Y’all know last week I received my second 90-day Lupron injection for cancer suppression.
The treatment will never become familiar and no appointment is routine. Write that on your calendar and prepare for the side effects. Plus, you’ll learn patience as you wait for those labs to come in as well as anger management. I couldn’t tell you how many times I’ve refrained from telling people off since having this disease.
Cancer changes everything. It has a way of reorganizing time. It doesn’t measure life in years. It measures it in injections, tests, scans and appointments. Along with whatever else your mind can conjure up.
After radiation in late 2023, I truly believed that the nightmare had ended. For a while, it felt like it had. But about a year and a half later, when my PSA started creeping up again, I realized it hadn’t.
A PET scan confirmed what the numbers were hinting at — active cancer cells. A follow-up biopsy of the confirmed it even more clearly: the cancer was back. Or never left.
Tests and Scans
Confined it’s return in 2025.
Lupron
That’s when Lupron entered my story.
It wasn’t part of the original plan. It became necessary after recurrence. And with it came a very human question I kept asking myself: What do the numbers actually mean?
The PSA Drop: 9.19 to 0.08
Before starting Lupron, my PSA had climbed to 9.19. Ninety-one days after my first injection, it dropped to 0.08.
On paper, that looks good. In reality, it’s a powerful biological response.
Lupron doesn’t kill cancer directly. It suppresses testosterone — the fuel prostate cancer feeds on. It starves it. So, when PSA drops that dramatically, it says something important: The cancer is hormone sensitive.
A drop below 0.1 after three months is considered a strong response. It doesn’t mean the cancer is gone. Lupron suppresses; it doesn’t cure but it does mean the treatment is doing exactly what it’s supposed to do.
The Testosterone Reality
I also had my testosterone checked for the first time when they did the PSA. It measured 0.48 ng/mL — about 48 ng/dL.
For perspective, normal adult male testosterone typically ranges from 300 to 1,000 ng/dL. Most men fall somewhere between 400 and 700.
Treatment aims to bring testosterone into what’s called ‘castrate level,’ traditionally defined as below 50 ng/dL. Many oncologists now aim for under .20.
At 48 ng/dL, I reached the traditional suppression target.
If my baseline was somewhere around 400–600, that signifies roughly a 90% reduction in circulating testosterone in three months.
Will the Numbers Keep Falling?
Now that I’ve had my second injection, the natural question is whether PSA and testosterone will drop even further.
Maybe.
PSA can move to a lower level as can my Testosterone. But the real goal isn’t endlessly falling numbers. It’s stability.
Doctors look for sustained suppression like PSA staying very low and testosterone remaining in the castrate range. Small fluctuations don’t matter. Trends do. Right now, the trend is in the right direction.
Would They Treat the Prostate Again?
My recurrence appears confined to the prostate. I responded strongly to hormone therapy. Thus, I technically fit the profile of someone who will be evaluated for salvage local therapy.
Options can include:
- Salvage prostatectomy (surgery after radiation — complex, higher risk of incontinence and ED)
- Cryotherapy (freezing the prostate tissue)
- HIFU (heat-based focal therapy)
- Brachytherapy in select cases
Repeating full external radiation is uncommon because tissues have already reached tolerance limits. But oncology hasn’t ruled it out.
My urologist, who does the injections, brought up surgery almost instantly during my latest visit. Even before we had fully walked through the other options. It wasn’t wrong. It was one possible path. But it felt fast.
His mention of it brought back memories of watching Star Trek. I recall hearing Dr. McCoy, in an old episode, use the old term ‘sawbones‘. It was a nickname from an earlier era of medicine. Back then, solutions were often immediate and mechanical. The approach was straightforward: cut it out. I wish he would cut it out because I’ll have none of that until all other available options are used. As I’ve watched my neighbor deal with its life altering side effects.
If my PSA remains suppressed on Lupron, oncology likely will continue systemic therapy and just watch and re-image. He’ll weigh whether aggressive local treatment would meaningfully change the long-term outcome or simply increase side effects.
That’s the strategic fork in the road. Does treating it again improve survival? Or is systemic control the bigger priority?
What a Positive Post-Radiation Biopsy Means
After radiation, PSA can bounce. But my second biopsy confirmed recurrence with living cancer cells after radiation therapy. That raised two critical questions: Is it only in the prostate? Or are there microscopic cells elsewhere that scans can’t yet detect? In my case, a follow up PET scan showed nothing outside the affected area. That places me in what’s typically called isolated local recurrence.
Even when scans are clean, microscopic cells can exist beyond imaging detection. That’s one reason many physicians start systemic therapy first. Lupron doesn’t just treat what we see. It treats what we don’t see as well. And my PSA response suggests that approach is working.
The Bigger Picture
When PSA rises after radiation, it’s called biochemical recurrence. In my case, the biopsy confirmed it. Imaging showed it was confined. And hormone therapy brought it under control quickly. In that space, I choose to see what the numbers are really showing me. They show not just the disease, but response. Not just recurrence, but resilience. They show me a future without surgery and that’s where my decision stands.
I Am Me
While this is my lived experience, the medical framework behind these decisions comes from recognized clinical guidelines and published research.
Sources & Clinical References
The medical information referenced in this article is supported by established oncology guidelines and peer-reviewed research, including:
National Comprehensive Cancer Network (NCCN)
Prostate Cancer Clinical Practice Guidelines in Oncology
American Urological Association (AUA)
Guidelines on Biochemical Recurrence and Salvage Therapy
American Society of Clinical Oncology (ASCO)
Hormone Therapy for Prostate Cancer
European Association of Urology (EAU)
EAU Guidelines on Prostate Cancer (including castrate testosterone targets)
Journal of Clinical Oncology
Peer-reviewed studies on PSA response and androgen deprivation therapy outcomes
European Urology Journal
Research on testosterone suppression levels and long-term outcomes
Medical Disclaimer
This article shares my personal experience and reflections on living with prostate cancer. It’s meant for informational purposes only and should not replace medical advice. Every situation is different, so please consult your healthcare provider about your own care and treatment decisions.
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