PSA not moving?

PSA can vary - exercise, sexual activity and of course ADT/EBRT can all fluctuate the PSA reading...and there is very little difference in the .19 reading vs .2 ( .01) so I would say hubby PSA is stable and no cause for alarm.

I would save all tests and you can easily plot direction of PSA over 1 yr onward...what would be disturbing would be a steady increase over 1-2 yrs up over .5 to 1.0 and above...and certainly, for now at least, that is not happening so I would conclude the treatment is working.. !

That’s such a small increase. As they say, it can’t go up and down, That’s not much of an up as you noted.

More recent studies have shown that removing the prostate is not beneficial in very aggressive prostate cancer cases.

Look forward to seeing a decrease next month.

What have his testosterone levels been? Is it still being suppressed?
(The difference between 0.19 and 0.20 is within margin of error.)

@jeffmarc Yes, exactly. The phase III STAMPEDE trial showed a benefit from primary-directed treatment for oligometastatic prostate cancer, but not (so far) for high-volume metastatic.

@beaquilter for metastatic prostate cancer, when they do treat the primary site it's almost always via radiation. STAMPEDE didn't even consider surgery as an option. It's extremely unlikely they'd recommend removing your spouse's prostate under any circumstances.

@jeffmarc Yes he was stage 4 from the beginning so surgery was out of the discussion, initially they mentioned radiation but after the PSMA scan showed it everywhere, we didn't hear more about it, I wonder if they will now? as it seems like just a few spots left, but they haven't.
At some point they said after probably 18mths on ADT the PSA would rise and they want to see a trend and doubling and even if it's from 0.2 to 0.4 or 2 to 4, it would be significant and meaning it's resistant. we'll see next month!

@northoftheborder Yes there's no mention of surgery since it's all over his body (or was at diagnosis) it's much better now but still some spots on bones and lungs also.
They want to see a trend of going UP and at what speed it doubles, even if it's low numbers.
We'll see next month!
I just wondered who else has been in this situation and what happened?

@brianjarvis I don't know, I think they stopped testing for that when he was on ADT for a while because it's GONE! The sex drive is gone for sure.

@xahnegrey40
Yes we have the trend in MY CHART and coming from 300 to this over the last year, we knew he'd hit a point where it would start rising again, but expected it after 18 months or do (they said) and expected him to hit 0.00 or nil or whatever, I guess it IS close still, but hasn't been undetected.
we'll see next month

@beaquilter In case it's helpful, the LIBERTAS trial currently underway (for pausing ADT in folk who responded well to doublet therapy using Apalutamide) uses this as their criteria:

"…reached a prostate-specific antigen (PSA) level < 0.2 nanograms/millilitres (ng/mL) after 6 months of treatment with apalutamide and ADT combination therapy…"

Abiraterone (Zytiga) is not _quite_ the same as the -lutamides (though still extremely good, and much less costly), so there's a reasonable chance he would have met this trial's entry criteria for strong responders if he'd been on that regimen, and he pretty much hit the target even on Abiraterone. 💪
https://clinicaltrials.gov/study/NCT05884398

@beaquilter I understand about the libido going to zero. My medical oncologist told me that would happen, and that the key is to continue doing it, despite the “want to” not being there. Keeping the blood flowing down there is important.

I’ve heard it compared to track stars who both injure a muscle. If one sits around and does nothing (because he doesn’t feel like it), while the other goes to PT and does his exercises (even though he doesn’t feel like doing it), the second one will do better in the long run,

Keep doing it.