Husband’s low psa, aggressive Gleason 8

In my case, it took about three months for my PSA to go down from 67.9 to undetectable (< 0.01) after I started on ADT + Apalutamide (Erleada) in 2021. It has stayed undetectable since

My cancer was already at stage 4b with a single large metastasis to my spine (so assume I would have been Gleason 8 or 9 and Decipher close to 1.0).

I had debulking surgery and post-op radiation to my large spinal metastasis in 2021, and then 20 fractions of radiation (SBRT) to the prostate itself 6 months later. We hit the cancer early and hard: so far, no sign of recurrence. 🤞

In my case, I was 68. PSA 7.9 Nov 2024, 10+ late Jan/early Feb 2025. Gleason 7 (3+4) unfavorable intermediate, no metastasis. On ADT Orgovyx since March 26, completed 5 sessions SBRT on April 9 - 22, July 7 PSA 0.36 -- if it becomes undetectable or less than 0.2 next To PSA, I want to go on ADT holiday. (My oncologist told me last April that we'd see if I get off Orgovyx after 8 months or a year; I prefer 8 months or sooner.

Took me 3 months too after RT/ADT. Great analysis!

Unlike other injectable ADTs, Firmagon lowers testosterone levels quickly, which should correspondingly drop PSA levels quickly.
Clinical studies have shown that Firmagon reduces PSA levels by about 64% after 2 weeks, 85% after 1 month, and 95% after 3 months,
> At each of his PSA readings, what were his testosterone levels?
> From his MRI and biopsy reports, was there any mention of cribriform pattern or intraductal carcinoma?

In my case —> For my localized, 4+3=7, PSA of 7.976, at 65y I had 28 sessions of proton radiation + 6 months of Eligard.
> my 1st Eligard injection was on 14 April 2021
> started 28 proton radiation treatments on 19 April 2021
> by 26 May 2021, my PSA was down to 0.224
> ended proton radiation treatments on 28 May 2021
> by 9 July 2021 (at the time of my 2nd & final Eligard injection), my PSA was down to 0.008, and remained there until the Eligard began to leave my system in January 2022.

Fantastic comeback!

It looks like your husband has done the right thing all along. His PSA is high, but he had radiation, and it can take years for the PSA to reach its bottom if you have radiation. Radiation kills off the cancer slowly, Though the rate of speed varies.

Don’t get panicked, You have a normal result, and you could wait a long time before it actually hits its bottom, For some people, it has taken years to reach the bottom, and every test has lower results. After having radiation, unless the PSA rises two points above the minimum it ever reached is not considered time to do any further treatment. Sometimes the PSA will bounce around a little and go up and then the next test go down. Give it time.

My oncologist said they hope for a 0.00 PSA, because if the cancer cells have no food (testosterone) they will starve and hopefully die (at least that is my basic understanding). Expect that if it doesn’t get that low they will try different meds and approaches. From point of view your husband is on the right track. Best of blessings to you both.

That’s interesting. I’ve never heard of a .00 PSA, Testosterone at that level, but PSA may never hit that low. < .01 is Considered undetectable by some, < .1 Is considered Undetectable by others.

Is your oncologist saying that your PSA must be below .00, so .001 would be acceptable? Or, are they saying that it will be completely eliminated? Something that just doesn’t seem to happen.

"Unlike other injectable ADTs, Firmagon lowers testosterone levels quickly, which should correspondingly drop PSA levels quickly."

Exactly. That's why they put me on Firmagon initially in 2021: I was in severe medical crisis (including paraplegia from rapid spinal compression) and couldn't risk the initial testosterone surge that comes with Lupron.

Now, I'd be able to go on Orgovyx instead, which works the same way as Firmagon but without the acute side-effects around each monthly injection (a few days of flu-like symptoms, swelling around the injection sites, etc), but Pfizer hadn't obtained Health Canada approval for Orgovyx yet in 2021.

For those who don’t start on Orgovyx (because some insurances here in the U.S. either won’t cover it or won’t cover much of it), they start on Casodex (Bicalutimude) for up to 30 days. I started on Casodex.

Casodex blocks testosterone from attaching to prostate cancer cells, which prevents tumor flare when hormone therapy is started. Once testosterone levels are suppressed, the risk of tumor flare goes away.