PC spread to some lymph nodes; radiation, ADT. intermittent ADT

Posted by gkgdawg @gkgdawg, Oct 4 12:08pm

My husband has Prostate Cancer. PSMA showed microscopic spread to some lymph nodes near the prostate. He had 5 weeks radiation August 2025, and has had 17 months of ADT. HIs PSA has shown less than .1 since Sept 2025. He had a CTscan of his chest, abdomen and pelvis on Sept 14 2026. No pathologically enlarged pelvic lymph nodes , no suspicious nodules or metastatic spots in lungs or abdominal organs. He had a prostate MRI in September , 2026. No suspicious regional lymph nodes , no visible sins of tumour recurrence or spread. I have asked my husband's oncologist if he can stop his ADT for now and be monitored every 6 weeks or so. She was hesitant. She has never introduced intermittent ADT to a patient. Once they are on ADT they stay on ADT. He will have a baseline blood test this coming week and then go off the ADT. Has anyone else ever done this?

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jeffreyg | @jeffreyg | Oct 11 7:12pm

In reply to @jeffmarc "You actually didn’t have radiation when your PSA was hitting .2 or a little higher? 3..." + (show)

@jeffmarc I've heard that the greatest writers are great editors. Check your work, Marchi.

Jeff Marchi | @jeffmarc | Oct 11 8:57pm

In reply to @jeffreyg "@jeffmarc I've heard that the greatest writers are great editors. Check your work, Marchi." + (show)

@jeffreyg
The thing is Eligard and Nubeqa Can bring the PSA down, but was the cancer treated when it came back and the PSA rose so much. You don’t mention having radiation to that what was causing the PSA. You just mentioned going on the two Drugs, doublet therapy.

The thing is ADT can make metastasis like your lymph nodes disappear while you’re on it and then come right back when you stop it.

You definitely have a good start with a low PSA now.

wheel1 | @wheel1 | Oct 11 9:07pm

In reply to @jeffreyg "For what it's worth, I am 70 years old, had radical prostatectomy at 61 years. PSA..." + (show)

@jeffreyg
It seems so low and reasonable at .2 for BCR might have raised issues, certainly going to .3, I would have hoped PET would have seen, but immediate BCR treatment with radiation. It seems allowing it to keep rising with no discussion of treatments? Especially standard if care is unusual, but then am I reading it that it went to 16 and 18 within two months and this is with your prostate removed. How long from .3 to 16? Are you being treated at a cancer center?

wheel1 | @wheel1 | Oct 11 9:58pm

What I am saying shouldn’t your Doctor have been discussing with you, your rising PSA before it hit the BCR treatment level standard of care .2, let alone continuing to .3.

jeffreyg | @jeffreyg | Oct 11 10:32pm

In reply to @wheel1 "@jeffreyg It seems so low and reasonable at .2 for BCR might have raised issues, certainly..." + (show)

Removed

wheel1 | @wheel1 | Oct 11 10:36pm

In reply to @jeffreyg "Removed" + (show)

@jeffreyg
Certainly was no attack on you, trying to understand your Doctor and I did not even know or understand that a PSA without a prostate could raise that high or how quickly it could for educational purposes of the members on this board. Everyone is entitled to their treatment decisions, this was nothing to do with where you are at or your decision’s but your Doctor’s explanations to help us.

heavyphil | @heavyphil | Oct 12 7:15am

In reply to @jeffreyg "Removed" + (show)

@jeffreyg I think we’re trying to understand if you had salvage radiation or not, after your prostate was removed and your PSA began to climb.
Since that is standard protocol in the vast majority of BCR cases, we are confused as to why it has not been mentioned. Perhaps you simply forgot to include it in your original post? Best
Phil

dhasper | @dhasper | Oct 13 6:52pm

In reply to @pesquallie "@gkgdawg Three studies I read found that low testosterone shortens life expectancy by 40%. This was..." + (show)

@pesquallie Be careful. Were these observational studies of men with naturally low testosterone, or randomized studies comparing mortality in prostate cancer patients receiving ADT versus those not receiving ADT? Because those are two very different questions. ADT reduces all cause mortality in men with prostate cancer. However, discussions about when and how much to treat are appropriate.

jim18 | @jim18 | Oct 13 7:20pm

In reply to @dhasper "@pesquallie Be careful. Were these observational studies of men with naturally low testosterone, or randomized studies..." + (show)

@dhasper In Nov 2025 JAMA a review of many studies with 10K+ (7K+ advanced) found that patients treated for local or regional prostate cancer ADT longer than 12 months continued to increase PCa specific survival, and time before recurrence and/or metastasis but overall survival decreased. For intermediate PCa the breakpoint was about 6 months of ADT. These are patients that were treated and went into remission so no need to continue ADT. Patients that have metastatic PCa will obviously survive longer on ADT as long as they are castrate sensitive.

pesquallie | @pesquallie | Oct 13 9:10pm

In reply to @dhasper "@pesquallie Be careful. Were these observational studies of men with naturally low testosterone, or randomized studies..." + (show)

@dhasper

The three studies I read all saw a 40% increase in mortality for low testosterone patients in the general population. Only one study also looked separately at those who had used ADT and it also showed a 40% reduction in life expectancy.