Interesting article time to PSA nadir

Thank you for posting the review. I have to admit it is a difficult paper to read due to some of the language they use and references made.

however does it show those of us with locally advanced or advanced PC on HT for a number of years could in fact come off ADT much earlier ?

Hello neil5234 . I have been looking at the studies published in 2024 for some of the newer second generation antiandrogens which seem to indicate that those who achieve an initial rapid PSA reduction, and certainly at least a 90% reduction in 3 - 6/8 months, but preferably a level below 0.2, have a better long term outcome in terms of time to progression and likelihood to have a recurrence. I think I am reading the article you have cited slightly differently in that once you have achieved the initial reduction then the longer you can push the time to reaching the PSA nadir the better which is logical because if it is at a consistent low level or still declining then this is better than starting to rise. This article is dated 2018 so a lot of the information is based on just ADT or with first generation antiandrogens so the initial level to which the PSA gets to is not as low as with things like Enzalutamide or Abiraterone on hormone sensitive high volume metastatic prostate cancer.

One example of a recent study is here.

https://www.researchgate.net/publication/385530163_Prognostic_role_of_prostate_specific_antigen_kinetics_in_primary_high_volume_metastatic_hormonal_sensitive_prostate_cancer_treated_with_novel_hormonal_therapy_agents

This article demonstrates that there is now a better understanding of the drivers for progression or recurrence such as visceral mets, initial PSA.....but also which treatments suit which type of prostate cancer better.

 Brizzy1 -you are correct in that it could be possible that men who achieve negligible PSA levels within 6 months, and maintain it for possibly 18/24 months might be eligible to come off HT and then monitored, only going back onto it if it meets the recurrence criteria- intermittent hormone therapy. This is thought to extend the time before the cancer becomes hormone resistant. 

How are things with you now Neil - I know you were really exercising through the chemotherapy but how is the Triplet Therapy going?

Hi Linda, I am good as I hope you and your hubby are, I had triple theraphy and my PSA has come down to 2.2 frpm 1540 in 10 months, it has been 2.2 for last 2 blood tests a month apart, feel OK the tiredness is wearing off and my last CT scan came back stable after a good reduction in lyph nodes the scan before. I still go to gym 3 days a week and apart from waiting for results doing fine.