rising psa

Well its been almost 3 years of good blood tests after prostatectomy and all of a sudden this past August psa jumped to .49. Went and did 39 treatments of radiation. Oncologist thought it would take care of it but it climbed to .6 one month after conclusion of radiation. Worst part is my urologist called the week before and said it had gone down to .06 and my wife and I were ecstatic. Radiation oncologist said oh no its .6. WE were devastated, not the type of news you want two days before Thanksgiving. Thinks that I should go back to Urologist for testosterone depro. but he also said we could wait another three months and retest. Thats the door I took. Not too excited about testosterone depro.

Urologists are not the best choice for treating advanced PC...It's time to make an appointment with a Medical Oncologist, preferably one who treats many PC patients and have a consultation with him...Waiting 3 months is not a good plan..

You might consider traveling to one of the major treatment and research centers like MD Anderson, Johns-Hopkins or Dana-Farber and have their doctors do a complete analysis and work-up...which will give you a solid plan to take back home for your Oncologist to look over and use as a guide....

But George, Allen as quoted and referenced studies showing the benefit and so have you. :)

Steve,

I'm in a similar situation. After failed RP and RT my PSA is currently 1.2. My first MO's suggestion was letting my PSA go to 20 (twenty), find the bone mets with a scan and irradiate them. He would also start me on HT at this same PSA of 20. I thought his philosophy was shocking and counter intuitive but he said there is no evidence that starting HT early has any benefit. Starting HT at PSA 20 would give me more quality time before having to start HT. I did not care for this MO's bedside manner. When I started asking him questions he rebuffed me and told me to let him do the worrying. He has since moved his practice to a cancer center in a different city. I have met my new MO one time but I love his demeanor. He has not given me a definitive treatment strategy but I believe he will recommend HT when I reach a PSA of 2.0.

When to start HT for people after failed primary treatments is controversial. It is interesting that both of these Oncologists were at the same university cancer centers and both run drug trials, yet they have very different treatment philosophies. I will discuss early/late use of HT with my current MO and then decide. It's a tough decision. I want to start HT as late as possible but my intuition and emotions tell me it's not a good idea to just the cancer grow to a PSA of 20 before doing something. We always want to do something NOW, when sometimes it may be better to wait? Human nature, I guess.

Sheepguy,

I wanted to present both sides and not just mention my viewpoint. Steve and his doctors will have to decide when to start with ADT.

The TOAD study, as it is reported, sees an advantage for early ADT while many researchers and I think you do not have to start early since the TOAD study does not represent sufficiant level 1 evidence for that.

In the first link I provided, Celestia Higano, a top-notch oncologist, says regarding the study presented: „.....they lack the statistical power due to short follow-up, too few events, and the hazard ratio does remain unstable.”

At the second link (Prostate Cancer Infolink) I read: „In all honesty it is very hard to interpret the potential impact of this trial“

So I am not alone being sceptical about the evidence this study provides.

George