Finished radiaiton therapy and Orgovyx: Normal to wait to do PSA?

Cessation of ADT requires some time for the PSA to rise. Recovery from Orgovyx is faster than Lupron. But 1 month is too short IMHO.

Is there a "normal...given he heterogeneity of PCa!?

When I finished triplet therapy, we tested three months after. Same for doublet therapy.

Normal may be what you and your medical team decide based on your clinical data. history and comfortableness with timing of testing.

Generally, over the 12+ years of my journey, we have tested every three months, on or off treatment. At times, we shortened the interval to two months or went "bold" and did four months. When my urologist switched me from a single decimal PSA test to a two decimal and it came back at .326, we tested again in two weeks (it went down)! Since we had switched tests, labs, etc., I was not comfortable waiting three months.

In my January consult with my oncologist, we went "bold" and both agreed that we were comfortable with waiting six months before PSA testing.

I guess the question is, if you test one month after coming off radiation and systemic therapy, what do you do with the results!?

Perhaps the discussion with your medical team is about what clinical data constitutes sufficiency to resume treatment? How far apart to you space your PSA tests and consults, what constitutes an increase, one, two, three tests, at what PSA would you image...@jeffmarc is right in that there is a possibility that even a recovery of T to say 50 or so in the first month (a distinct possibility with Orgovyx) may trigger activity measurable in USPA. But again, would that be "actionable?"

You say, "In any case I will follow my Doctors advice..." Yes, but you have a say. There is nothing wrong with his advice but over time you may find that your medical team's advice while "right," may not be the right decision for you. Who knows, but I ignored my instinct when I acquiesced to my medical team and did SRT to the prostate bed only instead of including the pelvic lymph nodes and short term systemic therapy. I did not follow my medical team's advice and do ADT monotherapy, instead, I did triple therapy, that brought a five year break. Had I done systemic monotherapy, would I have become castrate resistant in those five years, who knows. Same for my recent doublet therapy when my oncologist wanted to do 24 months ADT + ARI to go with SBRT. We agreed on 12 months systemic therapy, hold the ARI and do the SBRT. Here I am, 23 months later, OPSA undetectable.

In each of those cases, my medical team's advice was not wrong, it met the SOC, was it right, depends on how you define "right." In retrospect. I feel the SRT to only the prostate bed was not right, nor was the systemic monotherapy recommendation or the 24 months ADT +ARI.

Kevin

I agree with Mr. Marchi. My own experiences were similar, in that Firmagon (also an Antagonist, dropped Testosterone to < 10, PSA 0.006 and PET-PSMA showed clear of abnormal activity,
but as my body became resistant to ADT sure enough the Testosterone AND my PSA's went up. I is somewhat common, to become "castration-resistant" where the cancer cells (mutate??) to find alternate pathways...

I check my PSA and testosterone monthly and continue the Firmagon. According to my Oncologist it is good to keep with ADT to suppress what androgen dependent cell lines are still left...

Just came back from Uorologist. After 6 weeks since orgovyx my T is 297 and my psa is not detectable. Urologist said since my T is relatively normal and psa is down that is a reliable test and wants me to retest in 3 months.
Thanks to all very much
On Monday, March 30, 2026 at 08:29:11 AM CDT, Mayo Clinic Connect < nf+0653bfae+109429431@n1.hubapplication.com> wrote:

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| Comment posted by @deccakid on discussion "Finished radiaiton therapy and 18 months of orgovyx ".

I agree with Mr. Marchi. My own experiences were similar, in that Firmagon (also an Antagonist, dropped Testosterone to < 10, PSA 0.006 and PET-PSMA showed clear of abnormal activity,
but as my body became resistant to ADT sure enough the Testosterone AND my PSA's went up. I is somewhat common, to become "castration-resistant" where the cancer cells (mutate??) to find alternate pathways...

I check my PSA and testosterone monthly and continue the Firmagon. According to my Oncologist it is good to keep with ADT to suppress what androgen dependent cell lines are still left...

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@ctsenior
It’s actually the testosterone that rises when you stop ADT, which can cause a rise in the PSA. Doesn’t happen to everyone. Some people don’t have a testosterone rise. Some people don’t have their PSA rise, even though their testosterone does.

donald76, congrats on finishing radiation + 18 months of Orgovyx.

Checking your PSA & testosterone just one month after stopping Orgovyx may sound premature. But I think it's helpful to know that your testosterone recovery is progressing.

And maybe more importantly, along with your rising testosterone, I'd also expect a corresponding rise in your PSA. How big a rise?

In my case, 7 weeks after stopping Orgovyx (1 year + radiation), my PSA went from undetectable to 0.26 and my testosterone rose from < 6 to 450 (it was 454 before treatment).

Of course there are many factors that might affect how your recovery will proceed.

All that said, Dr Scholz says a PSA rise to 0.2 - 0.5 is normal...

Yes, congrats. Also noted is everybody is different. After Chemo and Firmagon, my PET-PSMA scans were clear, PSA 0.006 and T < 10...This lasted about 1-1/2 years. Last year my PSA slowly rose whilst T remained low, indicating castration resistance. Now PSA is flirting around 0.9 and the most recent PET-PSMA showed renewed activity in spine and soft tissue, I've decided to commence Pluvicto pretty much ASAP.

The point is: It's great, and I'm happy for you, to have low levels, but continue to monitor carefully. This is a pesky little creature that will find any pathway to rear it's ugly head!!

Blessings to all!!