Signs adt is not working as well?

Momschooling

Hi,

It's been a long time since I was on here. My husband is still undetectable and on Lupron/Zytiga combo since end of July 2021, prior he had 6 months hormone holiday after a full year of ADT (December 2019 to January 2021) but that turned out to be a bad move as it spread to his lungs. He had a CT scan about 6 months ago and he had many lung mets that had shrunk significantly and some that remained the same, he also had what was believed to be a dying spine met (we didn't realize it was in his bones so that was a surprise) the doctor said he had stable disease which was the best we could hope for, basically stable is good. I have taken the attitude as enjoy it when things seem okay, but lately I have started worrying again, wondering what signs to look for if adt is not working as well besides the obvious psa? Are there any signs besides psa? Anyone who has had this combo with stage 4, how long after did it stop working? Did you get more scans without waiting for psa to rise? Thanks!

Old Salt

Although one can ask for more scans, their interpretation is subjective. As long as the PSA hasn't risen significantly, I would just enjoy the time.

The time to castration resistance varies greatly among patients undergoing ADT; from just a few months to years and years. Sorry, no definitive answer.

VascodaGama

Hi mom,

I am sorry to hear about the scan's findings on the bone and lungs metastases.

ADT manages to "weaken" the bandit and control its advance during a period in time but it doesn't avoid spread.

I wonder on which basis did his doctor judged "stable disease". The PSA serves only as a reference information once spread is found at several far places like the lymph nodes, bone and lungs. You shouldn't try controlling the disease via the PSA or simple scans.

Aggressive types of cancerous cells (your husband's case) are known to produce little amounts of PSA. Also some cancers do not depend on Endogenous Testosterone (produced by the testicles), living on other body androgens (or start producing it (dehydrotestosterone-DHT), particularly when the period on castration is prolonged.

Typically PCa travels from the prostate to close lymph nodes, to bone, to chest lymph nodes, to the lungs and to the liver. You should check his liver functioning levels including a MRI imaging.

In your shoes I would discuss with his doctor on possibilities for spot radiation of the bone mets and dissecting of the spots on the lungs. He his young (60) and may be "healthy" wise to sustain additional therapy. I would start with a Whole-body SPECT/CT scan which provides better specificity and positive predictive value of bone scintigraphy than the traditional bone scan.

I hope my comment helps in your struggle in finding newer ways in your fight.

https://pubmed.ncbi.nlm.nih.gov/23974666/

Best wishes and luck in his journey.

VGama

Momschooling

I really appreciate this information. I was wondering if there was anything else we could bring up with the doctor and this gives me more knowledge. The doctor considers him stable because his PSA, scan and bloodwork appear to not have changed. You are very correct on the PSA not being a good judge of his situation, because he has never till now, had a very high PSA. I felt that going off his ADT for just 6 months and it already went to his lungs, might of meant it had progressed further than we had realized prior. He did have radiation on his whole pelvis and pelvic lymph nodes, bladder neck and one higher up lymph node mid stomach in 2020, but obviously the cancer was still there or it wouldn't have spread so fast. He gets liver levels checked every 3 months because of his zytiga, so far so good. Thanks again for your insight!