How long after salvage RA for PSA to drop?

Jack - If I understand his story based on your description, I am surprised that he was not on ADT with his salvage radiation therapy given his G9 and PT3b pathology? I might ask if his salvage radiation included lymph nodes or was just the local prostate area. I would agree that he needs to find a prostate experienced oncologist to take over his case as it sounds like his URO and RO have done their things without much luck so far.

At a PSA of 0.503 and probably rising, he might benefit from one of the newer PSMA scans that might find the source(s) of the PSA at this point. Could be in the lymph nodes which could be treated if not done yet. Could be elsewhere but still local to the prostate area and possible treatment. Could also be a mess where there are no great options.

On the other hand, his PSA could stabilize and start dropping if the radiation actually nailed the source of the PSA. If he was to go on ADT now, PSA would stop being an indicator of anything so I would probably keep monitoring it but get the oncologist on board to develop the plan of attack with him.

Somewhat good news. He visited his Uro and RO yesterday and both agreed that the salvage radiation failed. Sad to hear, but both agreed to set him up with a MO, a PSMA scan and recommended Orgovyx as a possible treatment. I did ask him again to come over here where there are a lot more veterans who will respond to any questions he has going forward. Thanks a bunch and best wishes all.
Jack

F8- I agree and when a Uro tells you that ADT is a last resort for palliative care and will fail in the end is absolutely bizarre. I would guess that in the meeting with both the Uro and RO, the RO took the lead.
My best you and congratulations on your long run of undetectable PSA results.
Jack

Jack - I am not sure referring to ADT as palliative care is appropriate as it conveys a sense of finality to end suffering that is typically not the case here. If his URO used that terminology, it is a poor choice of words. Your friend probably has no cancer symptoms and is facing a "numbers" problem at this point. Until such time as the PSMA scan is completed, he really should try to stay optimistic as there are still may be treatment options. Even if he has to go on ADT which generally kills most of the cancer, there is no reason for him to think that he is in his last months of living. There are lots of stories of men living a long time after failed treatment even with metastasis to scattered bones.

I am thinking he needs some positive mental attitude now after some nasty doctor visits. Try to give him some hope and to look forward to getting the scan done. There is a lot of neat stuff going on in the PCa treatment world currently that helps all of us cope with our cancer.

Jack64 said...
...when a Uro tells you that ADT is a last resort for palliative care and will fail in the end is absolutely bizarre.

Jack,
While it is true that long term ADT will not last indefinitely, there have been striking improvements just in the time I have been on the Forum. It went from ADT working for 2 or 3 years, to the addition of the "novel" anti-androgens, to the best sequencing of these ADT drugs. If I correctly understand the results of the drug trials, which have already been going on for years, the survival end points for some groupings of the participants have not yet been reached. With the current state of affairs, it wouldn't be a stretch to believe that your friend has a reasonable expectation of 10 years or more.

As Mumbo suggested, there's a lot of exciting treatments that show real possibilities for further extending men's lives. My non-expert feeling is that in the next 5 or 10 years the long-haul management of PCa can become a reality.

Hopefully I'll be around to take advantage of that. 🙂

It is not a certainty that ADT runs out and that it should be saved for later. How outdated an treatment position. On this board we know a very high risk G7 that continues on a 13 year ADT run successfully and a G9 that is also continuing successfully after some nine years. On the other hand, we have had members that were ADT resistant from the start and it never worked for them. And most men are in between.

With the additional drugs in the past decade and the evolving methods of timing, sequencing and mixing, ADT has, for many, if not most, become a more successful method of long term management of systemic disease. I suggest the uro that appears to have been resistant to both SRT and ADT should find another field of endeavor due to incompetence.

After my salvage radiation, the first PSA test (3 months) and all after have been <.03. Before starting SRT, I asked the radiation oncologist if I needed ADT at that point. He said bluntly, NO. Fine with me.