I am curious, in a situation like Howards, can anyone comment on at what PSA level systemic (ADT) treatment would generally begin?
When I first switched my care to an MO due to return of rising PSA four years after SRT he told me that due to my history of long intervals of undetectable or very low PSA both after surgery and after SRT he would be inclined to wait longer to start me on ADT than someone who had a more aggressive history. He mentioned probably looking to start somewhere between a PSA of 5 to 10 depending in part on doubling time. As it happened, my doubling time started accelerating about
two years later. I agreed to go into a clinical trial, and while I was in the screening phase my DT kept dropping - my PSA rose from about
2 up to 6.6 in the few months I was discussing and screening for the trial. Just as I was about
to start the trial I began having intermittent back pain on the left side that turned out to be a blocked kidney due to an enlarged lymph node pressing on the ureter. So, even if I hadn't yet been ready to start SRT that would have been the event that made it necessary. As for the trial I was randomized into the control group that would get Degarelix only (Firmagon), rather than a triple whammy of Degarelix, Zytiga, and Apalutamide. The Degarelix shrank the lymph node restoring normal kidney function and dropped my T and PSA to nearly undetectable within a month.
-2002-PSA 9.4, 5 of 10 cores 30-50%
-RP 2002 PT3B N0 MX Gleason 3+4 75% left lobe small focus rt lobe
-PSA low 0.01 slow rise to 0.4
-SRT 2010 1 lymph node targeted. Casodex during SRT
-PSA 0.00 thu 2014
-0.02 Oct 14; 0.04 Apr 16; 0.2 Oct 16; 0.51 Jan 17; 2.46 Jan 18, 4.19 Apr 18;
-6.62 May 18 enlarged lymph node start Firmagon; PSA 0.45 Jun; 0.08 Jul '18; 0.02 Jan '19
Post Edited (Bohemond) : 2/22/2019 10:28:41 AM (GMT-7)