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Should I end break from ADT?

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Prostate Cancer
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Posted 8/28/2020 9:27 PM (GMT 0)
In November 2019, I started break from ADT treatment for my lymph node metastatic prostate cancer. Here is the history of PSA and Testosterone(T) since then

November 2019 PSA 0.06
February 28, 2020 PSA 0.07 T < 20
May 28, 2020 PSA 0.135 T 114
August 28, 2020 PSA 0.453 T 147

My PSA is now rising with a PSADT of 1.7 months and my Testosterone is still very low. Is my cancer becoming castrate-resistant? Should I restart ADT soon?
Posted 8/28/2020 11:53 PM (GMT 0)
Once your T is over 30 it will feed the cancer and you should expect the PSA to rise. You are deemed castrate resistant or refractory when your PSA goes up when you are on ADT and actually castrate with T under 30. The 30 is general as some docs use 50 and some use lower than that, but it is well accepted that under 30mis castrates.

You have been on an ADT vacation for a year and your PSA is now increasing. The only way to know whether you are castrate resistant is to go back on ADT and see what your PSA does. If it goes down, you are still sensitive. If it continues to go up, then you are resistant and need to go on to second line ADT or perhaps chemo.
Posted 8/29/2020 12:29 AM (GMT 0)
I hope you have an experienced oncologist on your team, ideally someone that specializes in prostate cancer. I'd follow his/her call on this. But my non-expert opinion is that based on your doubling time--actually more like a tripling time--you'd want to re-start sooner than later. I do know that guys can do intermittent ADT for a long time, so hopefully that knocks the PSA back down and you have many more ADT vacations ahead of you.
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