Continuation of undetectable PSA after radiation in 2013

cvg

Congratulations Jim, I am very glaad about your good news. Since I found this board in 2011 you have been allways an inspiration, specially each time that my father has to go to check his PSA.
Big hugs and keep this way.;

NoCrystalBall

Congrats, Jim.

As you pointed out, PSA after EBRT or seeds does not go to 0 but over a few years reaches a nadir. I would be interested if the PSA will rise over time from the nadir even in the absence of recurrence.
best to all.

IADT3since2000

New Test - Same Wondrously Surprising Story!

I had another PSA test on May 5 with the same result: < (less than) 0.05! That date is a few weeks past the three year anniversary of the end of my course of IMRT with TomoTherapy.

I could get used to this!

IADT3since2000

Hi Jack,

I'm glad to be able to provide to you some of the kind of reassurance I myself received at the beginning.

Modern radiation is just as good as surgery for less challenging cases and appears to be significantly better, generally for higher risk, so you can be confident. The side effect profile, while not completely flat, is pretty low after you get past the treatment. (I did not want to be too far from a bathroom during the latter weeks of the surgery and for a while afterward.)

Usually no ADT is given for low-risk cases, so I'm guessing that your case has somewhat higher risk. Will you be on ADT for a long time?

Jim

IADT3since2000

Hi again Jack.

"Gleason 8" gets your attention, but there have been many good outcomes.

There is substantial research indicating that men with "high-risk" cases (Gleason 8 makes a case high-risk) generally do a lot better when on a longer course of ADT, in contrast to no advantage for any ADT for low-risk men and a fairly short course for intermediate-risk patients. That was convincing to me: I definitely wanted the long course of ADT. "Long" means from 18 months to 36 months, though it appears there may be no advantage beyond 24 months. Six months has been compared to 24 months and found inferior, but researchers/doctors are not sure just where the ideal sweet spot is.

My highly respected second opinion oncologist advised me that 18 months of triple ADT (for me, Lupron + an antiandrogen like Casodex + Avodart) would be more potent than 18 months of single blockade (such as just Eligard) and should be plenty sufficient. That's what I did, and unless my PSA test Friday is a surprise, I will continue on a great course at the 3 1/2 year point since radiation.

I'm convinced that combined blockade, such as Eligard plus Casodex, is much better than single blockade for most men, though I believe triple blockade is even better than combined two-agent blockade. You do not need to have detectable mets to go on either combined or triple blockade.

The "what life is like" issue is a big one, of course. There is great variation among patients of the burden of side effects, and countermeasures for those side effects often make a major difference. About 10% of us are in the lucky group that gets all the benefit and hardly notices side effects. At the other end, a few of us have such bad side effects that we have to stop the drugs. Recently progress has been made in figuring out which of us patients is more likely to have a greater burden from ADT side effects. While preliminary, the paper abstracted at the following site is the kind of research showing promise: http://www.ncbi.nlm.nih.gov/pubmed/27485119 .

Most of us are somewhere in the middle, as I was. With countermeasures, my hot flashes were quite tolerable, though sometimes a nuisance; countermeasures like soy probably helped, and a variety of fans helped for sure, including a standing fan I had on all night. There are several drugs that can virtually and quickly knock out hot flashes. Bone density preservation medication and supplements did a great job. Exercise helped overall, and in particular helped maintain muscle mass and strength, keep weight in bounds (even found out eventually how to lose weight while on ADT and get down to ideal weight), prevent depression, prevent fatigue, and preserve endurance. (I did take naps during the latter part of radiation and for a time afterwards.) There are countermeasures for other side effects too, such as breast growth and soreness that some of us experience.

All this said, you might do well on just your current course of ADT, but that is a higher-risk approach. It is especially important to learn about side effect countermeasures if you are on ADT more than several months.

IADT3since2000

My PSA on August 19 continued the record of no result exceeding less than 0.05 following IMRT (TomoTherapy radiation with pelvic coverage supported by 18 months of ADT3)!

Also, for the first time in sixteen years my oncologist said seeing him in six months instead of three or fewer months would be fine (but labs every three as usual). I graduated!

Max1822

Jim you are inspiration to all those in here. Many more successful readings. Cheers bud!

Baptista

Hi Jim,
I just login to congratulate your results. Two years of undetectable PSA under "clean" ADT environment is super. You may have knocked down the bandit for good with the RT shot.
Best wishes and peace of mind.
Baptista

IADT3since2000

Hi Baptista!

Thanks, and it's great to see you posting!

Jim