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My Dad's rising PSA after op & radiotherapy

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Posted 4/12/2010 1:25 AM (GMT 0)

Hi All,

 

I was just after some advice, I will give you a quick overview of what has happened...

 

My Dad was diagnosed with PC in June 2007, Gleason 7 (4 + 3) (aged 54). He then had a Radical prostatectomy in Aug 2007, his PSA then started rising.

 

He then had radiotherapy, but again his PSA has continued to rise. Today (12th April 2010) he got his results and it again has gone up slighty. It is now at 1.4. The Dr told him ideally, it should not be going up at all, and may have to look at Hormone Therapy, which I dont think my Dad will cope with well...

 

He has to go back again in June to get another test....

 

Can someone please give me an idea on what stage he would need to start this hormone therapy, considering he is still relatively young, I am really worried confused  We just wish that this PSA would just stop going up. Everytime he has this test, it goes up slighty....

 

Any advise or help would be greatly appreciated!!

 

Posted 4/12/2010 1:41 AM (GMT 0)
Since your father has already had surgery, and then had recurrance, and then had radiation, and it has failed too, he has used the curative treatments available to him. Now would be the time to discuss HT. With his current PSA at 1.4, sounds plenty high enough to consider starting now, so that it can help slow things down. Perhaps someone currently on the HT path can answer first hand a bit better.

David in SC
Posted 4/12/2010 3:11 AM (GMT 0)
The progression of my disease is somewhat similar to your fathers. The operation didn't scare me. Radiation was no problem. But for some reason I didn't want to deal with hormone therapy at all. I probably put it off 9 months longer than I should have. I had excuses...a trip to Europe, my son's wedding, I just didn't know how the side effects would impact my life. I finally faced reality the end of last summer and got my first implant of Zoladex. In my case the side effects haven't been that bad, manageable hot flashes and weight gain
(especially the belly). But I'm trying to eat right and exersize and I'm getting the weight off.

The advise I can give to you and your dad is to find a good MED-ONC hopefully one who specializes in PC. Take his or her advise on when to start.
Although the side effects haven't effected me much my doctor assured me that if they did, that there are medicines to help.

Hoping for the best for your Dad.

Dallan
Posted 4/13/2010 1:04 AM (GMT 0)
Thanks Dallan. Your case does seem similar to Dads. Do you mind me asking you how old you are?
So your PSA was 3.8 when you started HT?
I can understand you wanting to put it off...I think my Dad will be the same! I just want him to get the best treatment possible, so he can enjoy his life for a long time yet!
Posted 4/13/2010 2:50 AM (GMT 0)
Roxy, I'm 55 now and was 50 when diagnosed. After radiation my numbers were low so the Rad-Onc I'm seeing told me that there wasn't any urgency to start HT. But when The PSA jumped from 1.5 to 3.8 it was time.
Posted 4/13/2010 5:11 AM (GMT 0)
Thanks for your response Dallan.

Fingers crossed for you that your PSA remains low while you are having HT.

Dad goes back to see the Rad-Onc in June so we shall se what happens from there. Hopefully it stops rising!
Posted 4/13/2010 11:21 AM (GMT 0)
Roxy,

There are all sorts of theories as to when is the best time to start HT (some theories suggest that HT is a waste of time, however I will not bet my life on that). My Uro suggests a psa of 10 but will be willing to start me when it goes over 5, if I insist. That seems a little laid back for me, so with an undated psa prescription, I will be getting a psa test after I get back from Las Vegas in June (my wife's retirement gift to me) and will hone in to an oncologist for a second opinion. What concerns me is my velocity and if the velocity is getting wild, I will get the HT by summer, no matter what. 

Posted 4/13/2010 5:44 PM (GMT 0)
JoeyG, You've looking at it right, It's not the number (PSA) it's the number AND how fast you're getting there.
Posted 4/13/2010 11:46 PM (GMT 0)
My situation is similiar, I went to the mayo clinic and had a MRI to see if there was a mass in the pelvic area, they found something  that appeared to be a mass, they biopsied it and it was negative , but the other side of the uretha they found cancer cells, which explains rising psa, I go again in a month  and possibly may give me a low grade chemo combined with  lupron for a short period as opposed to  hormones for quite some time
Posted 6/16/2010 6:40 AM (GMT 0)
Hi All,

Further to my post earlier on in April, we have just had the results from Dad's latest PSA test and it has jumped from 1.8 in March to 3.2 today.

The Dr has now advised him to have a bone scan...what is the likely hood this has spead to his bones. Where else could it be. The Dr asked him if he has any aches or pains (which he doesn't)...

We are so upset that his PSA has had a big spike, everytime he just gets further bad news. It never gets better VIEW IMAGE

Anyone with advice or similar stories, I would be very greatful to hear from you.

From a very worried daughter...

Posted 6/16/2010 11:20 AM (GMT 0)
Try not to worry too much about the bone scan. PCa very seldom will show up in bone with a PSA of less than 20. Can happen, but very unlikely.
Posted 6/16/2010 2:31 PM (GMT 0)
With a PSA of this level the size of the PCa cells is likely to be microscopic, literally and so they won't show on a scan. My understanding is that if you have the chance to act before things can show up on a scan it is much better to do so.

I have not yet got to this stage as my RT only finioshed last week, but I feel that I had a pretty sharp rise after surgery from 0.1 to 0.4 between November and March. (if you think of that in terms of it being a four-fold increase in four months it's scary) So I am kind of anticipating the idea that at some point sooner or later I will need HT as I may have naughty PCa, and with that in mind am trying to get exercising again to get rid of the tummy I have already started to develop since seeing the robot.

I have a friend in UK who husband is same age and who had rising PSA a year ago afterv surgery two years ago and he did RT and HT at the same time. He had all the problems associated with RT & HT, but my friend said last week that he is now feeling normal again especially as his PSA is undetectable. So that's clearly what to aim for.

There does not seem to be a perfect journey with PCa. It is almost impossible not to worry when PSA readings keep shouting at you like this that there is still something wrong, but try to just think about what to do next rather than worry about it.

Alfred
Posted 6/28/2010 4:54 AM (GMT 0)
Hi All,

We have just had the results from Dad's bone scan and it has showed up with a spot on his right hip.

Doctor is now putting him on HT and he will have to go back in 6 weeks for another test.

We were really hoping nothing would show up, but again we are hit with bad news on this PC journey. He cannot seem to get a break or any good news....

Any advice would be helpful....
Posted 6/28/2010 12:48 PM (GMT 0)
Roxy,
I just wish the best for your father and your family. Not a Dr. so really cant give you advice as I have not been in your fathers shoes yet. Keep us posted.
Michael
Posted 6/28/2010 1:00 PM (GMT 0)
Has the spot on hip been confirmed to be cancer. They find a lot of hot spots that turn out to be old injuries.
Posted 6/28/2010 1:17 PM (GMT 0)
logoslidat asks a question that brings up a point my doctor made in the continuing discussion of "too many" tests. I was asking about the validity of a bone scan with a low PSA. Reviewing the tape again, he talked about establishing baselines. In this case, unless there was a known injury in the interim, comparing the results would give a way to measure change.

Roxy,
There are no magic lines - just the advice of doctors you trust mixed with self-education. My numbers were worse (our ages are the same), and I've done both DaVinci and IGRT, so a PSA rise would bring me to have to make those same decisions.
My best wishes to you and your dad.
Posted 12/13/2010 4:54 AM (GMT 0)
HI Everyone,

I just wanted to get your opinions as I am a little bit worried.

Dad is due to get his PSA tested again this Wednesday (15th Dec), he has had 2 hormone injections (Lucrin) with the first one dropping it to from 3.2 to 0.2 - which was fantastic news! After his bone scan (before the first shot of Lucrin) the doctor did say he could see a spot on his hip.

Anyway, my concern is that he has had lower back pain for the last 5 weeks or so, I think he felt a twinge, then did some work in the back yard shovelling dirt, which seems to have made it worse and it really hasn't gotten much better since, also keeping in mind that he hasn't rested it.

I am really hoping that this has nothing to do with the cancer and that the Lucrin has continued to drop his PSA. He has had problems with his back in the past, so its not totally strange that he has sore backs?

What are your thoughts? I know I may be jumping the gun, but I just am concerned.....
Posted 12/13/2010 5:23 AM (GMT 0)
If the doc saw nothing in his back on the earlier scan it is very unlikely that, assuming his PSA is still around the 0.2 mark, there is anything there related to PCa. I wouldn't mind betting that he just has a bit of a crook back (bloody arthritis!!)
Bill
Posted 12/13/2010 5:26 AM (GMT 0)

Sorry I should also say that his last PSA result (after his first shot of hormone therepy) where it went down from 3.2 to 0.2 was on August 16 (exactly 4 months ago). He then had the 2nd shot in Oct/Nov?

Any thoughts would be appreciated...I am just a little worried. I know it could be just a simple pulled muscle in his back also...but I cant help but worry!

Posted 12/13/2010 12:17 PM (GMT 0)
I am pretty much a mirror  of what your father is going through, I was 50 when diagnosed, had surgery,radiation and just over a month ago started HT. I go to the Mayo Clinic for my doctoring and when my PSA reached 1.5 they pulled the trigger. So far I haven't noticed any side effects, knock on wood, Tell your father he will  do fine

Posted 12/13/2010 7:52 PM (GMT 0)
Roxy
I wish for your dad the very best. You are among friends here. I had a robotic prostatectomy Oct. 26, 2010 and my first psa was .3 after surgery and my urologist started me on Harmone Therapy right away. I will be starting radiation in January but since my psa was not 0.3 but 3 he decided to go ahead with the HT. From what I have read HT and Radiation are a good combination. I am 67 yrs. old and thus far no side effects. He tells me the HT injection will last for 4 months.
Stay well and blessed
TTaylor
Posted 12/13/2010 9:14 PM (GMT 0)
Roxy,
Read your post about your Dad's bone scan results. I have just heard about a new drug sold under the name of Xgeva (Denosumab) to help prevent skeletal related events in patients with cancer that has spread to the bone.
I went to Google and checked out the FDA News Release about Xgeva. You may find this interesting.
This is my first posting. I have been a member for a short time but never felt I had anything worth while to add until now.
I certainly hope that the spot on the bone scan is not cancer but since you are asking for information, I thought this might be of some interest,
Bayou Jackal
Posted 12/13/2010 9:58 PM (GMT 0)
Roxy:

Geographically, where is Dad? Are you nearby?

It appears that he is outside the USA, as Lucrin is not used here. However, it is exactly the same as Lupron: leuprolide acetate. You can look up the "label" information. In the USA the site would be www.rxlist.com

Has Dad consulted a genuine cancer specialist, medical oncologist? That is the specialist who IMO should now be treating him.

It is not unusual to suspect PCa is the culprit for every twinge we patients experience. A competent cancer specialist should be able to help.

Has he experienced any of the side effects (SEs) of the Lucrin? There are means of dealing with them, which all too many medics either don't know about or don't care about. For excellent insights, see:

http://www.prostate-cancer.org/education/andind/Guess_TestosteroneSideEffects.html
or
http://tinyurl.com/2ymb8f

http://www.prostate-cancer.org/education/sidefx/Strum_ADS.html
or
http://tinyurl.com/g6fzp

Regards,

Steve J
Posted 12/13/2010 10:55 PM (GMT 0)
HI All,

We are based in Melbourne, Australia. Yes, I think Lucrin is the same as Lupron. He hasn't had any really bad side effects, just some hot flushes and he is tired alot of the time, but this is also due to not sleeping.

I am just praying that his PSA has even dropped lower tomorrow! He deserves some good news! It worked the first time so well....so hopefully it will drop it again!
Posted 12/20/2010 1:04 AM (GMT 0)
Hi All,
Well we got Dad's PSA results and they are not what we were looking for. We are just devestated.
His PSA actually didn't drop from 3.2 to 0.2 last time it was actually at 0.8. Anyway, this time it has gone up to 1.1. Because of Dad's back pain, they are sending him for another bone scan on Friday and a blood test to measure his testostorone levels?
This is just another kick in the guts. How can this happen? Its not fair, he has had such a round time since being diagnosed, hardly anything has gone his way.
Why isnt the HT working? What other options do we have to keep this awful cancer at bay? He is only 57 and I need him around a lot longer yet? What else can be done to help him? I am hoping this bone scan will show up nothing in his back, but that does not explain why the PSA has gone up a touch while he has been on the hormone therapy?? We are all so confused now...
Dad said his back feel ike a nerve has been pinched. The Dr also said that sometime that particular HT needle may not have worked? I dont know?
Anyway, if anyone has any advice or if anyone has anything similar, please let me know. I just feel sick VIEW IMAGE
I love my Dad so much and this is just tearing me up inside....

Roxy152
 
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