whole pelvic lymph node radiation a part of the treatment decision vice follow-up?
New PSMA pet scan shows some positive node activity in pelvic region and abdomen.
My thoughts - so, while he was on Doublet Therapy, new activity was detected? That would indicate castrate resistance!?
Radiation put on hold. Chemo is suggested as possible next step, combined with the ADT.
My thoughts - Chemo is certainly an option though the data points to greater effectiveness in high volume which does not seem the case here. Still, I did chemo in conjunction with ADT +WPLN and I was not high volume so there's a study of one, I did have an almost five year break from treatment as a result of the ADT + WPLN Radiation + Chemotherapy so...
PSA down to .1 by end of November 2025.
Doc is pleased with results, puts chemo on back burner, says it may not be necessary at this time. Doc said the great response to the ADT is an excellent prognostic sign going forward.
My thoughts - His Doc should be pleased...I think most, if not all, on this forum would agree chemo may not be necessary at this time...yes, great response to ADT is a favorable prognostic indicator, see the EMBARK Clinical Trial.
Update Feb. 2026 - PSA .04
My other comments may still be pertinent.
Given his clinical data, the duration of systemic therapy is likely 24-36 months, leaning towards the 36.
For now, stay the course, systemic therapy...
What lies ahead, nobody can say. If when he will need to go back on treatment and with what. That will depend on the clinical criteria you , he and your medical team agree on that constitute the need to go back on treatment, what imaging shows , what the guidelines say and results from clinical trails entering mainstream clinical practice at the time. As an example, there are clinical trials exploring moving radio isotopes such as LU-177 into the HCSPCa space - https://clinicaltrials.gov/study/NCT04443062 and https://www.urotoday.com/conference-highlights/esmo-2025/esmo-2025-prostate-cancer/164097-esmo-2025-phase-iii-trial-of-177lu-lu-psma-617-combined-with-adt-arpi-in-patients-with-psma-positive-metastatic-hormone-sensitive-prostate-cancer-psmaddition.html
What I am uncertain of - is he castrate resistant or not? I would think not given the timeline you lay out.
Kevin
Replies to "ok, now that I read his clinical data from your profile... My husband, 64 yr. old,..."
@kujhawk1978 One other thing you asked about was other testing. His hereditary and genomic tests didn’t show anything significant. Of note though is that lymphoma and prostate cancer run in his father’s family.
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@kujhawk1978 Thank you for such a thoughtful and informative response. I will try to fill in the blanks for you as best I can.
In hindsight we recognize the ADT should have been started sooner. Not any radiation because of needing time to heal but the ADT, yes, right away I would think with 1.9 PSA post-prostatectomy. Water under the
bridge…we didn’t know then all that we know now.
The PSMA scan that showed new activity in abdominal nodes was done very shortly after the start of ADT, around a week or so. We assume there were micrometastacices that decided to show themselves at that time that didn’t show up on the initial scan.
The first time we met with our oncologist he made it clear he recommends a minimum of two years ADT.
I don’t think he is castrate resistant. The meds are working well and our doc would have told us if he had become castrate resistant.
We have brought up the Pluvicto option with him and he was receptive to it, making clear that may be something for the future and/or some appropriate radiation and/ or chemo.
We have an appointment this week. Anxiously waiting to hear what he has to say about the .04 PSA.