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Posted 12/14/2020 6:54 PM (GMT 0)
Hello
My dad had a radical prostatectomy in 2012. All was good for 5 years then PSA went to .24. He went on Lupron for 6 months and then had about 35 radiation treatments. He did that June-August 2018. PSA had been fine until February 2020 and it was .18 but urologist said he wasn’t excited. Also, dad had gone off of metformin for his diabetes. We had his PSA done again in May 2020 and it was less than .13 which was good and what it had been. He just had it taken last week and it was .14. He is also back on metformin. Any reason to be concerned here? His dr said they will, as always, keep a close eye on his PSA levels and if they would creep up start him on Lupron. Any opinions on this?
Thank you!
Posted 12/14/2020 7:37 PM (GMT 0)
Your doctor seems to have it about right. Your dad probably already had systemic mets at the time of his treatments. No need to panic. Even though your dad is likely at the palliative stage of his path, he still has a lot of life ahead of him.

The big question is at what PSA level should he start ADT ( Lupron plus one of the second line ADT medications). These medication can be effective for many years. This would be best discussed with a medical oncologist who has good experience with PCa.

Good luck!
Posted 12/14/2020 7:44 PM (GMT 0)
Hi! Thank you for your response. No mets. Recurrence was just in the fossa bed. He is 74 and is very active. Praying that PC stays away and PSA stays low. We sure hope he has a lot of years left. His doctor indicates as long as they are on top of things, he should be around a while.
Posted 12/14/2020 10:27 PM (GMT 0)
"My dad had a radical prostatectomy in 2012. All was good for 5 years then PSA went to .24."

#########

when you say "all was good" does that mean he non-detectable for five years? if so most likely the cancer was not systemic and the PSA should have never been allowed to hit .24 before SRT was initiated.

i say this for the next guy because your dad is where he is and like you said there's a good chance he won't die from prostate cancer
Posted 12/15/2020 6:21 PM (GMT 0)
Yes, his PSA was undetectable for 4 years. It went from .1 to .24 in the 6 months between tests. They tested again in a couple weeks and it was .22 so that is when they started the radiation.
Posted 1/12/2021 2:10 AM (GMT 0)
Well all was going well. PSA December 11, 2020 was .14. He went to VA (which uses a different lab) PSA .28 on December 29. That seems like a very high jump in 2 weeks. So I have contacted his urologists office where he had the .14 PSA. They will look things over and likely do a retest to be sure. They are the ones we typically go with as he only sees VA a couple times a year. Below are all of his PSA levels from this year.

Urologist 2020
February .18
May <0.13
December .14

VA 2020
Jan .06
Dec .28
Posted 1/12/2021 3:25 PM (GMT 0)
Yes, that's a pretty good jump, but measurements at lower PSA levels don't always reflect the true doubling time. As stated before, when a clearer picture of his PSA trend forms, the decision will be when to start ADT.

I suspect your husband has a long time ahead of him.

Good luck!
Posted 1/12/2021 3:27 PM (GMT 0)
Whoops! You're speaking of your Dad. Good on you for advocating for him.
Posted 1/16/2021 12:29 AM (GMT 0)
Thanks!
So the ADT should then stop the growth? That’s where it’s confusing to me. I’m assuming scans would have to be done. I just hate the thought of nasty cancer growing elsewhere in his body. We do all that we can to stay on top of it.
Posted 1/16/2021 12:36 AM (GMT 0)
Yes the ADT will halt the growth. Eventually the cancer will become resistant to the ADT, but it likely will keep your dad around for years.
Posted 1/16/2021 1:21 AM (GMT 0)
That is good to know! He was on Lupron for a short while before his radiation. He is 74 and we certainly hope to have several more years with him. I’m praying that the VA tests were off since there was such a difference in results in just 2 weeks, even tho they were different labs.
Thank you
Posted 1/18/2021 4:13 PM (GMT 0)
VA labs .06 in January
.28 December 29
Urologist labs
.18 Feb 2020
<.13 May 2020
.14 Dec 11 2020
.34 Jan 15 2021
He just had a retest at urologist due to the difference in labs. It returned as .34. It doesn’t make sense how it is climbing so fast. He is a type 2 diabetic and his sugar has been high for a few months. He is scheduled with urologist this coming Wednesday.
Posted 1/20/2021 7:53 PM (GMT 0)
Dr said he wants to retake blood to check PSA and testosterone levels. Dad is supposed to go back in a month for blood work then they will schedule him based off what that shows. He said we want the PSA to be the same or not much higher. He wants testosterone to be in the normal range I believe he said. That would mean that the PSA is feeding off of the testosterone (I believe is what he said) We don't want an even higher PSA with no, or low, testosterone. If it's the first scenario I think he said they'd likely start the Lupron shot to knock PSA back down and then if it stayed down for a year they could take a holiday and monitor to see if it went back up. If it was scenario 2 and the PSA goes up a lot again, then he can either start on hormone shot and knock it back down/stop growth or let PSA get to 1 and then go in for the specific prostate cancer scan and see if they can see anything anywhere. He said it has to get to at least 1 to be able to see anything, as in bad cells, then they could do radiation if needed and shots. He said it's all treatable but scenario 1 would be best
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