Opinion wanted on PSA result

In my opinion, his PSA is declining well post the three treatments (Orchiectomy, RT , and ADT). His eventual PSA nadir is dependent upon the several factors, including the known prostate cancer prior to the first treatment.

Did scans indicate the PCa was contained to his prostate orior to treatment initiation or unknown?

The nadir resulting from RT can take 6 to 18 months (sometimes longer), so in my opinion, his PSA response is indicative of the Orchiectomy and ADT, and encouraging that his PCa is responding well to hormone therapy treatments.

If you are seeking more precise input, you can find online studies for the typical PSA decline rates post Orchiectomy and post initiation of ADT. Also same for RT.

Given the Orchiectomy and ADT treatments, I presume that he has also initiated other therapies to help counter the rapid reduction in testosterone.

i need to know the age of your Father and what stage of cancer he was in?

@jsh327
Hi. Thank you for your detailed response.
No, it was not contained within the prostrate, I think there was an involvement of a lymph node and SV. RT was 50.4 gy to pelvic LNs and 70gy to Gross tumor + SV and nodes. (thats what is mentioned in discharge summary). I will look for online studies, however, could you add any directional inputs on countering rapid reduction in Testosterone.
@gscott0223 - Hi. He is 78 yo and stage was IVA (as mentioned above, lymph node and SV, but no distant metastasis) / locally advanced or regional.

A few questions:
> how old is he?
> what was his Gleason score?
> where did his pre-treatment PSMA PET scan show the cancer was located? And what were those SUVmax scores?
> what was his testosterone level at each pre-treatment and post-treatment PSA tests?

I’d wait for a 3-month post-radiation PSA test before jumping to any conclusions.

However, with no significant testosterone being produced and if no metastasis initially, PSA should be undetectable.

> since he hasn’t been on any ADT, only Abiraterone (Zytiga) which is an androgen receptor pathway inhibitor (ARPI), any residual testosterone shouldn’t be picked up by any (potentially) remaining prostate cancer cells.

My experience with having 28 radiation treatments with ADT (which has the same temporary effect as an orchiectomy; my testosterone level went as low as 3.0): on the last day of radiation, my PSA was 0.224; at 6 weeks post-radiation my PSA was 0.008 (and remained there for 6 months). Now, almost 5 years post treatment, my most recent PSA (in December) was 0.314.

If his testosterone levels are single-digit, but PSA is still elevated, then yes there is need of another PSMA PET scan.

(Also - and this is just a curiosity question - why did he choose an orchiectomy?)

@brianjarvis
Hey,
He is 78 yo, and the Urologist recommended that at this age, orchiectomy is better vs monthly/quarterly injections, so there is no chance of missing it for any reason and relatively lesser side effects. Orchiectomy is also a form of ADT, (just not medical but surgical-if I am right). Gleason was 4+4, PCa as I mentioned above, was in one LN, and Sem. Ves. I will need to check ok the SUVmax scores.
For your ADT, was it a once in a quarter injection? I am not sure if the rate is psa decline with an injection vs orchiectomy are similar/comparable .... Haven't checked for Testosterone, but will do this soon.

@sbd
When someone is on ADT, their PSA may not get much below 20. If you add abiraterone It locates other places in the body that create testosterone and shut them down. This results in a much lower testosterone level. The same effect would be happening after an Orchiectomy.

I’ve heard of cases where it has taken three years for the PSA to reach rock bottom after radiation. His PSA has continued to drop.

There is an option to take one 250 mg abiraterone pill with a low-fat meal in the morning. It is just as effective as taking 1000mg. Not all doctors are really aware of this.

I was on 1000 mg of abiraterone For two years when I tried to cut back to 750 mg to see if it would ease the brain fog. After 19 days, my PSA rose from .2 to 1. In my case, just cutting back Abiraterone A little bit, directly caused my PSA to rise. Your father is not even taking the standard 1000 mg dosage. That could be a factor and why the PSA is not dropping more.

I am 78, I’ve had prostate cancer for 16 years and I’ve had four reoccurrences. I’ve been taking ADT for eight years. I am now on Nubeqa And have been undetectable for the last 28 months. I’m just bringing this up so that you realize that at 78 your father could have many more years to go because of the great drugs and other treatments we have available.

@sbd (Note that they offer 6-month injections for the ADTs.)

If the cancer was identified in one lymph node, it had already escaped the prostate. They probably treated that lymph node during the prostate radiation treatments.

At 65y/o, my ADT was planned for just 6 months and was comprised of two 3-month injections of Eligard. (At 79y/o, my oldest brother is on Eligard right now; he’ll get quarterly injections for two years.)

While on ADT (or after an orchiectomy) it’s important to track testosterone levels; that’s what causes starvation/weakening of the prostate cancer cells, making them more susceptible to DNA damage from tge radiation, resulting in their death (and as a result, PSA dropping).

Good luck!

@jeffmarc Hi Jeff, can you provide @sbd with your recommendations for best practices of managing the side effects of hormone therapies (Orchiectomy + Abiraterone) . His question was embedded in a response to me, but your expertise is better. Thanks

@sbd

A reduction and testosterone caused by the following drugs, cause the below problems.

Due to their different mechanisms of action. ADT which includes Orgovyx, Firmagon, Lupron, Eligard, Prostap, Camcevi, Lucrin, Zoladex, Trelstar, Pamorelin, and Decapeptyl can cause numerous side effects. Actually due to a lack of testosterone.
Hot flashes
Fatigue
Muscle deterioration
Bone weakening
Brain fog
Depression
Weight gain
Joint pain
Difficulty in breathing

Not all of these side effects occur to everyone on the drugs. Most of them are just things you have to be aware of and circumvent. I run on the track twice a day, 1 mile at least, to help prevent bone weakening, fatigue and muscle deterioration. I also go to the gym three days a week (usually) and spend an hour with all different types of weight exercises. One thing that happens is people get a beer belly from the muscle deterioration, I do a lot of sit-ups to offset that.

Some people get depression but it is not common. It is easily treatable, according to people that have reported it on here and on Online Meetings I have participated in. If he has that problem Come back and ask for help, Or see a psychiatrist about doing something to relieve the depression.

Some people get no hot flashes at all. Others only have a few hot flashes and they are very minor. I had severe hot flashes for the first year on Lupron. As a hot flash was hitting I would feel a lot of fatigue. After a year, my oncologist prescribed a depo-provera shot every three months and it really stopped those hot flashes on Lupron. There are other hormones that can do this, speak to your doctor. If you have this problem, we can give you a list of drugs that can stop it. Ae doctor at a recent conference, put out a big list
I know one person that says eating tofu every day really controlled his hot flashes, another person in this forum said the same thing. Tofu does have properties similar to endocrine hormones but a lot weaker. Can’t hurt to try it. Seems they ate it daily.

According to a doctor that spoke to a recent webinar, many people on ADT, if they are staying on ADT for an extended period or have become castrate resistant should be taking bone straighteners. I took Fosamax for six years and I’m now on Zometa. That along with calcium taken daily helps keep your bones strong. Ask your doctor about this.

I have never gained any weight while on ADT. I get on the scale every morning and base what I eat on what I weigh. Skip lunch at times. Some people gain a lot of weight. The average is 5 pounds but some gain more and some gain none..

If there was a lot of fatigue, exercising actually can offset it. It sounds kinda productive, but actually getting out there and walking bike riding, weight training, isometric exercise exercises whatever you want to do to exercise can help reduce the fatigue you feel.

Try not to let PSA define you and your cancer. It's hard to do. For me my PSA never been normal, never good. 6.3 Years in on this advanced prostate journey and my PSA always high, causing another exam, another test, another appointment. Last year my oncology and I went heart to heart and I asked him for a break from PSA Lab and his response surprised me. He said "You deserve one, it will help your quality of life." He's right, and the PSA break helped my QOL.