psa rising fast - anyone got any advice?

Hello all,

We are in a fair amount of shock after my husband's recent appt with his oncologist. His psa, which was 8.3 two months ago, has shot up to 12.5.

He has been told that he will need chemotherapy, probably after his next appt in two months time, but that this is the last resort and will be merely palliative. 

He outlned a bleak scenario whereby only 60 - 70% of patients receiving chemo see any improvement in psa levels and that this is a very temporary improvement anyway.

Is this really all that is left for my husband? We are in the UK so know treatment and approach differs from people in the States.

Any extra information would be really appreciated as we are struggling to deal with the seemingly futility of his situation

Thank you

Missy J

Sorry to hear the unhappy report. Though I am not a doctor, I have a couple of thoughts. First, has your husband had a testosterone (T) level test, and a dihydrotestosterone (DHT) level test? If not, you want to do that. You want to make sure the T is at a "castrate level". If it is not, then the Zoladex is not doing what it needs to do and before concluding that the cancer is androgen independant, you could try an alternative drug to lower T level. You want the T to be at castrate levels because the T "feeds" the cancer. T also gets converted to DHT, and DHT feeds the cancer even more than T. So you want the DHT levels low too. Depending on the DHT level, you could consider adding finasteride or dutasteride. Some oncologists will offer what is referred to as ADT3 -- a combination of an LHRH agonist (such as zoladex or lupron), an anti-androgen (such as Casodex), and either finasteride or dutasteride. There is relatively little good literature to support this combination, but there is some. And some medical oncologists with expertise in prostate cancer recommend it. There are also some so-called "second line" treatments that are sometimes used after the cancer stops responding to LHRH agonists and anti-androgens. These include ketoconazole (sometimes you will see LDK or HDK for low dose keto or high dose keto), DES, thalidomide, estradiol, and some others. Many docs do not know about these treatments. It is worthwhile to see a doctor, if you can, who has particular expertise with advanced prostate cancer, and who knows about these options. As for chemotherapy, though the "averages" are not super encouraging, some of the chemos (such as taxotere) have helped extend people's lives for quite some time. It worked for quite a while for my father, and he had very little side effects. My best wishes, Medved

MissyJ,
I was sorry to read of your husbands increasing PSA. Don't be overly alarmed by the term palliative..........such care can go for many years. I don't have anything that can help with your questions but there are a couple of fellas here with a good knowledge of hormone refractory disease. I am sure they will come in with some valuable suggestions shortly. In the meantime there is a forum (address is below) whose members are mainly comprised of guys with the same problems as your husband. It might be worthwhile having a visit there as I am sure they will have more detailed knowledge of possible treatments. Additionally the Dr "Snuffy' Myers book "Beating Prostate Cancer:  Hormonal Therapy and Diet" is a valuable tool. I recently heard him speak in Australia and he is an expert in refractory disease.
This is the site:
www.hrpca.org
I hope you find the answers your seeking,
Bill

Missy J

Not an easy situation for you both to be in.

I'm English, but don't live in the UK. (I'm across the North Sea in Holland)
You don't have to be too specific with your answer, but whereabouts in the UK are you? , as there are all sorts of places around the country that will surely be able to offer help and advice.

I am sure you will have done a lot of asking over the last couple of years

try looking at this thread of James C's:
www.healingwell.com/community/default.aspx?f=35&m=1368720

it lists where people are from and while there are only a handful of people in the UK they might be able to offer some help.

The only place I know a lot about and can suggest is the John Radcliffe Hospital in Oxford:

www.oxfordradcliffe.nhs.uk/forclinicians/referrals/cancer/palliative/palliative.aspx

Alfred