Will PSA ever hit 0 or close to it?

Still falling is good. My PSA dropped from the high 60s to < 0.01 (undetectable) after three months on a combination of ADT and Apalutamide (Erleada, an ARSI in the -lutamide family), and has stayed there for nearly 4 years now, but I had a lower starting point than your husband.

The big recent innovation (triggered by TITAN and other major trials) is starting the ARSI at the *same* time as ADT for metastatic castrate-sensitive prostate cancer (mCSPC), rather than waiting until the cancer becomes castrate-resistant to introduce an ARSI, like they used to do until recently.

Best of luck!

After chemotherapy, the PSA will continue to go down over time as the cells die. Most cells die when they try to split in order to create more, though some die from excessive damage by chemo.. There can be a small bounce in PSA and it’s considered normal since the PSA will usually continue to drop over time. Yes, the faster the PSA goes down the longer the overall survival, but you can get Pluvicto after chemo if it is not effective enough. There is also chemo with carboplatin, which can be used if the original chemo treatment was not effective enough.

If that Firmagon shot starts to become painful Orgovyx Is a great choice. It’s just as aggressive as Firmagon And has fewer side effects for many people than Lupron.

Going down (or even stable) is a good trend. The nadir may be slower to achieve for some.

PSA is trending down- exactly what you want it to do.. ..it is headed the right way...slowly but surely...!!!so relax !!!

@beaquilter
I did not have hormone treatments so won't get any personal experience with hormone treatments from me.

Regarding the PSA. What is considered undetectable depends on the lab and their equipment. Different labs can use very different numbers used that indicate undetectable level of PSA. Mayo Lab Jacksonville uses >.10 as undetectable able. So Mayo Lab Jax would never see a 0 just >.10

Other labs use different levels of what is considered undetectable and quite frankly seems a very different from one lab to another. I have not seen any posters list a lab that has a 0 number as undetectable.

Good luck!

@jc76
Yes I get that
0.1 or 0.01 is undetectable

@jc76
Actually, The medical community generally considers < .1 as undetectable. Some labs can go as low as < ,001 And others < .006 But that is not considering undetectable that is just the value they come up with.

@beaquilter
I actually collected a bunch more information about this today.

The threshold for an undetectable PSA level is not universally standardized. The American Urological Association (AUA) and the European Association of Urology (EAU) generally define undetectable PSA as below 0.1 ng/mL post-prostatectomy. However, with ultrasensitive tests, some clinicians consider values below 0.03 ng/mL as more indicative of remission. This has sparked debate over whether lower detection limits provide meaningful insights or cause unnecessary anxiety due to minor fluctuations.

A study in The Journal of Urology found that many patients with ultrasensitive PSA levels between 0.03 and 0.05 ng/mL remained stable for years without progression. However, those with steadily rising PSA levels, even within this range, were more likely to experience biochemical recurrence, typically defined as a confirmed increase to 0.2 ng/mL or higher. This suggests that while an isolated reading of 0.04 ng/mL is not necessarily concerning, its trajectory is key in guiding clinical decisions.

The significance of 0.04 ng/mL also depends on treatment considerations. Some oncologists use ultrasensitive PSA levels to determine the timing of additional interventions like radiation therapy. Research in European Urology indicates that initiating salvage radiotherapy when PSA is below 0.1 ng/mL improves long-term outcomes. However, distinguishing between transient PSA elevations and meaningful recurrence is challenging, as unnecessary treatment can lead to side effects like urinary incontinence and bowel dysfunction.

@jeffmarc
I do not speak for medical community nor should you. I am not a medical professional nor an expert on PC with medical training and medical degree.

I post my personal experiences with information given to me by my personal experiences and information given to me by my Mayo doctors. I will post what I am told directly from my doctors and did so here.

Mayo Jacksonville lab does not post any PSA numbers below >.10 as consider undetectable. I was told this by my Mayo PCP as my PSA not my opinion or fact checking.

At one point my PSA reached .10 and I asked how much lower it could go. Then I was told Mayo Lab does not post numbers below that as undetectable. What I posted is I do see other labs results given to posters that do post numbers below >.10

What is difference in >.10 and >.1 Nothing

I post from my personal experiences and not trying to speak and post for the medical community.

@jeffmarc
So your previous post "Actually, The medical community generally considers < .1 as undetectable" does not reflex all of the medical community.

Some medical professionals use different levels per specific cases and medical specifics and labs do come back with lower numbers than what Mayo Jacksonville uses >.10 as undetectable. So some labs with more sensitive tests to give lower numbers where needed by specific medical professionals.

Again, I will not try to speak for medical community. I will post my specific experience and my specific information given to me for the medical information I post and directly for my case.