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Lupron - PSA question?

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Posted 4/4/2012 5:01 PM (GMT 0)
It's been a while but I have a question about PSA and Lupron.

Dad went to the urologist today for his shot and his recent PSA test the PSA to be .19. (The test was last week Fri).

The previous PSA reading at this lab was .03 (in early Jan).

His urologist gives the Lupron shot, then he always follows up with the onclogist 2 weeks later. Her PSA test from 4 months ago was 0.00 (different labs).

Is a rise from .03 to .19 alarming?

The urologist wasn't worried (although he's always optimistic). He said he believes the PSA will drop to undetectable by the time he meets with the oncologist in two weeks. He thinks it was higher because it was time for his next Lupron shot.

Any thoughts from anyone? I'm worried to see a rise in the PSA.

He's a Gleason 9 w/questionable mets to the bones.  (hopefully my signature will include the rest)

Posted 4/4/2012 5:39 PM (GMT 0)
As the doctor is not worried, I would go along with the doctors attitude
Posted 4/4/2012 6:07 PM (GMT 0)
Is he having his testosterone checked? In theory, if the Lupron injections are being provided on the correct schedule, the testostorone should remain at the castrate level between injections and thus should not be driving the PSA up between injections. What formulation of Lupron injections is he receiving (i.e. 1 mo, 3 mo, 4 mo, 6 mo?) and is he sticking to the required interval?
Posted 4/4/2012 8:38 PM (GMT 0)

Hi Concerned,

After radical prostatectomy + HT any increase in PSA is an alarm that needs to be clarified. As SC mentioned your Dad should have his testosterone level checked. Same with the last PSA. It should be verified to be elevated. Treatment decisions should always be done after PSA verification to rule out errors.

In your Dad’s case, with a GS9 and known bone metastasis after failing RP, the probability of disease progression is very high. If progression (by an elevated PSA) is verified, he should consider adding an antiandrogen to Lupron and monitor PSA closely (at least every 3 months) to be able to address the situation as early as possible.

Be sure to create a Plan B with your medical oncologist to be ahead of any potential situation. Wish you and your father the very best.

RalphV

Posted 4/10/2012 4:57 PM (GMT 0)
Thanks everyone! To answer the questions:

Southern Comfort: I previously asked them to check his testosterone and they did. I do not know if they checked it this time. I will have to have a look at the blood work to check and will report back.

He has his Lupron shot every 4 months, religiously.

Ralfinaz- As you stated, I agree with you. I'm very worried because of his stats. The PSA is always tested at two separate labs because his Uro is at the local hospital and the oncologist is at the Cancer Center. When I asked about adding something to the Lupron the oncologist was hesitant. She said those drugs increase bone loss and he is already beginning osteoporasis. I will ask again though.

Thanks for the feedback on creating Plan B. This is good advice!

My other concern is he has had a cough now (pretty bad) for the last 8 weeks. They've done Xrays, treated for acid refulx, 2 rounds of different antibiotics and nothing is working. He started a new BP mediciation (Amlodapine) but was told this is not one that creates a cough. Any ideas on that?
Posted 4/10/2012 6:49 PM (GMT 0)
Hello Concerned,

The drug that lowers testosterone is Lupron. Your Dad is already on that drug. Antiandrogens (like Casodex) do not lower testosterone. They are blockers that prevent any androgen from linking to the androgen receptor (AR) and preventing tumor cells to grow. If the med onc is cocerned about your Dad's osteoporosis, he should be treated with a med to prevent the condition such as Xgeva, Zometa etc.

The drug that is being used to treat blood pressure (amlodipine) is a calcium channel blocker and could have a side effect in your Dad's repiratory system such as dry mouth causing the cough. Ask to see if a med change to an ACE inhibitor or an angiotensin II receptor inhibitor or even a beta-blocker would eliminate the cough and still control BP.

Wish you and your Dad the very best,

RalphV

Posted 4/11/2012 4:02 AM (GMT 0)
I wonder why urologist get to provide the $2k Lupron shot and then send you to an oncologist....You would think the oncologists would want that action.....They should also be doing a "T" level test to be sure the drugs are working effectively..
Posted 4/11/2012 2:26 PM (GMT 0)
Fairwind,

The urologist does the Lupron shot by our request. It's a 1/4 mile to his office verses 30 miles and downtown Detroit for the oncologist. The uro is out of our local (yet very well respected) hospital and the oncologist is out of the cancer center.

The thing I don't like is Dad has multiple doctors and none of them seem to talk to each other (except the uro and the oncologist). His primary care is useless. They did a chest xray for the 8 week cough and simply said "it's clear". I'm hoping its not PCa related. He's been on everything under the sun to try and cure the cough.

Not sure what "it's clear" means ... clear from pneumonia or clear from lesions? Doesn't help that us kids are working and we have to try and get the information second and third hand since we can't go to every appointment.

Ralfinaz,

They are expecting to start something similiar to Zometa this month. When we went last time there was a national shortage of it. He has requested several times a change in BP mediciaton but his primary doctor is a quack and doesn't seem to know what he's doing. We are pushing for him to get a new primary care physician.

We have a call into the onco -- hopefully she will give us some insight as to whether or not this is Pca related. Seeing the rise in PSA is worrisome :-\
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