After Prostate Removal PSA Numbers?

Hello!  My dad is 78 and been fighting prostate cancer for a long time having it removed in 1995...17 years ago.  His PSA starting climbing a few years ago and he's been most of the meds that help including Keto, then Zytiga (pre-chemo).  They have taken him off of Zytiga because his PSA slowly rose to 10.  The problem is they took him off of Zytiga to put him on Provenge.  Almost 3 months from first infusion (he finished all 3), his PSA has gone from 10 to 117.  He can't eat and just looks terrible and we're hoping it's just his gallbladder which is being removed this week.  How high is a high PSA without a prostate?  I know i've seen people with PSA's in the thousands, but I'm assuming that is with a prostate?  Besides the PSA increase, we know it has spread because his gallbladder doctor noticed lymph nodes and some areas in his bones around the gallbladder which he didn't have before, even 3 months ago.  I know Provenge doesn't reflect much on PSA, but it's scary how much it's increased.  Thanks again for your help.

Matt

The small amount of good news is it (depending on the value of "a few") took 14-15 years to start climbing again.

The bad news is that any significant number post-prostate removal means it's "out there" and evidence of bone lesions would be further confirmation. PSA comes from the cancer more than the prostate itself, so prostate removal really doesn't affect it that much unless the cancer is all in the prostate. Really big numbers tend to be from folks where it's spread far and wide. Going from 10 to 117 in less than 3 months is a bad sign regardless of having a prostate or not, as it implies a really short "doubling time" indicative of rapid cancer growth. 10->20, 20->40, 40->80, 80->160 - so it's doubled 3 times already and is about halfway to doubling again in less than 3 months.

I don't know a lot about this end of the disease, but that much I've picked up in passing.

Thanks for all the replies. I had a feeling the meds were keeping it in check because in between meds it seemed to jump up, then the next med would lower it. Keto did well for a long time, then zytiga which is closely related also worked. We wanted him to try provenge before his PSA got to 20 for the most benefit, but I really don't agree with the "wait 3 months to see" plan. He's part of the trial for provenge, I think it's called affirm? I don't think his data will support Provenge in a positive way. Does anyone know if Xtandi is covered by any insurance pre-chemo like Zytiga was, or is it too soon? I'm by his side for all of it and keeping positive with him. I told him PSA's can go into the thousands, I just wanted to be sure I wasn't lying to him. Thanks so much

Matt

Yes, psa can go into the thousands,easily. How long he can go with readings in the thousands depend on his body and any more advanced treatments he may receive. There's just no predicting its end, as far as a timeline. What is his doc saying about steps beyond Pronenge? Any discussions about that yet?

upstatematt, Im so sorry to hear this news.


Cajun Jeff

Today was a better day for dad. Basically when dads bonescan information hit the hospital, they saw "widespread metastatic disease" and thought the worst and that the gallbladder issue wouldn't matter because they thought his cancer was at fault for everything. It seemed like the hospital staff wrote him off, saying nothing would really help him. I tried to buffer the hospital doctors negativity but when I went to eat dinner, the hospitalist came in and told him he was very sick and had cancer everywhere and it would prohibit him from getting his gallbladder out. I called his cancer doctor (not the provenge dr) and he immediately sent representatives from his office to tell the hospital staff that this is prostate cancer, not other forms where widespread metastatic disease is much worse. He had to explain it goes to the bones, it's widespread in the bones. They put into his chart that there was no reason to delay surgery due to cancer. HIs cancer doctor told me he would help me advocate for dad and also expressed his frustration with specialists in other areas basically writing people off from prostate cancer because they don't know any better. Anyhow, long story short, dad's getting his gallbladder out which is much more troublesome than the cancer right now and then next week he will most likely begin chemotherapy to address the cancer. With meds to suppress the gallbladder issue, he's ate in one day more than he has in probably a week just in one day and feeling strong again. He's thriving. I've learned through all of this that you really need to advocate for yourself, or in my case my dad and just how useful forums like this one are to educate yourself and have support. He passed out from not eating due to his gallbladder and it's been a 2 day fight trying to convince the hospital and doctors it was that and not cancer.