Hormone treatment - were you given a choice of methods or drugs?

I am just completing 18 months of Orgovyx. One pill a day in the morning was easy to remember. The side effects are the same as most of the other treatments. No libido, some weight gain, some loss of energy in the afternoon. A short nap takes care of that. Some sweating off and on that has diminished as the months went on. Some have complained of brain fog on other forms. I have never had that SE. My testosterone has moved down to zero and PSA has been undetectable for many months. If you have any serious SEs, you can stop it at any time. It is your personal choice, so advocate for yourself when you visit the doctor. I hope for the best possible outcome for you.

Hi again,

How old are you?

When we exchanged opinions, in Dec '22, your PSA was close to 0.5 in a slow growing path of PSAdt greater than 12.

I wonder if the increase has maintained a similar growth.

Probability it has and with that you may be still far-away from starting an ADT sequential in a systemic approach.

In any case, you are doing well in exploring what is or would be available to you by the time you need something, if you give up in pursuing an oligometastatic treatment (spot radiation) for the intent of still killing the bandit and getting cured.

In your original thread we talked about thresholds used by oncologists to identify the clinical status of a systemic case and project a therapy.

That "threshold methodology" provides milestones along the period of our treatment, giving us a discipline way to follow and fill accomplished.

But, interestingly, last week I had a zoom consultation with a famous american medical oncologist that told me that there is no such fixed PSA thresholds dictating the start of a treatment in systemic cases.

His practice is based on the needs to treat when such time arrives. In other words he recommends to follow a maintenance approach dependent on periodical multi disciplinary testing and exams to evaluate the clinical status along the lifetime of a person.

The multi disciplinary testing should include the whole healthy parameters, genetic performance and imaging. That is to say that in systemic treatment the idea of earlier therapy doesn't exist. In fact, ADT only aims in "regulating" the PSA. The bandit continues alive and progressing.

Here is your initial thread:

https://csn.cancer.org/discussion/326041/definition-of-biochemical-recurrence#latestm

Best wishes

VGama 

Hi,

Your situation is typical of recurrences from salvage radiotherapy (SRT).

Ten years ago any oncologist would classify the situation as "systemic", that would lead doctors in recommending systemic treatment with ADT, chemo or immunotherapy.

But due to the success in treating breast cancer cases with spot radiation, before advancing with chemo, doctors "discovered" a newer sequential approach for PCa cases they call The Oligometastatic Therapy.

This is restricted to cases of a fewer number of metastases (used to be lesser than 5 numbers), which would be found/located at preferential locations avoiding the areas radiated in the SRT procedure.

To such extent, one needs to locate the spots firstly. For that, PSMA PET scans provide the most advanced imaging which in combination with previous CT and MRI results, helps to identify the areas for treatment.

Some guys have benefitted from this approach and some encountered trouble in radiating areas previously radiated. It seems that the best is to commit to this approach if the spots are located at newer areas, or only advance the treatment after 5 years of the SRT to allow healing of affected soft-tissues.

PET scans also provide better results (less false negatives) when the PSA is above 1.0 ng/ml.

I have tried to locate the bandit with a 18F-CHOLINE PET in 2018 that succefuly detected one lymph node deep in the Abdomen, in a difficult access to extract a biopsy. The doctor was reluctant in doing RT for it being closed to previously radiated area.

Again In 2019, I did a 68Ga PSMA PET (PSA =1.7) which results were negative, in spite of an increasing PSA. Surely that was a false negative.

A friend radiologist confirmed the negative result but I think that the image of the area close to the bladder (prostate bed) was blurred due to the excretion of the die (radiopharmaceutical) via the urine at the time the picture was taken.

If interested in a similar approach I recommend you to give preferences to an 18F-DCFPYL PSMA PET scan, done when the PSA is above 1.5 ng/ml.

Remember that ADT works the same at any level of PSA. You can wait. Earlier attacks in systemic situations do not represent a better choice.

Google the matter and discuss with your doctor to check for possibilities.

Best of lucks in your journey.

VGama

In 2007, my husband was diagnosed with prostate cancer. He had Radiation treatment, and Zoladex. His PSA level came down and was taken off the zoladex after 3 years. One of the last appointment with his consultant, was his PSA was undetectable. We have had 15 years , thinking he is clear of the cancer. Now, We have been told it has now come back. His PSA level have been creeping back up. Had his first Zoladex injection today. He has been told he will be on it for life. We are not sure what to expect.