Hormone treatment after IMRT and when PSA goes up

I would like to receive feedback from those who have had external beam radiation which later resulted in a rising PSA. I had IMRT about 42 months ago. My PSA was 10.5 before treatment. I had a Gleason 3+4=7, Stage T1c, with about a 3% involvement in one area, Left APEX.

My PSA went down to 1.8 after some months post treatment but never got to a nadir of less than 1.0. Over the past two years it has gone up to 2.1, 2.3, 2.6, and now 3.1. Recurrence is most likely. I only have a couple options which are Cryosurgy or hormone treatment. My radiation oncologist advises to postpone hormone treatment until the PSA rises further, possibly until it reaches 10.0. I haven't discussed this with my oncologist yet, but will do so on the 27th.

I would be interested to learn the experience of others who are in the same boat. When did you decide on hormone, what was the lowest you PSA went down to and how long after treatment and what was the PSA when you went on hormone treatment. Did you receive intermittent or steady hormone treatment? What was used? What was the effect?

Chuck

If this were psa bump(bounce) from radiations it would have gone up some and went back down thereafter and more likely the bump starts within 18-20 months(avg.) and probably back down within months, although examples of longest psa bump for radiations are recorded at 60-84 months (fyi). Kind of like a radiation induced 'prostatitis' concept that causes this uniqe and bizarre event for radiation patients, with alot of anxiety attached (duh). I don't know much on the bump/bounce thing otherwise, it seems if bump was your case it should have gone back down by now (dropped back). So, my swag guess is it is not bump/bounce but psa rise due to PCa somehow or somewhere. I did say s.w.a.g.-ok.

In the past some docs concurred about the psa of 10 level before getting aggressive on resuming hormone treatments. The onco-docs like Dr. Strum et al, believe that doubling time is very significant in PCa and especially if it is in short duration months or 1 year, red flag. You are having psa velocity which is scary to anybody with PCa and also written about in his book. (A Primer on Prostate Cancer)

How do I provide a signature with history info?  Thanks!

Chuck

Go to Control Panel at the top of the page, then Edit Profile, then go down to Signature, then save it. I believe that is the correct sequence

Hi Chuck,

Welcome to the site. My situation is slightly different than your own but I would like to make a suggestion to you. There is another PCa support site prostatepointers.org that has a patient to physician (P2P) group where the questions are answered by a Dr. Strum (I think he is the same Dr. Strum that you see mentioned here so often). You will need to put a data sheet together similar to you signature. The form is on the site.
There is also an EBRT group at this site where you can post questions. As I recall there are a few with problems similar to yours. I have recieved some good information and support there as well as at this site. It never hurts to have more than one reference point. The EBRT group is mostly guys who had radiation as primary and some who had it as secondary.

Chuck, best of luck to you.
Don

Hi Marine man!
Welcome to HealingWell. You are obviously a veteran already and have done well for quite some time. Each case is different but I can see where your radiologist is coming from. But I would probably start the HT sooner. Just my mind set. I have tolerated it well, and I have had good results. Great job on the PSA post. I really tells a story. Let me know if you need anything as all. Otherwise welcome to ethe best place, I think, on the web for caring and compassionate support.

Peace,

Tony

I'm confused. Your urologist wasn't suggesting IMRT again was he? Also, did your previous IMRT include the pelvic area or just the prostate?

Thanks for continuing discussion and information.

Doting Daughter: sorry for the confusion but in my 1:16pm but I was referring to treatment options going in and not after decision and treatment. I guess I didn't make that clear but my urologist said he would do the operation if I decided on it (he is a very well thought of an experienced doctor in South Central PA) but thought IMRT would be a better choice since he thought based on PSA history and percent of involvement (only 3% in one area) IMRT would suit me better. The IMRT was delivered after the radiation oncologist reviewed the results of the biopsy. previous biopsies, bone scan, and C-Scan. He mapped out the region but I believe it was confined to prostate.

Dale: considering your Gleason and percent of involvement in several areas it appears you are doing quite well with the IMRT and hormone. I imagine they used the hormone going in to IMRT, correct? When did you receive the IMRT?

I understand based on information I have read: Some doctors think that hormone therapy works better if it is started as soon as possible if the cancer has reached an advanced stage (for example, when it has spread to lymph nodes), if it is large (T3) or has a high Gleason score, or if the PSA starts rising after initial therapy, even though the patient feels well. Some studies have shown that hormone treatment may slow down the disease and perhaps even lengthen patient survival. But not all doctors agree with this approach. Some are waiting for more evidence of benefit. They feel that because of the likely side effects and the chance that the cancer could become resistant to therapy sooner, treatment should not be started until symptoms from the disease appear.

One thing for sure is nothing is certain or guaranteed. My goal now is to learn more about hormone treatment and other options for a rising PSA post-IMRT.

My best to all.

Chuck

Diane:  Thank you for your input and advice.  I am so sorry to learn of your husbands experience but from what I have learned over the years, an operation after radiation is very risky.  I do not believe I would chose it.  I will go with the hormone treatment but am trying to determine when is best.  If intermittent or continuing is best.  What to use? 

Combination of drug therapy (i.e. Trelstar, Lupron, Zoladex) & the antiandrogens (i.e. Casodex) which work by preventing the cancer cells from using testosterone?  Lots to learn.

Thanks for recognizing my service.  My twenty-five years as a Marine NCO & commissioned officer were the best years of my life.  I felt I was doing something really important. 

I truly hope your husband's condition improves and his quality of life gets better.  Decisions we make so much affect the quality.  I was lucky to have a very conservative urologist who is not too quick to treat.  He encouraged me to hold off treatment after the initial positive biopsy due to the small involvement of cancer (3% in only one area).  So for three years I had a better quality of life before IMRT, some do good for many more years before treatment.  Everybody is different.   The IMRT didn't adversly affect me at all.  Unfortunately, my PSA didn't go down to under 1.0.

Chuck

Chuck

My husband was diagnoised with prostate cancer 2 and a half years ago. His PSA was 9.8 with a gleason of 8-9. The Dr. did not reccommend surgery since the cancer had already spread outside of the prostate. He also felt that seeding would not work because of the aggressiveness of the cancer.

We opted for IMRT, which was experimental then, and hormone therapy (Lupron injections) for two years. My husband experienced some hot flashes, but his PSA went down to 0.5 almost immediately.

He completed his hormone injections in July 2008. His PSA was still 0.5. The PSA slowly went up to 0.6 then 0.33 then 0.48 (in March 2009). I received a call today from his oncologist office stating that his level as of Monday had jumped to 4.8. I am sitting here on pins and needles waiting for the oncologist to call and let us know what to do next.

 

zdy:  I hope your husband finds effective treatment.  Every day we hang in there we are a winner. 

You may be able to get a lot of good information and some comfort from those who share in this journey none of us planned. 

Chuck

Chuck,

welcome to the site from an ex grunt. From everything I have read about reoccurrances, psa doubling time is the most important factor. If it is over three years, which yours seems to be then it is very controllable for a long time and you will probably die from something else.

The best protocol is ADT3, which is Lupron, Casodex and Proscar. You may want to ask your oncologist about Casodex as a mono therapy as your psa is not rising fast and the side affects are about 20% of Lupron. The best thing is to get a good prostate oncologist even if you have to travel to see one. His recommended treatments can be done locally so you may have to travel only once per year for followups if at all. My neighbor has been on Lupron since 1996 and is doing fine.

Good luck,

JT