ADT DELAYS DETERMINING YOUR NADIR AFTER RADIATION ?

Was told that men who had radiation treatment and ADT cannot
determine their nadir until all of the ADT is out of their system.

How do you know or tell when it is no longer in your system?
How long does it take to no longer be in your system (6 months,
1 year, 2 years) ?

PhilC

Tall Allen,

What number is T considered at castrate level? What number do you need to be at to be ABOVE castrate level?

Before ADT my T was 826. I read where you only regain
60% back after ADT. Is that right?

When I started IGRT on April 15, '13 my T was down to 11.
Finished IGRT June 14, '13. Had my first PSA test after IGRT
on November 2, '13 showing PSA at 0.064 with T at 13.

Didn't know about the ADT effecting the nadir so didn't request
a T test when I had my second PSA test on January 16, '14 showing 0.544. Will not happen again!

If my PSA goes up two more straight times will I have a recurrence
without knowing my nadir? I know if it goes up 2 points above your
nadir you have a recurrence.

Thanks Allen,
Phil

I don't know how low it is supposed to be but I'm at 2.5 and psa has been holding steady at 0.01 since May. Happy with the numbers but man I feel like crap still have another year and a half to go hoping it doesn't kill me first.

While I was on Lupron, my T got down to low single digits. PSA went undetectable (<.1). Three month after shot "expired" I still had full on SEs, T was less than half pre-shot levels, and PSA was rising.

After 6 months, still full on SEs, T was back to pre-shot level, PSA rising quickly.
At 9 months, SEs are not so bad (occasional hot flashes), am losing some of the HT weight (down 32 pounds at last check), T is about 50 points above pre-shot levels, and PSA is rising.

Will probably go back on Lupron in March, expecting a PSA of 7 (my pre-treatment PSA) by then based on current path.

I'm not sure where the idea that your T doesn't recover comes from. It might have to do with the initial levels, or how long you were on HT?

142,

You write:
"After 6 months, still full on SEs, T was back to pre-shot level, PSA rising quickly."

Your T was back to pre-shot level after 6 months. My first PSA test
was done 6 months AFTER my second 3 month shot of Lupron, so
it should qualify as my nadir, right? That is if I also recovered my
pre-shot T level as you did in 6 months.

You do a great job of keeping track of everything. I try to also but
somehow don't measure up to the detailed job you do. How do
you do it (notebook, diary, computer)?

Thanks,
Phil

PhilC,
You had two concurrent treatments so that your nadir is a product of how those two treatments affected your cancer. The combination of HT + RT normally has better results that each treatment by themselves. Based on what you report your 11/13 PSA of 0.06 is your nadir.

Rather than worry about definitions you should look for a stable, non progressing PSA to evaluate your treatment results given that you still have whatever is left of your prostate gland in place.

Wish you the very best outcome,

RalphV

Two important things about the nadir. First, it indicates how successful the initial treatment was, and second it is used as a baseline for determining wheter subsequesnt treatments are indicated. As Ralf said, the most important aspect is that of a steady PSA. A man could reach a nadir of only 1.0 but if he stayed constant at that level it would likely indicate that the PCa is gone.

I reached a nadir of <.10 90 days after my first Eligard shot and just after I completed radiation therapy. I have stayed there for three years. My T has also been very low. Now that I have had my last HT shot (last August) I will now see what happens as my T begins to rise. Hopefully my PSA stays undetectible and my HT side effects become undetectible as well.

PhilC said...


This is my conundrum. I have been told that over 4 months after I
completed my second Lupron shot and radiation that my PSA test
result of 0.064 could NOT be my nadir. Same time frame as yours.
What is different?

But unlike yours staying steady my second PSA test rose to 0.544.

It took my husband 6 months after IMRT and ADT to reach .02.
A year later, it dropped to .01 which sort of surprised us in a great way.

Is it possible that your PSA of .544 was a misread?

PhilC

I think that your question in your first post relates to worries of recurrence. However the “purified” nadir you are looking for may not be determinant in judging your present status.

As commented above, the PSA and T are important markers to judge the progress of our disease but one should take into account the fact that there are PCa cells that produce lesser PSA and some others do not depend much on T (to produce PSA) because they have less active Androgen Receptors. These ones can produce own androgens for survival (intratumoral effect), therefore they are prune to increase the PSA level even at low levels of T circulating in the body.

Accordingly, your PSA or T values serve only as reference, and recurrence, if any, should be judged including other means such as continuous progressive PSA values (from periodical tests in intervals greater than 45 days), symptoms and image studies (using the latest contrast agents and methodologies). Your present “dirty” nadir (0.064 ng/ml) stands as valid, independently of the treatment (HT or RT or both) causing the effect.

Physicians using the PSA to judge the post RT status of a patient follow different thresholds taking into account the fact of having a prostate gland in place. Guys with the prostate experience more often the bounce phenomenon in high values of PSA, but guys without the prostate (RT patients that had surgery initially) are expected to be less conditioned to the occurrence so that small increases in the PSA become more significant in the judgement. These guys have PSA levels in the bracket of 0.0X to 0.XX and are the ones where the nadir plus three consecutive increases signifies biochemical failure. In you, nadir plus 2.0 seems to be better to judge your case. However, this concept is valid only after both treatments have ended.
Your PSA has increased a fraction but it is too early to judge your status (as commented by Allen above).

You can read in my signature my experience with Leuprolide acetate (Eligard, Lupron, etc) and its effects on Testosterone and subsequent PSA. These levels may serve as an example but the action of the drug and your body response may provide different results. You can see that in my case T is bigger now at 490 (ng/dL) 20 months after stopping ADT effect, than the level before starting ADT of 385 (ng/dL).

You should try to avoid what many call as “PSA anxiety”. Let time judge your success.

Enjoy.

PhilC-

Read it for yourself. It says "a rise by 2 ng/mL or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT." So for purposes of identifying a recurrence, the HT-suppressed nadir does count.

Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference.

- Allen

Tall Allen said...

"Read it for yourself. It says "a rise by 2 ng/mL or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT." So for purposes of identifying a recurrence, the HT-suppressed nadir does count."

Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference.

That solves the question finally. But that brings up what Baptista
said...

"Now that you have ended the treatment, the PSA is “free” to maintain its levels or increase as it did in January 16th (PSA = 0.544). This value is higher but it cannot judge cancer progression because you got benign prostatic cells producing the serum (you got your prostate in place). In fact, nobody knows at what level your PSA will stabilize. It could be at much higher unit level than the present nadir and still mean that you are cured."

Does he mean that even though I might have a BCR it doesn't mean
that I have a clinical recurrence and STILL be cured? How long after
the BCR does it take for a clinical recurrence to occur? I know that
Mayo uses the C-11 Choline Pet Scan to determine recurrence.

PhilC