When to get PSA test after starting ADT?

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watertender
watertender Member Posts: 9 Member
edited April 2022 in Prostate Cancer #1

I have been on Orgovyx now for one month and am wondering when I need to get a PSA check to see if it is actually working. How often are folks getting a PSA test while on ADT and are you also getting testosterone checked at the same time or is there a need?

Thanks!

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  • VascodaGama
    VascodaGama Member Posts: 3,662 Member
    #2
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    Hi,

    Just to serve as reference, I have been testing the PSA every three months to have an eye on cancer development.

    When on ADT I checked the testosterone (T) every six months to verify drug's effectiveness.

    T should be lower than clinical castration (T< 30 ng/dL), and the PSA should be lower than remission levels (PSA < 0.05 ng/ml).

    ADT failure or refractory would be considered if the PSA starts to increase while T is on castration levels. On the contrary, we could expect "cure" when T is at normal levels (T > 250 ng/dL) and the PSA continues in remission.

    LHRH agonists (Lupron) and antagonists (Orgovyx) work at the pituitary to disrupt the endocrine system. Failure of these drugs are rare and such occurrences are regarded as bad administration of the drug.

    The PSA test is used to quantify prostatic antigens in circulation. This serum is produced in higher volumes when prostate cells multiply but not all types of prostate cells produce equal amounts. Aggressive high Gleason grades commonly produce lesser PSA than lower grades.

    Not all urologists use the testosterone as a marker, however, recurrence in hormonal treatments should not be considered just from a rise of the PSA if T is also high.

    Some oncologists also test the prostatic acid phosphatase (PAP) in patients diagnosed with aggressive Gleason grades. PAP test was the common test used to check PCa in my times (1990th), before the era of the PSA. In my case of Gleason 6, the PAP was negative while the PSA was 22.4 ng/ml.

    Best,

    VG

  • Old Salt
    Old Salt Member Posts: 1,345 Member
    #3
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    I would get a PSA test at the 3-month mark (like Vasco wrote) and a testosterone test at the same time.

  • watertender
    watertender Member Posts: 9 Member
    #4
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    https://csn.cancer.org/discussion/comment/1695563#Comment_1695563

    Thanks for that very detailed response.  Thinking about the addition of Zytiga since I am at a Gleason 9 T3a, but my RO is unsure on that.

    Regards.

  • VascodaGama
    VascodaGama Member Posts: 3,662 Member
    #5
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    Hi Watertender,

    I wonder how was your husband diagnosed. You commented him being Gleason 9 T3a (locally advanced case) but how far advanced is his case?

    Did the MRI identify metastases?

    What is his PSA histology?

    How old is he?

    In your first thread you mentioned on his doctor's recommendations for Brachy plus EBRT. I wonder if the treatment option changed to ADT?

    Why do you say that the doctor is not sure in adding Zytiga?

    You may be worried with the combination protocol but this is one of the therapies recommended at the NCCN guidelines followed by thousands of doctors around the world. You need to create confidence in the team treating your husband. Surely you can get second opinions at a separate institution.

    Let us know what is worrying you.

    Best,

    VG

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