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psa up from 0.01 to 0.82 in 3months

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Posted 4/18/2014 5:13 PM (GMT 0)
Hi everyone, my dad had a surgery to remove his prostate in 2011,his PSA post surgery was 0.59 ,he is gleason is 8(3+5) he started radiation therapy with hormones zoladex+casodex, after he finished the radiation therapy,his doctor put him on zoladex injection every 3 months. So after 18 months on zoladex,my dad explained to the doctor to regarding financial issue it s very hard for him to carry on with zoladex.
The doctor suggested removal of testicles so she refered him to a surgeons who did a Subcapsular orchiectomy witch is the removal of the tissue from the lining of the testicles where testosterone is made. This leaves a nearly normal-looking scrotum.

He had surgery last June and since than his PSA was 0.00 the last one was on juanury and came back 0.01 and just 2 weeks ago he started feeling hot flashes and breast ten dress and going to toilet many time at night, so he done another PSA yesterday which came Bach 0.82. He went to see the doctor who did the orchiectomy and he said that it s normal and there is nothing to worry about and asked him to repeat PSA in 2 months time and go back to see him.
What do you think please? Thank you
Posted 4/18/2014 5:35 PM (GMT 0)
Have they been testing his testosterone levels? It sounds like they may have finally crashed to zero (the desired / expected results).

The hot flashes and tender breasts are side effects I experienced starting several months after my testosterone got to a low level on Lupron. He may have taken longer to experience (or maybe complain) about them. We tend to refuse to believe these things happen until they are problematic.

I wouldn't expect the PSA to cause these, and if it rises in multiple PSA tests, they will start looking for metastasis. But my guess is that the two are not directly related.
Posted 4/18/2014 5:47 PM (GMT 0)
Hello Laila,

Welcome back to the forum. Sorry you dad has worries. Hope we can help.

From my mostly-uneducated point of view your dad went to the doctor with four complaints and in telling him things were normal the doctor was right about two of the complaints, technically right about a third and, at least as you tell it, he ignored the fourth.

The two normal complaints are the hot flashes and the breast tenderness. Those are normal after his surgery. They are also treatable if they become really troubling for him.

The "right by a technicality" complaint is the rising PSA. Doctors usually want to see a pattern of rising PSA measurements above a certain level before they do anything. If your dad's PSA continues to go up like it has done for his last few measurements his doctors will give him the OK to worry about it around the end of the year. For now, its just an isolated bump and getting too upset about it is borrowing trouble.

I don't see the urinary complaints as "normal". They probably aren't related to the orchiectomy. My guess would be a bit of radiation cystitis, assuming a urinary infection has been ruled out. That would be something to talk to his regular urologist about.

We have a lot of guys here who know more than I do. I'm sure they will be along any minute to correct all of my notions.

Welcome back.
Posted 4/18/2014 5:54 PM (GMT 0)
What was his testosterone level (and free testosterone if they measured that)? There are non-testicular sources of testosterone from the adrenal glands that can be controlled with ketoconazole, which is relatively inexpensive, or Zytiga, which is very expensive. Zytiga also controls intratumoral sources of androgens. Bicalutamide can block the cancer from using androgens and the generic drug is available.

- Allen
Posted 4/18/2014 6:42 PM (GMT 0)
No he didn't have his testesterone level checked
Posted 4/18/2014 7:04 PM (GMT 0)
Well, I think it is safe to think that the Testosterone is now basically zero, which would account for hot flashes and tenderness.

It doesn't help now, but knowing the "before" number would have helped understand how much impact there would be as to SEs, and how soon. But decision made to go that route, it would have been academic, and in the scheme of costs, a few hundred dollars of "wasted" money. Whether he was prepared for them or not would make little difference, because when hot flashes start, they will be everything but what you had expected.

My T was never real high, so it didn't have far to fall.

PdA and TA covered the rest for now.
Posted 4/18/2014 7:27 PM (GMT 0)
Thanks for all your answers, my main concern is the raised PSA. what do you think about it? your opinions please.
Posted 4/18/2014 8:00 PM (GMT 0)
The raise in PSA does not look good to me. He may have Castration Resistant Prostate Cancer. The cancer seems to be advancing in the absence of much testosterone . Knowing his testosterone level would clarify his situation.
There are other things he can try as Allen mentioned.
Posted 4/18/2014 9:27 PM (GMT 0)
The serum T is critical to know - if it is above 50, the PSA means one thing, if it is below 20, it means something very different. I'd ask for a blood test.
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