Why PSA Can Drop While Testosterone Slightly Rises

My labs from yesterday have come in and it seems I’ve hit that point in this process where the numbers start to matter. Not just because doctors are watching them but because now, I understand enough to watch them too.

And that can either bring you peace… or mess with your head a little.

Where This Started

Back in November, my PSA was 9.19.

That was before treatment. Before I really knew what any of this would feel like long-term. Before everything became about tracking progress through lab results.

Then I started Lupron.

What Treatment Is Doing (Without the Medical Jargon)

Lupron lowers my testosterone. And the cancer feeds off testosterone.

So, the idea is simple: Take away what feeds the cancer.

By February, my PSA dropped to 0.8. That told me the treatment was doing something real.

It’s also when I saw my testosterone for the first time: 0.48.

Which means it’s been pushed down to what they call ‘castrate level.’ Not a term anyone loves hearing, but it means the drug is doing its job.

Adding Xtandi

In March, I started Xtandi.

If Lupron lowers testosterone, Xtandi makes it harder for anything left to even work.

So even if there’s a small amount still in my body, the cancer can’t really use it the same way.

My Latest Numbers

When I saw my medical oncologist labs from yesterday posted to my hospital chart things got interesting. One I hadn’t expected them to post at all and two something seemed off. So, a little research was in order.

April numbers:

• PSA: 0.28
• Testosterone: 0.55

PSA kept going down but testosterone went up slightly.

And yeah—that caught my attention.

What That Actually Means

At first glance, it feels backwards. I expected everything to just keep dropping. But treatment doesn’t always move in perfect straight lines.

I’m on a 3-month Lupron cycle, and what I’ve learned is toward the end of that cycle testosterone can creep up a little before the next injection.

So that small shift from 0.48 → 0.55 can just be timing.

The Part That Matters More Than Anything

My PSA went from 9.19 → 0.8 → 0.28.

That’s the real story. Because PSA is what shows whether the cancer is responding. And right now, it is.

What I’m Paying Attention to Now

I’m not ignoring the testosterone number. I’m just not overreacting to one reading either.

What matters is the pattern:

• Does testosterone keep climbing, or was this just timing?
• Does PSA continue to drop or stay low?
• Do things stay consistent over the next few months?

This isn’t about one lab result. It’s about the trend.

What Could Change Later

If my testosterone keeps rising, there are ways to adjust:

• Shortening the time between Lupron shots
• Watching levels mid-cycle instead of right before injections
• Tweaking the approach depending on how everything lines up

But none of that happens off one number.

Where I Am Right Now

I feel OK where I’m at. Yet that doesn’t mean I’m ignoring reality. It just means I’m not walking into every appointment expecting something to go wrong.

The treatment is working. The numbers show that.

And for now, that’s enough.

Life Outside the Labs

There’s still life happening in between all of this.

There’s time for that trip to Boston to be with Maya. And moments that don’t revolve around appointments or results coming in May.

And those moments matter just as much as anything printed on a lab report. Because I am not going to let cancer run my life.

What Comes Next

More labs injections and watching numbers. But now I understand what I’m looking at. And that makes this feel a little less uncertain than it did before.

Click for more on my cancer journey

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