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First PSA taken after treatment

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Posted 7/1/2018 4:46 PM (GMT 0)
I have completed 26 sessions of imrt + HDR brachytherapy(1fraction)+ on going Lupron injections(18 months)my initial psa was 26.6 , first 3 months down 1.1 , 6 month 0.4 which was about 2 weeks after my HDR brachytherapy. My question is should I be undetectable at this point or is my numbers ok at this point in my treatment.
Posted 7/1/2018 4:56 PM (GMT 0)
Sober1: with primary radiation treatment, you may never reach non-detectable--you still have a prostate gland in there that is putting out some PSA. With radiation, what happens is that you track it over time and it will reach a nadir--two or three readings in a row that are about the same. THAT becomes your tracking value for the future--if it changes, and how much, determines your future needs.

That being said, 0.4 is a great value to be at, down from your initial 26.6
Posted 7/1/2018 5:07 PM (GMT 0)
Thanks halbert
But since I’m on ht shouldn’t I be undetectable?
Posted 7/1/2018 5:37 PM (GMT 0)

Sober1 said...
Thanks halbert
But since I’m on ht shouldn’t I be undetectable?

No, re-read halbert's post please

PS: Your results look great!

Post Edited (Sr Sailor) : 7/1/2018 12:07:44 PM (GMT-6)

Posted 7/1/2018 5:46 PM (GMT 0)
Since you are on ADT you may get to undetectable. Many of us that used radiation and ADT were and continue to be. Using radiation you eventually want to be under .50 for the best prognosis. But as long as you are on ADT and then for about a year, the main effect on your PSA will be from the ADT. I reached undetectable in about 100 days from my first shot of Eligard and more than seven and a half years remain undetectable. Using radiation it is not expected to be undetectable, but nor is it unusual either. The radiation does quite a number on the prostate tissue and it then expresses very little if any PSA.
Posted 7/1/2018 5:58 PM (GMT 0)
Ok thanks you guys

So my psa should continue to drop and may become undetectable but the goal is 0.50 or less?
Posted 7/1/2018 6:58 PM (GMT 0)
Have you had your T-level tested? With ADT (HT) you should have almost no PSA. On just RT it can take awhile. With RT there is no absolute number you're trying to get to. You want to get to a nadir (lowest point) and then never rise above 2.0 above that.

So far, you're doing good.

Andrew
Posted 7/1/2018 7:12 PM (GMT 0)
Thanks
T=18
Posted 7/1/2018 7:45 PM (GMT 0)
I had the same treatment as you so I pulled my charts to look at my PSA. After starting ADT, but prior to my HDR brachy, my PSA had gone down to 0.25. Then after treatment while I was on ADT my PSA hovered between 0.01 and 0.02.

But...my doctor didn't do any PSA tests while I was in the middle of radiation since he said that would raise my PSA and there was no sense in checking it during that period. So if your last PSA was only two weeks after your brachy, then maybe it's a bit higher due to that?
Posted 7/1/2018 9:38 PM (GMT 0)
Thanks
PSA has dropped at 3 months and again at 6 months, I’m just wondering if it matters how long it takes to drop to its lowest level on HT
Posted 7/1/2018 9:41 PM (GMT 0)
Also I’m only getting Lupron injections no other ADT
Posted 7/1/2018 10:02 PM (GMT 0)
FWIW, I was also on Casodex and Zytiga, along with Lupron.
Posted 7/1/2018 10:25 PM (GMT 0)
Yes, but does that make a difference? Should I be on more ADT?
Posted 7/1/2018 11:05 PM (GMT 0)
I'm not knowledgable enough to know if you should be on more ADT...and your ADT is clearly working since your testosterone is 18. But clearly my doctor thought that there was a benefit in having me include the other drugs, which is I mentioned it.

The use of Zytiga is pretty new in guys without advanced disease and I'm not sure how much data there is to support its use in early diagnoses. (This is definitely Tall Allen territory.) The use of Casodex is much more common, but again if your testosterone is as low as it is, there may not be any additional benefit. Hopefully, some of the more knowledgable guys will weigh in.
Posted 7/1/2018 11:09 PM (GMT 0)
Thanks
Michael T
Just trying to understand the numbers
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