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Posted 1/14/2013 5:57 PM (GMT 0)
My ex-brother-in-law was diagnosed a year ago at age 78. His PSA was 22.0, gleason 6, no mets. The docs put him on Lupron every four months. I just talked to him recently (he lives in another state) and he told me he's now getting Lupron shots every month, his PSA is 1.2, and he sometimes sees a little blood in his urine when it first starts. The docs say his prostate is about half its former size but he still has urinary frequency and gets up about four times during the night. Shouldn’t his PSA be much lower by now? Could the blood in his urine be related to his biopsy of a year ago? He’s now 79 years of age and still no mets.
Posted 1/14/2013 6:50 PM (GMT 0)
I suspect that moving from a 4-month Lupron shot to a 1-month would be because they are wanting to be able to change meds sooner if needed, so I would think there is a lot of attention on direction.

What is not said is - was 1.2 the lowest it got, or is it coming back up?

I have intermittent bleeding that is known to be from RT, so if any were added by my Lupron I wouldn't realize it unless things changed dramatically.

Posted 1/14/2013 7:10 PM (GMT 0)
The 1.2 PSA was the lowest. I was under the impression that with Lupron it should be close to zero. If it's not close to zero does that mean he's becoming castrate resistant?
Posted 1/14/2013 7:47 PM (GMT 0)
Going from 22 to 1.2 is getting close to zero. My Lupron took a month to go from 5.2 to 1.x and then another 2 to get to <.1.

So my non-medical speculation would tell me he had a lot farther to go, and, as we've seen in a lot of the articles, he could have multiple variations of PCa - so the idea of moving to a monthly shot may be to see what happens with a shorter window to react if it starts going back up.

He may have had a variety that was partly-resistant all along, and they are just peeling back the part that isn't. My oncologist laid out a similar idea (which is why we were all surprised that mine went to undetectable - that was totally unexpected). Get it as low as it will go. If it does not get as low as desired, or starts back up, try a different drug.

Posted 1/14/2013 8:17 PM (GMT 0)
For what it is worth.....My husband has a little blood in his urine when he first starts to pee. It seems to come and go. As you can see from my signature, he started Lupron in December but he had some blood in his urine before the biopsy which ceased until a little while ago. Perhaps it is from the Lupron

I will be interested to see if anyone else has had similar experience
Posted 1/14/2013 8:38 PM (GMT 0)
Sounds like a pretty huge drop, actually. It may take more time to bring it down closer to "zero", or he may have reached his bottom number.

david
Posted 1/15/2013 3:25 AM (GMT 0)
Thanks to all for the excellent replies. I'm wondering that even though the biopsy showed only g6 it doesn't necessarily rule out a g7 (3+4) or even (4+3) that could simply have been missed. Given his age (79) and the fact that there are no mets at present, isn't there a good chance that he'll outlast the cancer even if it's g7 or greater and his cancer is hormone refractory? Doesn't the cancer have to metastasize for it to cause death? He had a terrible experience with his first biopsy and I don't think he's willing to have another. What would you do under those circumstances?
Posted 1/15/2013 3:35 AM (GMT 0)
I don't expect to get to 79, so I would be happy to have to be there to make a decision.

The key is what happens in the future - PSA stays where it is, goes down, or does go up. No real way to predict that.

The biopsy is 12 needles in a haystack, so of course it could have missed something worse, if it was there. Mine missed my G4+5 that was found in the path report. But maybe there isn't anything worse.

Mets can kill you, yes. But nothing is predictable until there is a trend, or something shows on a scan. So far the trend is down.

Posted 1/15/2013 10:54 AM (GMT 0)
Chances that his cancer will kill him are pretty slim, and kill him any time soon, very close to 0. :) It took my Dad`s PSA over a year to sink to its lowest. Best to you and your family.
Posted 1/15/2013 11:18 AM (GMT 0)
Did his doc mention Flomax for urinary assistance or similar drugs, might work wonders. If his psa starts rising and/or T level is much higher from 20 range, then you should start looking towards second line therapies quickly. See www.hrpca.org Best to you. He might find estradiol patches or gels, not only control the PCa better but assist with bone density, and memory and little to zero side effects and cost less.
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