Can Prostate Cancer "Take a New Trajectory"?

You might Google AI your question
There's a Dr. Roy who is following this.
The follwing appeared in conjuntion w his name. But I don't know if he'd go along with all of or any of it. GOOD LUCK!!
After a patient completes a course of androgen deprivation therapy (ADT), testosterone levels gradually recover. A long prostate-specific antigen doubling time (PSADT) following this testosterone recovery indicates that any remaining cancer cells are growing slowly, which suggests a lower risk of biochemical recurrence (BCR).
This "flattening" of the PSA curve compared to more aggressive disease occurs when:
Residual cancer is less aggressive: The remaining prostate cancer cells are not highly proliferative, so they respond more slowly to the return of testosterone. Their slow growth leads to a longer PSADT and a less steep increase in PSA levels.
The initial treatment was highly effective: The previous treatment, such as radiation or surgery, successfully eradicated the bulk of the more aggressive, faster-growing cancer cells. What remains is a smaller volume of more indolent disease.
How a longer PSADT happens
Several factors influence the rate of PSA increase and lead to a flattened curve after testosterone recovery:
Return of androgen sensitivity: After a period of being suppressed by ADT, the PSA-producing cells—both normal and cancerous—become re-stimulated by the return of testosterone. In cases with less aggressive residual disease, this re-stimulation causes only a slow and gradual rise in PSA, resulting in a long PSADT.
Duration of ADT: The length of ADT can impact the PSA curve. A shorter duration of ADT (e.g., 6 months) often leads to a quicker recovery of testosterone to normal levels compared to a longer course (e.g., 18 months or more). However, regardless of the recovery timeline, the slow PSA kinetics following the return of androgens are what signals a less aggressive, or "favorable," recurrence.
Lower-risk disease characteristics: A longer PSADT is consistently associated with more favorable disease features. Conversely, aggressive cancers are characterized by a short PSADT and a rapid rise in PSA.
What a flattened curve indicates
A prolonged PSADT, or flattened PSA curve, is a significant prognostic indicator. It suggests:
Lower risk of future progression: Men with a long PSADT after testosterone recovery have a significantly lower chance of progressing to clinical failure or requiring further therapy.
More time before further treatment: The slower increase in PSA allows for a longer period of observation, potentially delaying the need for further, more aggressive salvage treatments.
Improved personalization of treatment: Monitoring PSA kinetics after ADT can help doctors recognize potential failures earlier and personalize management decisions, tailoring follow-up and future interventions to the patient's specific risk level.
This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes. Learn more

Tell me more about how ADT duration affects the PSA curve

What other factors besides PSADT help predict prostate cancer recurrence after ADT?

How does a longer PSADT influence decisions about salvage therapy after recurrence?
Association of PSA kinetics after testosterone recovery with ...

UroToday
Association of PSA kinetics after testosterone recovery with ... - PubMed

National Institutes of Health (NIH) | (.gov)
Prostate-specific antigen doubling time predicts clinical outcome and ...

International Journal of Radiation Oncology, Biology, Physics
Show all

Icorps, Thanks for the ‘AI take’ on that. After reading the explanation maybe Sam Altman is right and it’s just a bubble and not the next greatest thing?🫣 It almost seems like we didn’t need billions of dollars worth of GPU’s to understand that longer PSA doubling times usually indicate less aggressive cancers, right?
Hopefully, future models will be a little better than this! Thanks again,
Phil

Phil
That approach is why Im in this clinical trial at NIH (NCT05588128) w Dr Ravi Madan. He's looking for volunteers.

Might want to help get the word around.

NIH covers travel expenses of us "lab rats". Plus it's first rate detection and follow up w all results sent to your attending docs who remain the lead dogs on the sled.

Dr. Ravi Madan is leading a clinical trial to determine the natural history of prostate cancer recurrence in patients with very low PSA levels that are detectable with sensitive PSMA scans. The core question of the trial, and the answer to your query, is: Just because a sensitive PSMA scan can now detect recurrence at very low PSA levels, does that mean we should immediately treat it? The current consensus is often no, and the study aims to definitively answer this question.
The clinical trial and its implications
Study design: Dr. Madan's trial (NCT05588128), conducted at the National Cancer Institute, monitors patients with biochemically recurrent prostate cancer (a rising PSA after initial treatment) using repeated PSMA PET imaging, along with regular PSA tests and biomarker collection.
Understanding the disease's "natural history": The primary purpose is to follow patients without immediate intervention to see how the disease progresses over time. PSMA scans can show tiny spots of cancer earlier than ever before, but it's not known if these micrometastases represent an immediate threat to the patient's health.
Challenging the impulse to treat: Previously, conventional imaging like CT and bone scans were far less sensitive, so visible recurrence was treated. Now, very sensitive PSMA scans can create anxiety by revealing tiny spots of cancer that may be clinically insignificant and progress very slowly. The trial questions whether this finding necessitates immediate, aggressive therapy.
Early findings: Preliminary results presented at ASCO 2024 showed that of 86 patients monitored, 76 had PSMA-positive findings, but only one progressed in the short term, with 85% receiving no treatment. This early data suggests that many patients with PSMA-detected recurrence can be safely monitored without rushing to therapy.
Preserving quality of life: A major goal of this research is to delay the need for systemic treatments like Androgen Deprivation Therapy (ADT), which can cause significant side effects and reduce quality of life. The trial seeks to find low-toxicity alternatives or determine that surveillance is the better option for some patients.
PSA doubling time remains important: The study reinforces that PSA kinetics—specifically, the rate at which PSA levels are rising (PSA doubling time)—are still a crucial indicator for risk stratification and may be more important than a single positive PSMA scan.
Conclusion: A change in approach is likely needed
The research by Dr. Madan and others suggests that simply seeing a spot of cancer on a PSMA scan at very low PSA levels does not automatically mean treatment is necessary. The high sensitivity of PSMA imaging requires a new understanding of what "recurrence" means in this context. The findings from this trial will help develop new, evidence-based guidelines for managing patients with PSMA-detected recurrence, potentially allowing for active surveillance in certain cases and avoiding or delaying unnecessary toxicity from treatment.

Is their PSMA Pet test different than the normal one. The normal PSMA Pet test cannot detect micro metastasis. Smallest metastasis they can see is 2.7 mm and the RO at UCSF Said during a recent seminar that even at 5 mm it is hard to see metz.

But as to yout major point on detection, I'm sure Madan understands this and has a system of seeing whether the remaining cancer is "PSMA stable" etc.
That PSMA PET is still not "all seeing" is why my guy at Georgetown Dr. Sean P. Collins used a nearby field radiotherapy zapping system even w SBRT where he'd zap nearby nodes that weren't glowing
He's now at U of Southern Fla.

Phil
That approach is why Im in this clinical trial at NIH (NCT05588128) w Dr Ravi Madan. He's looking for volunteers.

Might want to help get the word around.

NIH covers travel expenses of us "lab rats". Plus it's first rate detection and follow up w all results sent to your attending docs who remain the lead dogs on the sled.

Dr. Ravi Madan is leading a clinical trial to determine the natural history of prostate cancer recurrence in patients with very low PSA levels that are detectable with sensitive PSMA scans. The core question of the trial, and the answer to your query, is: Just because a sensitive PSMA scan can now detect recurrence at very low PSA levels, does that mean we should immediately treat it? The current consensus is often no, and the study aims to definitively answer this question.
The clinical trial and its implications
Study design: Dr. Madan's trial (NCT05588128), conducted at the National Cancer Institute, monitors patients with biochemically recurrent prostate cancer (a rising PSA after initial treatment) using repeated PSMA PET imaging, along with regular PSA tests and biomarker collection.
Understanding the disease's "natural history": The primary purpose is to follow patients without immediate intervention to see how the disease progresses over time. PSMA scans can show tiny spots of cancer earlier than ever before, but it's not known if these micrometastases represent an immediate threat to the patient's health.
Challenging the impulse to treat: Previously, conventional imaging like CT and bone scans were far less sensitive, so visible recurrence was treated. Now, very sensitive PSMA scans can create anxiety by revealing tiny spots of cancer that may be clinically insignificant and progress very slowly. The trial questions whether this finding necessitates immediate, aggressive therapy.
Early findings: Preliminary results presented at ASCO 2024 showed that of 86 patients monitored, 76 had PSMA-positive findings, but only one progressed in the short term, with 85% receiving no treatment. This early data suggests that many patients with PSMA-detected recurrence can be safely monitored without rushing to therapy.
Preserving quality of life: A major goal of this research is to delay the need for systemic treatments like Androgen Deprivation Therapy (ADT), which can cause significant side effects and reduce quality of life. The trial seeks to find low-toxicity alternatives or determine that surveillance is the better option for some patients.
PSA doubling time remains important: The study reinforces that PSA kinetics—specifically, the rate at which PSA levels are rising (PSA doubling time)—are still a crucial indicator for risk stratification and may be more important than a single positive PSMA scan.
Conclusion: A change in approach is likely needed
The research by Dr. Madan and others suggests that simply seeing a spot of cancer on a PSMA scan at very low PSA levels does not automatically mean treatment is necessary. The high sensitivity of PSMA imaging requires a new understanding of what "recurrence" means in this context. The findings from this trial will help develop new, evidence-based guidelines for managing patients with PSMA-detected recurrence, potentially allowing for active surveillance in certain cases and avoiding or delaying unnecessary toxicity from treatment.

You might Google AI your question
There's a Dr. Roy who is following this.
The follwing appeared in conjuntion w his name. But I don't know if he'd go along with all of or any of it. GOOD LUCK!!
After a patient completes a course of androgen deprivation therapy (ADT), testosterone levels gradually recover. A long prostate-specific antigen doubling time (PSADT) following this testosterone recovery indicates that any remaining cancer cells are growing slowly, which suggests a lower risk of biochemical recurrence (BCR).
This "flattening" of the PSA curve compared to more aggressive disease occurs when:
Residual cancer is less aggressive: The remaining prostate cancer cells are not highly proliferative, so they respond more slowly to the return of testosterone. Their slow growth leads to a longer PSADT and a less steep increase in PSA levels.
The initial treatment was highly effective: The previous treatment, such as radiation or surgery, successfully eradicated the bulk of the more aggressive, faster-growing cancer cells. What remains is a smaller volume of more indolent disease.
How a longer PSADT happens
Several factors influence the rate of PSA increase and lead to a flattened curve after testosterone recovery:
Return of androgen sensitivity: After a period of being suppressed by ADT, the PSA-producing cells—both normal and cancerous—become re-stimulated by the return of testosterone. In cases with less aggressive residual disease, this re-stimulation causes only a slow and gradual rise in PSA, resulting in a long PSADT.
Duration of ADT: The length of ADT can impact the PSA curve. A shorter duration of ADT (e.g., 6 months) often leads to a quicker recovery of testosterone to normal levels compared to a longer course (e.g., 18 months or more). However, regardless of the recovery timeline, the slow PSA kinetics following the return of androgens are what signals a less aggressive, or "favorable," recurrence.
Lower-risk disease characteristics: A longer PSADT is consistently associated with more favorable disease features. Conversely, aggressive cancers are characterized by a short PSADT and a rapid rise in PSA.
What a flattened curve indicates
A prolonged PSADT, or flattened PSA curve, is a significant prognostic indicator. It suggests:
Lower risk of future progression: Men with a long PSADT after testosterone recovery have a significantly lower chance of progressing to clinical failure or requiring further therapy.
More time before further treatment: The slower increase in PSA allows for a longer period of observation, potentially delaying the need for further, more aggressive salvage treatments.
Improved personalization of treatment: Monitoring PSA kinetics after ADT can help doctors recognize potential failures earlier and personalize management decisions, tailoring follow-up and future interventions to the patient's specific risk level.
This is for informational purposes only. For medical advice or diagnosis, consult a professional. AI responses may include mistakes. Learn more

Tell me more about how ADT duration affects the PSA curve

What other factors besides PSADT help predict prostate cancer recurrence after ADT?

How does a longer PSADT influence decisions about salvage therapy after recurrence?
Association of PSA kinetics after testosterone recovery with ...

UroToday
Association of PSA kinetics after testosterone recovery with ... - PubMed

National Institutes of Health (NIH) | (.gov)
Prostate-specific antigen doubling time predicts clinical outcome and ...

International Journal of Radiation Oncology, Biology, Physics
Show all

Well, icorps, it certainly seems like a study worth doing; overtreatment is nobody’s idea of fun, right? And of course, thank you for your service to our cause!
In another discussion (last week maybe?) it was mentioned that before PSMA, bone scans were the gold standard for retreatment; if it’s not in the bones you’re OK. We can all see the shortcomings in that line of reasoning, but it mostly worked…
I’ve long felt that PSA doubling time/velocity is the real measure of aggressiveness and I hope the study - of which you are a part - validates this beyond a doubt.
But I can think of the men with very aggressive cancers whose cells do not produce much PSA really throwing a wrench into the hypothesis.
What do you tell a patient who has multiple metastases to the ribcage discovered on a chest Xray during a yearly physical? Yikes! Again, so many damned exceptions…Best,
Phil