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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
@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.
Replies to "@kujhawk1978 Thank you for such a thoughtful and informative response. I will try to fill in..."
Thanx, I understand as to the timing of the imaging generated ADT.
I'm guessing at your appointment, your doctors going to say .04 is great, see you in three months!
Mine's been stable at .03 for 20+ months now.
I do think it may be possible for many, albeit not all, high risk patients to manage their high risk PCa as a chronic disease
I think you and your medical team are making appropriate evidences based decisions.
Best wishes!
Kevin
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@ucla2025
To become castrate resistance, the PSA has to rise while on ADT. That usually takes at least two years and for some people much longer. Richard Wassersug PhD Who wrote a Popular ADT book made a claim about that in the posting I wrote about using estradiol instead of ADT.
He says If there are few cancer cells to mutate, there is little chance of the cancer becoming castrate resistant. In contrast, if there are gadzillion cancer cells around, the chances go up that some cosmic ray will damage a chromosome in one of the cells and lead to a mutated cell that is both castrate resistant and proliferating quickly.
He’s been on estradiol for 22 years and has not become castrate resistant.