From the Guidelines
A PSA level less than 0.006 ng/mL on ADT is a strong indicator of a favorable response to treatment, and patients should continue their prescribed ADT regimen as directed by their oncologist. This very low PSA value suggests that the hormone therapy is effectively suppressing testosterone production and controlling cancer growth, which is associated with improved survival in patients with metastatic prostate cancer, as seen in the 2019 NCCN clinical practice guidelines in oncology 1. The guidelines recommend ADT as the gold standard for initial treatment of patients with metastatic disease at presentation, with options including orchiectomy, LHRH agonist, LHRH antagonist, and combination therapies with docetaxel or abiraterone.
Some key points to consider in the management of patients with a PSA level less than 0.006 ng/mL on ADT include:
- Regular follow-up appointments every 3-6 months to monitor PSA levels and assess for any treatment side effects
- Continuation of ADT as prescribed, as discontinuation could lead to cancer progression
- Management of side effects like hot flashes, fatigue, decreased libido, and bone density loss with supportive medications as needed
- Discussion of treatment options and side effects with a healthcare provider to ensure optimal management and quality of life. According to the guidelines, a PSA value ≤4 ng/mL after 7 months of ADT is associated with improved survival of patients newly diagnosed with metastatic prostate cancer 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
PSA Levels and Prostate Cancer
- PSA levels are a crucial indicator in prostate cancer diagnosis and treatment monitoring.
- A PSA level of less than 0.006 on androgen deprivation therapy (ADT) is a significant indicator of treatment response.
Androgen Deprivation Therapy (ADT)
- ADT is a common treatment approach for prostate cancer, aiming to reduce testosterone levels and slow cancer growth 2.
- Studies have shown that combining ADT with other treatments, such as abiraterone acetate, can improve treatment outcomes for patients with localized high-risk prostate cancer 2, 3.
Prostate-Specific Antigen (PSA) Response
- PSA response is a critical factor in evaluating treatment efficacy in prostate cancer patients.
- Research has demonstrated that achieving a 95% or 99% PSA decline is associated with improved treatment outcomes, including overall survival and cancer-specific survival 4.
- A study found that abiraterone was significantly better than apalutamide in achieving a 99% PSA decline in patients with high-risk metastatic hormone-sensitive prostate cancer 4.
Diagnostic Accuracy and PSA Density
- The combination of multiparametric MRI PI-RADS score v2.1 and prostate-specific antigen density (PSAD) can improve diagnostic accuracy for prostate cancer detection 5.
- A study found that a PSAD cutoff of >0.18, combined with a PI-RADS v2.1 score ≥ 3, increased diagnostic accuracy for prostate cancer detection 5.
Characteristics of Prostate Cancers Detected at Low PSA Levels
- Prostate cancers detected at low PSA levels can exhibit characteristics of malignant cancers, including multifocality, tetraploidy, and high proliferative activity 6.
- Research has shown that using low PSA levels as a biopsy criterion can lead to the detection of prostate cancers at an early stage, potentially improving treatment outcomes 6.