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PSA wrong direction after IMRT - What do you guys think?

Posted by mjp0512 @mjp0512, Dec 5 4:37pm

ADT/ARSI (Orgovyx/Nubeqa) since 6/7/25. IMRT X 20 9/30/25- 10/27/25. Appointment coming up 12/10 for review w/ GUO doc. More history in profile if needed.

PSA...
3/12/25 - 24.77
4/21/25 - 30.11
7/9/25 - 0.55
8/26/25 - 0.19
12/3/25 - 0.23

I'm leaning toward just a pissed off prostate after being zapped. Nothing to worry about yet but then again, it shouldn't be going up on ADT. Whatcha think? No worries or time to break out the single malt?

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mjp0512 | @mjp0512 | Dec 7 4:48am
In reply to @brianjarvis "> What was your Gleason score at the start of treatments (and the reason you were..." + (show)
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> What was your Gleason score at the start of treatments (and the reason you were on doublet therapy)?

> Are you still on Orgovyx? (For as long as the hormone therapy is in your system and your testosterone remains suppressed, your PSA should remain nearly undetectable.)

> What is your testosterone level now?
===========

My experience —> I received 28 proton radiation treatments during April-May 2021 (@ 2.5 Grays per session). I had Eligard injections in April & July 2021; the hormone therapy remained in my system through January 2022. It was only after the hormone therapy left my system and my testosterone level began to rebound did my PSA levels increase and then somewhat stabilize. (I charted my PSA results.)

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@brianjarvis
T = 9...just came back, Brian.

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brianjarvis | @brianjarvis | Dec 7 6:06am
In reply to @mjp0512 "@brianjarvis T = 9...just came back, Brian." + (show)
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@brianjarvis
T = 9...just came back, Brian.

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@mjp0512 That’s a very good number (9.0 ng/dL) for testosterone (T) while on ADT.

The goal of hormone therapy (ADT) is to suppress your T from whatever it normally was to get it far below 50 ng/dL.
> If T goes below 20 ng/dL that results in even better outcomes.

With your T level at 9.0 ng/dL, your next PSA test should continue the trend downward (it may zig-zag downward) until it goes to nearly undetectable while the Orgovyx is in your system.

Always discuss all of your results with your doctor so that both your and his expectations will be on the same page.

> Ask them for a T test with every PSA test.
> Do they do a complete blood workup (CBC & CMP) with every PSA test?
> Did you have a DEXA scan prior to starting ADT?
===========

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mjp0512 | @mjp0512 | Dec 7 6:43am
In reply to @brianjarvis "@mjp0512 That’s a very good number (9.0 ng/dL) for testosterone (T) while on ADT. The goal..." + (show)
Profile picture for brianjarvis @brianjarvis

@mjp0512 That’s a very good number (9.0 ng/dL) for testosterone (T) while on ADT.

The goal of hormone therapy (ADT) is to suppress your T from whatever it normally was to get it far below 50 ng/dL.
> If T goes below 20 ng/dL that results in even better outcomes.

With your T level at 9.0 ng/dL, your next PSA test should continue the trend downward (it may zig-zag downward) until it goes to nearly undetectable while the Orgovyx is in your system.

Always discuss all of your results with your doctor so that both your and his expectations will be on the same page.

> Ask them for a T test with every PSA test.
> Do they do a complete blood workup (CBC & CMP) with every PSA test?
> Did you have a DEXA scan prior to starting ADT?
===========

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@brianjarvis

> Yep...T test is done each time
> Yep...CBC, CMP, along with BMP and Troponin T (I'm a CHF patient as well so Cardio-Oncology wants their 2 cents.) So far, the only thing out of whack is a slightly elevated glucose (150ish)
> DEXA is scheduled for mid-January. Was originally scheduled for October but then radiology got an opening for me, and they didn't want to do it in the middle of IMRT.

Hey, thanks for taking the time to chime in!

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duberdicus | @duberdicus | Dec 8 1:07pm

0.23 sounds pretty good to me.
Smile and say "I hope it stays that way."

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