rising PSA next step

Hi Steve,
I'm sorry, though not surprised to see your rise has been confirmed by the latest PSA. I'd ask the doc about when to start Lupron - right away or wait for a higher number. And also ask about intermittent treatment. Does your doc think periods of Lupron alternating with Lupron vacations is a reasonable plan for you. It's very unlikely the PET scan will show anything at such a low PSA.

My history is different from yours in that I had much longer intervals between surgery and SRT and then another long interval after SRT before PSA returned, so what my oncologist recommended for me may be different than what yours might recommend for you. But my oncologist was inclined to let my PSA rise quite a bit before starting ADT - Degarelix (Firmagon) in my case, in part because I had such long intervals of low PSA after surgery and after SRT. I started ADT with a PSA of 6, but also with a rapidly shortening doubling time. Which seems to be my pattern over the 17 years I've had PCa - long periods of very slow increase that then suddenly accelerates. He thinks there is no added risk from an intermittent approach, so I'll be starting my first ADT vacation in April after a year on Degarelix.

I'm also in a clinical trial, but was randomized into the Degarelix-only group, so I'm getting the same treatment I'd have been getting otherwise other than a requirement that I stay on Degarelix for a full year before getting my first vacation.

Jim

I do have an MO.....I am a Vet and he is with the VA.... I will have an appointment with him late April.... I don't like all the stuff I read about side effects with Lupron, but I see it does prolong our life....

Now you go to the stage of chronic disease management. I agree that the uro and to are done and that you use the mo. I would also get an opinion of an mo that is documented as a specialist with advanced prostate cancer. ADT is next, just a question of when and what. You are too soon for any Mets to be found by most of the scans so you don’t know where they might be. And until you have a trend of PSA you don’t know the doubling time to determine how aggressive the cancer might be. At this stage many more questions than answers. As to being on ADT, it is no picnic. I was on for more than three years and certainly don’t want to be on it again. I would definitely pursue an intermittent strategy in your case managed by PSA levels. But that is up to an mo that does this every day with men in similar situations.

All they best to you.

I found out my "T" is only 171, so will Lupron really help....

Steve, the Lupron will knock your T down below castrate levels (<20), so yes it will definitely help.

Also, if/when the time comes to act, consider Firmagon. It knocks the T down to castrate levels more quickly. But the real upside is that it is thought to be less detrimental to the chance of developing or exacerbating heart issues. The downside is some guys, not all, have a bad reaction at the injection site.