Is PSA rise inevitable after hormone therapy?

@ajpernsteiner I would like to learn from your experience how you approached your oncologist. did you have PSA tests every three months after taking a break on Orgovyx?
I am surprised that you had bone lesions after the break. Can the lesions not be radiated? Did Xtandi work?
I ask because I was on Orgovyx for six months, starting from two weeks before my SBRT for Gleason 7 (3+4), Stage 2, unfavorable intermediate, positive on 8 of 14 cores, no metastasis. I am off Orgovyx for a week now. I am hoping for the best, but I'm not ruling out that there was undetectable metastasis before my treatment, and that I may have a recurrence in the future.
My second post-SBRT PSA test is this coming week and radiation oncologist consultation the week after. Maybe you can provide some tips on what questions to ask my oncologist. Before my treatment began, she said I might be on Orgoyx 8 months to a year, maybe longer, it depends. But after she reviewed my first PSA test result down to 0.36 from 7.9 and 10.5 at diagnosis, she said 6 months was enough.
I was glad to stop after 6 months, knowing that some of us who had radiation opted out of ADT and did well; one saw his PSA continuously declining the last 26 months post-radiation which is a very good trend. I hope mine does not begin to rise too soon.

@vircet Hello, It began when my PSA went from 2.4 to 4.3 in one year. I got a biopsy asap. I was diagnosed Gleason 10, cores were 80% positive for cancer. I was 79, so radiation plus adt. I had 45 radiation treatments, and after those and being on orgovyx, my psa was 0.04 it stayed that way for 18 months....or considered non detectable. I stayed on Orgovyx for 18 monhts. My urologist had said at the beginning with the agressive nature and gleason 10, there is a likely chance of cancer cells "out there". I had a bone scan, but not a PET scan. I decided to try a vacation at 18 months in. In hind sight, would not have, but too late for that. My psa did raise, with in 3 months, within 6 months it was up to 1.5 At that point a PSMA was ordered. I was back on orgovyx immediately. I had 3 mets. Cyberknife to the one on the spine, radiated the other 2.... I then was put on Erleada, but with it plus adt my psa began to double. Then I had another PSMA scan, and lit up all over. Xtandi did not work, Erleada did not work, doublng continued. By the time I got to Pluvicto, I was up to 134PSA. I just completed my 3rd pluvicto. My psa has come down to 93....I have almost zero side effects from it. I am also on Orgovyx. As to questions for your oncologist. Is there a way to have a PET scan BEFORE getting off ADT? Even better a PSMA? Have you had the gene testing, and all the bio marker tests. PSA tests should be often at first, never go longer than 3 months. If possible a 2nd opinion. Other than that, I work out at the gym, I manage properties, I do not have pain, and any questions out there on Pluvicto, I can tell you all about it. Best of Luck

Prostate c discovered summer of 2021. Gleason high 7 — decided to have prostatectomy. Residual c on bladder neck. PSA increased rapidly post surgery - decided to have Decipher test - results .97… Hormone therapy and prostate bed radiation began September of 2022. Non-detectable until late summer 2024. Was enrolled in Pluvitco study late 2024 - control Arm - but had frequent checks and eventually went through metastasis into bone — discovered over 30 Mets in late May this year. Now undergoing triplet therapy (chemo, hormone and Nubeqa)… just wondering what my outlook is, given all parameters. I’ve now had 5 (of 6) chemo treatments. Been told the hormone and Nubeqa will be administered indefinitely…Receiving care at Siteman Cancer Center (St. Louis) — I LOVE my “team” and am confident they are managing my case well. Just always wonder - what’s left?

Prostate c discovered summer of 2021. Gleason high 7 — decided to have prostatectomy. Residual c on bladder neck. PSA increased rapidly post surgery - decided to have Decipher test - results .97… Hormone therapy and prostate bed radiation began September of 2022. Non-detectable until late summer 2024. Was enrolled in Pluvitco study late 2024 - control Arm - but had frequent checks and eventually went through metastasis into bone — discovered over 30 Mets in late May this year. Now undergoing triplet therapy (chemo, hormone and Nubeqa)… just wondering what my outlook is, given all parameters. I’ve now had 5 (of 6) chemo treatments. Been told the hormone and Nubeqa will be administered indefinitely…Receiving care at Siteman Cancer Center (St. Louis) — I LOVE my “team” and am confident they are managing my case well. Just always wonder - what’s left?

@bjrhinos1
In 2010 I had surgery because they said I had a 3+4 Gleason. After surgery, it turned out it was a 4+3. 3 1/2 years later, my PSA started rising so they did salvage radiation. That lasted 2 1/2 years before my PSA started rising again, and I went on Lupron.

I have a genetic problem, BRCA2, Which is why it keeps coming back. Have you had genetic testing? That could be why your cancer keeps coming back and if it’s the same genetic issue, as I have, there is a drug specifically for it.

After four reoccurrences, I am now on Orgovyx And Nubeqa. It is kept my cancer undetectable for the last 23 months. I did have to have a metastasis in my spine, zapped a couple of years ago, The drugs seem to keep everything under control.

You can Get genetic testing to find out if it could be a factor. Does anybody else in your family have cancer? You can get it here for free, If you live in the USA,, takes 2 to 3 weeks to get the results and a genetic counselor will call you. They will send you a kit that you return in the mail. Don’t say you want your doctor involved or they will hold off sending the kit until they contact your doctor.

Prostatecancerpromise.org

While Pluvicto Works well for some people. It only works real well for 1/3 of people OK for 1/3 of people and not at all for 1/3 of people. Some genetic problems, cause it to not work well. It sounds like it didn’t work too well for you, But the amount of time it actually is effective is not that long for many people.