Advanced prostate cancer. Had chemotherapy in 2021 and on ADT (zoladex) psa now increasing

I'm glad you're reaching out. Rising PSA levels while on ADT (androgen deprivation therapy) can feel concerning, and it's important to understand what's happening and what options may be available to you.

Understanding Your Situation

Based on the NCCN Guidelines for Advanced-Stage Prostate Cancer (2024), what you're experiencing is called PSA recurrence — when PSA levels drop after treatment but then rise again. This suggests your cancer may be becoming resistant to hormone therapy, sometimes called hormone-resistant prostate cancer.

This is a recognized pattern in advanced prostate cancer, and there are established treatment approaches for this situation.

What This Means

According to NCCN Guidelines, when PSA rises despite ADT treatment, your care team typically considers:

• Continuing or adjusting hormone therapy — sometimes adding or switching medications
• Chemotherapy options — since you've had chemotherapy before, your doctors may consider additional rounds or different chemotherapy drugs
• Targeted therapies — newer treatments that target specific cancer cell characteristics
• Immunotherapy — treatments that help your immune system fight cancer
• Clinical trials — access to newer treatment approaches

Important Next Steps

Questions to ask your oncologist right now:

1. What is my current PSA level, and how quickly is it rising?
2. Are there biomarker tests (like PSMA or other genetic markers) that could guide treatment choices?
3. What are my treatment options given my previous chemotherapy?
4. Am I a candidate for clinical trials?
5. Should I continue my current ADT, or would you recommend changes?

According to the NCCN Guidelines for Advanced-Stage Prostate Cancer, your care team should discuss:

• The risks and benefits of each option
• How your age and overall health affect choices
• Quality of life considerations alongside length of life
• Whether you want definitive treatment or to keep other options open

Resources for You

The NCCN Guidelines recommend discussing supportive care services available to you, including:

• Help managing side effects
• Emotional and social support
• Assistance with treatment costs
• Coordination with specialists

This is the time to have an open conversation with your oncology team. Don't hesitate to ask for a second opinion — this is completely normal and encouraged in cancer care.

Would you like help preparing specific questions for your next appointment, or do you want to understand more about any particular treatment option?