Rising PSA after Surgery, Radiation and Hormone Treatment

Welcome.
That is a pretty significant rise. You will not know if it is castration refractory / hormone resistant till you go back on the hormone therapy. Hopefully you with respond to the HT again for a long time.
Some use a special diet, supplements or metformin to try to slow the progression of the disease. That is probably all you can do until you try the HT again. Good luck.

Robert

The thing that i have learned about Prostate Cancer during my Journey of treatments is that everyone is different and responds differently to treatments, i guess it has to do with our body makeup and our attitude towards the Cancer and life in general. My choice is to remain positive and get on with the life that is left in me, God alone knows what the future holds for any of us. Thanks for your post.

Regards

Michael

Hi Greenan,
It seems to me that a PSA doubling time of 6 months needs to be treated with more urgency, but then what I believe for myself could be totally wrong for others. I have followed that precept through the years.

No question that this is a complex and confusing issue and very much related to the individual patient. I believe based on published studies that early deprivation can benefit an individual patient and that some study results are clouded by many participants being too advanced when treatment is initiated. This is just my opinion and I totally respect and support your decision whatever it is. I am here to support and help others.

Early versus delayed hormonal suppression ... the evidence for early treatment.

Hormonal suppression has been the mainstay of treatment for advanced forms of prostate cancer. Although early clinical studies
suggested that major improvements and even sporadic cure could occur, later randomized prospective investigations showed that
hormonal treatments were palliative rather than curative. The real question then became one of comparing quality of life issues with
survival potential in utilizing hormonal suppression as early or delayed treatment.

As a result of the data generated by Veterans Administration Cooperative Urologic Research Group showing high toxicity in
patients treated with estrogen therapy, delayed hormonal suppression has been accepted as standard practice. Reanalysis of
those data using cancer-specific deaths showed improved cancer-specific survival with early hormonal therapy in selected patients diagnosed with early stages of advanced disease. A large and growing body of clinical data now suggests a superior benefit to early hormonal therapy. Aside from the survival benefit, it is now well established that early hormonal treatment significantly delays the onset of disease progression, which may correlate with an improved quality of life.

In a randomized study by the U.K. Medical Research Council Prostate Cancer Working Party Investigators Group, results
demonstrated a 32% survival benefit with early hormonal suppression over delayed suppression, and at the same time
pathological fracture, spinal cord compression, ureteric obstruction and development of extra-skeletal metastases were twice as common in deferred patients. Improving quality of life is thus an important issue in applying hormonal suppression at an early stage of advanced disease.

For many years, there has been published evidence that demonstrate that the lower the tumor burden the better the response to hormone suppression. This was clearly demonstrated by Crawford ED et al. in 1989. In this study, men were stratified by the degree of their cancer progression at diagnosis. The response to combined suppression was as follows:

1. Advanced disease with major symptoms such as bone pain, weight loss etc. responded for only 8.5 months.
2. Advanced disease with minor symptoms, responded for 15.4 months.
3. Advanced disease limited to lymph nodes, responded for 4 years.

In this study done almost two dozen years ago, 10% of the patients in the No. 1 category were still responding after 4 years while 35% of the patients with disease limited to lymph nodes were still responding after 10 years. This is a clear indication that hormonal
response is directly proportional to the degree of disease progression at the time of therapy application. The earlier the better to avoid the cancer from becoming resistant on its own.

RalphV