Thanks Sr Sailor, can you talk about the progression to 1.3 ng/ml ? Did it slowly inch up while you sweated bullets and then leveled off....or was it more like a step function ? That's the toughest thing I see about my situation, how to balance increasing PSA to see if it levels off vs when do I give up and engage treatment.
Hi there, DaysBetween. I just saw this post. I was on ADT for 3 years, and saw my testosterone and PSA both rise pretty quickly after it "released", the term for when the Lupron finally wears off.
This alarmed me at the time, but it seems some of us experience this. Here's my understanding of what happens. If you didn't have ADT, your PSA would follow a trend after radiation. It would typically rise a bit, then fall, with a bounce or two along the way, down to some ultimate stable level, say 1.3 for example. If it stays there, then all is well. This could take a couple of years, but eventually it would just stay around 1.3 with some test-to-test variations up and down.
Now if you have ADT, that squashes the PSA down to nearly zero. That's generally done along with the initial radiation therapy, so all you see for a couple of years is undetectable PSA. Again, without the ADT you'd see the post-radiation trend, but it's suppressed due to the ADT.
When ADT releases, the testosterone recovers, and the PSA rises with it (and quickly). But it is just popping up to what it would have been after radiation anyway. So the rate-of-rise after ADT releases can be scary, but it's really rather meaningless. Once it gets back to the post-radiation trendline level, it should stop rising and just hang out at that level.
If it keeps on rising, well, maybe then there is reason for concern. But that "step function" characteristic rise after ADT isn't necessarily trouble in and of itself. That whole thing can take months to a couple of years to work through, as a lot of guys take a long
time to recover testosterone after ADT.
[Edit to add: One of my oncologists didn't buy this theory at all, so I would be remiss if I didn't mention it. He was alarmed that my PSA had risen at all
after testosterone recovery. He wanted it to stay undetectable, which is the case for many guys (forum member JNF for example), after primary radiation/ADT therapy. So, as with everything in this disease, there isn't a really clear answer. We all have to talk to doctors, research, and derive our own conclusions.]
Post Edited (Redwing57) : 4/5/2021 12:15:24 PM (GMT-6)