What Does Undetectable PSA Really Mean?

Got my latest PSA result last week: <.06, undetectable. I know it's good news, but I wonder just how good. Asked my radiation oncologist about it and he said it means we're ablating the cancer cells (I'm 29 treatments into a schedule of 39 IMRT treatments). It hard to tell where I"m at from doctors. They don't want to be too positive is my impression. He also told me there's a recent report in the New England Journal of Medicine that says dual hormone therapy is worthwhile for some patients and that might something for me. If my PSA is undetectable, would I really need to add another hormone drug?

Just how good is this PSA result?

The reason your PSA has dropped to undetectable is the lupron shot, not the radiation..It takes a year or more for radiation to have its maximum effect. Gleason 10 IS curable but it's a 50-50 deal...That's why your doctors are a little shy about giving you a solid prognosis..It will be a year or two before they can do that...Best of luck to you...

PS...They will want to keep you on the ADT for at least a year, maybe two years to get the maximum benefit from it..

Glad you're responding well to the HT!

TA...28 months? Is that specific to a G10 diagnosis or is there some new data out there? I know length of HT is one of those things that hasn't been clear so wondering if I've missed something new.

Thanks Allen.

Hi af1001 - it seems I missed your introductory post back in March. You've found already some of the most knowledgeable folks here, so let me just welcome you. I've added you to a thread focused on those of us facing these high/very high risk diagnoses. You're in the G10 group there. This roster is to provide some forum names and links to their initial posts for others in a similar situation. Here's a link to that thread:

The Gleason 9 Crew -- Part 2, continued.

Back in 2013 my ADT began before radiation therapy, about 2 months. During that time, we were watching for the PSA to drop to less than 0.5 before starting RT. Mine seemed to be falling but not fast enough, and we added Casodex to the Lupron, so I went on "ADT2".

The next PSA check was after RT, and it was undetectable as hoped. I stayed on ADT2 for the whole planned 3 years, commonly suggested for such cases at the time (though ADT2 is arguable vs just ADT). There has been discussion about 2 vs 3 years, and lately it seems 2 years has become more accepted (actually more like 28 months as described in this thread). If you include the initial 4 months (2 before RT, 2 during RT), mine would be most precisely described as really 34 months from start through "release" of ADT2 (May 2013 through March 2016).

At about the 2 year mark, I was protesting to my MO. She said if I could tough it out another year she suggested I do so. Two points: 1) We'd rather find out in 10 years that 3 years was too long, rather than that 2 years was too short, and 2) Length of hormone therapy in breast cancer is a hot topic too, but they're discussing how much longer, not how much shorter, they should do!

All of this was part of my primary therapy with curative intent.

The side effects of ADT are so onerous that we males find it very difficult to live with, considering what it does to us.

You'll find that most studies have very few G9-10 cases, so applying their generalized "high risk" results to our specific situations is a stretch. There aren't enough of us to draw statistical conclusions in their studies, so they lump us in with other cases saying they have similar risk profiles (like PSA > 20, any cT3/T4, or G8-10]. I don't really like that, since we know that G8 are lower risk than G9-10 due to lack of the rogue Type 5 cells. Similarly, I find it's hard to accept that a cT3 G6 is similar risk to a G9, but that grouping would say so. It just blurs things too much, making the results of such studies hard to apply to us.

RobLee-

SRT is a different situation from primary RT for a high risk diagnosis (which is what the OP was asking about).
Here's a review of the evidence so far of adjuvant ADT in the salvage situation:

/pcnrv.blogspot.com/2016/08/combining-androgen-deprivation-therapy.html

Tall Allen said...
RobLee-

SRT is a different situation from primary RT for a high risk diagnosis (which is what the OP was asking about). Here's a review of the evidence so far of adjuvant ADT in the salvage situation:

/pcnrv.blogspot.com/2016/08/combining-androgen-deprivation-therapy.html

Thank you for the link. I failed to note that the case in point was primary RT.

My RO did say he preferred starting HT prior to SRT, and presumably throughout treatment and probably for some period beyond. Exactly how long I will not know until I see him again next month. But one snippet from the article you provided caught my attention:

Jackson et al. at the University of Michigan reported 5-year incidence of distant metastases was 6% if they received more than 12 months of additional ADT after SRT, but 23% if they received less than 12 months of additional ADT. In fact, every month of ADT was associated with a 10% reduction in biochemical failure, distant metastases, and mortality.