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Father's PSA increasing after removal of prostate 15 years earlier.....

lsugirl
Posts: 10
Joined: Jul 2011

I hope someone might be able to help me help my dad with his results today. 15 years ago he was diagnosed at 53 with prostate cancer (PSA was 14 I believe at the time) - he had his prostate removed along with some tissue/nerves around the area. 6 months later his PSA started going up again and he did radiation for 6 weeks - awful for him and he still has side affects.

Well now he is almost 70 and his PSA has gone from 1.5 to 2.3 in 3 months - what would be causing this? His bone scan was clear but that doesn't mean he could get cancer somewhere else right? The doctor is retesting him in 3 months and said if it's up again then he will treat him with Lupron. Amazingly that was the medicine I was offered for my endometriosis.

I'm also very interested if anyone has had a situation where the father was dx early with prostate cancer (early 50's) and the daughter was dx with breast cancer early (40). I tested negative for the BRCA gene so it's not genetic but it seems that there might be some connection to us? Anyone else had this or heard of this?

Thank you so much for any help/advice you can give - I want to be strong for my dad and help him.

Blessings to you all!

mssa58
Posts: 21
Joined: May 2010

I also had my prostate, along with other tissue, removed in Oct. 2009 and then in May of 2010 they did female hormone treatment along with radiation therapy. I understand how he must have felt having the radiation treatments, they made me so weak and tired that my daughter often had to wheel me back out to the car in a wheelchair. Like him, I am still having weakness and tiredness a year later, although it is getting less and less.

If his PSA has gone up that much in 3 months he should be getting treatment now. It is my understanding that after your prostate is removed you should never have a detectable PSA score. It might me a good idea to get a second opinion from another doctor rather than wait another 3 months for another PSA test. The doctors made me wait 4 months from my diagnosis until they removed my prostate and thanks to making me wait my Gleason score went from 8 to 9. You and your father should both be very proactive in your care and don't let the doctors use you as a guinea pig by making you wait to see what happens.

Good luck to both of you.

Terry

Old-timer's picture
Old-timer
Posts: 109
Joined: Apr 2011

My PC history is much as your dad's. Here is a brief summary of what I have experienced: At age 64, in July 1991, I was diagnosed with PC. My PSA was 4.0. Had RP in Sept 1991. PSA dropped to .0. After 13 years, in 2004, PSA began a slow climb upward. In 2005 (with PSA at 1.16) I had 36 sessions of radiation. The radiation treatments were ineffective. Apparently, the cancer had moved out of the area where the radiation was directed. PSA continued to climb. It reached 20.4 in 2008, at which time I went on hormone therapy. PSA dropped to less than .01 (undetectable). It has remained at that level for three years. My urologist said my cancer is in remission. Very good news.

Did your doctor give you a Gleason score? Mine is 7 (3+4). This is said to be average, not bad but not good either.

My mental attitude is generally upbeat. I was uneasy for a few months back in 1991, but most of the time since then, I think it is fair to say, "I am a happy camper." I extend a word of encouragement to you and your dad.

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Isugirl

Your father is experiencing recurrence. I agree with Mssa58, you shouldn’t wait three months to certify metastasis. You could get a second opinion from an oncologist or just do another PSA test in one month to verify for PSA doubling time (PSADT) and PSA velocity.
Nevertheless, recurrence is apparent because there is no other cause then cancer activity to justify the produce of PSA and its firm rise in three months.
Your father is systemic and that needs a quick action to stop the advance of the cancer.

Systemic cases are treated with hormonal or chemotherapy or a combination of both. In my case of 11 years (dx at 50 years old), I also had two failed treatments (RP and RT) and now I am on HT (hormonal treatment). After RT, the PSADT was not bad at over 9 months but recurrence was evident for the continuous climb of the PSA curve. Bone scan and MRI were negative to metastases or lesions in bone or organs. My doctor’s trigger to start HT was a PSA=1.0. I am now on mono blockade with Leuprolide acetate (Eligard = Lupron).

HT is a palliative treatment that aims in controlling the advance of the cancer by lowering the testosterone levels in our bodies. The purpose is to “kill” cancer cells that are hormone dependent (cells that feed on testosterone). Agonists like Lupron will cause the testis to stop manufacturing testosterone on approximately 95% of its total in the body. The left 5% are almost all produced in the adrenal glands and that is impossible to “close down” (the glands could be dissected but we need them for other functions).

You have not posted other data regarding the diagnosis of your father such as Gleason patter or score which would indicate on the aggressiveness of the cells in your dad’s case. However, in high risk cases with Gleason grades of 4 and 5, oncologists use double blockade composed of an agonist plus an anti-agonist (similar to Casodex), which will attempt to stop the feeding of testosterone (near to 95 + 5%) to cells. In a triple blockade drugs labelled 5-alfa reductase inhibitors are used to “block” the fabrication of Dihydrotestosterone which is a 5-fold powerful type of testosterone that exists in lower quantities in our body.

Your dad should be acquainted with the side effects from HT. There are also medications that interact with the drugs of treatments for other illness, particularly drugs related to heart problems, if any.
Periodical tests such as PSA and Testosterone, and a bone density scan is advisable to patients on HT because bone loss is an evident side effect of the treatment.

You can read details on these three types of blockade by searching in the net or in the book titled “Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on treatments for systemic cases. In the book Dr. Myers explains about the side effects from hormonal treatment and how to handle those symptoms.

I have read that mmutations of the brca genes in men have been indicative of elevated risk for developing male-breast cancer, but never idealized on the possibility of existing female-prostate cancer. I presume that if these genes were the culprit of these hormone dependent cancers then the some condition could apply in both genders. Your case could be one of the very rare.
(http://prostatecancer.about.com/od/riskfactors/a/prostatecancerbreastcancerlink.htm)
You can read about the theme; “Male prostate cancer raises risk for female breast cancer”, in this site;
(http://www.breastcancer.org/risk/factors/ask_expert/2008_03/question_29.jsp)

I hope my insight is of help.
Wishing the best to you both.

VGama

tarhoosier
Posts: 181
Joined: Aug 2006

Isugirl:
Welcome here. I invite your father to read and participate himself.
As to his current condition, he likely has persistent disease located outside of the prostate region, though this is not certain. The difficulty is that with current imaging technology one cannot be sure where the disease is located, if indeed localized to any particular area. Even if found then his previous radiation will not permit radiation in the same area again. I am sorry for his long term side effects. Technology in radiation had improved dramatically in the intervening years since his treatment.
His choices seem to be:
1.) waiting and watching the psa to determine the best time to intervene. This may include diet, supplements and or mild treatments including anti androgen such as bicalutimide, and also Avodart. These may affect the psa increase or doubling time, without the more serious side effects of the intervention below.
2.) immediate intervention with testosterone (hormone) inactivating drugs. Lupron is just one of several which act in similar ways. These drugs also have the same effect in women to reduce estrogen production which is essential in treating endometriosis and a few other conditions. This may include the interventions listed above or not, as recommended by the oncologist.
3.) an investigational trial of a drug or treatment in research.

It is likely that these treatments in some order will keep your father in remission for years and newer drugs will come on stream in a few years to last longer still.

There is a relationship within families and generations between prostate and breast cancer. These two diseases are both sexual related and each can be treated with estrogen or androgen related drugs. The female equivalent of bicalutimide (Casodex) is Tamoxifen.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Isugirl,

As others have suggested, the symptoms you describe are strong indications that your father's cancer has recurred. In all liklihood, it never really went away but over the years the amount of cancer cells have grown to where the PSA they produce can now be measured. Since prostaste cancer is usually a very slow growing disease, this can take several years. The rate of increase you describe, however, is troubling. Most urologists consider that a PSA greater than 0.2 ng/ml following salvage radiation is an indication of recurrence. Your father is well beyond that stage at this point.

If it was your father's GP who made the suggestion to wait three months and see what happens I suggest that you strongly urge your father to schedule an immediate appointment with an oncologist that specializes in prostate cancer. If it was his urologist or oncologist that made that suggestion, I would get a second opinion as soon as possible since that advice, given your father's condition as you have described it, just doesn't make sense.

You may know that a likely course of treatment at this point is hormone therapy. HT will not cure or reverse the cancer but it will block the testosterone that is feeding the prostate cancer cells and slow the progression of the disease. There are frequently side effects with HT that range from very mild to quite severe depending on the dosage and how the individual patient reacts to the particular drug being used. Your doctors should thoroughly explain the potential side effects of this treatment so that you can both understand what to expect.

There is a strong statistical correlation between breast cancer and prostate cancer. They are like brother-sister diseases and men who have mother's with breast cancer are more likely to have prostate cancer and vice versa. There could very well be an enviornmental connection as well, particularly if you live in an area with a high level of carcinogens such as pesticides, heavy metal contamination, and so forth. Studies have also shown a high degree of correlation between high dairy intake and both prostate and breast cancer. If you take the time to peruse some past postings on this board there are many excellent threads on this subject.

BTW, prostate cancer past a certain stage almost always spreads. In is inherebntly metatastic and once cancer cells escape from the prostate gland via the bloodstream or lymph system they can eventually find a place to grow in the liver, lymph nodes, lung, pancreas, or most commonly the bone. Fortunately, our body's immune system can handle most of these wandering cancer cells but eventually a few will survive and start growing. Exposure to dairy (which has hormones that feed cancer growth) or other chemicals in the enviornment can hamper the ability of the body to fight these cancer cells. Also, once the cells leave the prostate they tend to grow faster than than before.

Studies have shown that survival after recurrence has occured is 10 years or more, even if no treatment is taken, so your father has an excellent chance to be around for a long time to come but I do hope that you seek a doctor who is up-to-date with the most recent advice on treatment of recurring prostate cancer.

As tarhoosier suggested, it would also be good if your father got very involved in his own diagnosis so that he can understand what is happening to him and what options the doctors will recommend. Your support is obviously important but he needs to take ownership.

Best to you and your family,

K

lsugirl
Posts: 10
Joined: Jul 2011

Thank you all for your comments and advice/suggestions - I really appreciate it. I will definitely pass this information on to my dad - especially the part about him needing to register on here and be involved. By the way - I talked to him yesterday and his PSA results came in - not good unfortunately. It went from 1.7 to 2.4 in the last 3 months so I'm going to ride him about getting a 2nd opinion and getting a PET scan - a bone scan in my opinion is not helpful - if they found something in his bones then I would have to believe that it would be too late. I think he told me that it has doubled in a year so we need to be vigilant and stay on top of this.

Unfortunately he is hard headed about going to doctors and staying on top of things - hopefully by reading your posts this might get him motivated - especially seeing the survival rates.

I'm wondering if he should get genetic testing? I don't have the BRCA gene but that doesn't mean he might not be a carrier right? I have a brother who turned 40 this year and has 2 little girls so he needs to know not only for him and his chances but for his daughters.

Thanks again and have a great weekend! I will keep you posted as we hear more and hopefully my dad will be a member. :)

Kim

mrspjd
Posts: 688
Joined: Apr 2010

Kim,

Welcome to the PCa forum. Breast cancer and prostate cancer are hormone sensitive cancers. A little known fact is that men can be carriers of the brca 1 and 2 genes, common in breast cancer. The only way to know if a man is a carrier of the brca gene is through genetic testing with follow-up genetic counseling.

What this means (in the realm of PCa) is that if there is a history of prostate cancer in a man's family, not only are his sons at a higher risk of PCa, but if he is a carrier of the brca gene, then his daughters may be at higher risk of breast cancer.

Wondering if you (or another poster) can share your views or explain the differences between a PET scan vs a bone scan and why (if I understood your post) you indicated a PET scan might be better/more helpful than the bone scan for detecting metastasis (or micro-metastasis). Would a CT w/contrast be another diagnostic test? Thanks.

Best,
mrs pjd

lsugirl
Posts: 10
Joined: Jul 2011

Hi Mrs. PJD,

Thanks for your post. Yes, I do know about the BRCA gene and the correlation between prostate and breast cancer. However, I tested negative when I was first diagnosed b/c of my age (40). The genetics doctor I met with said that they can't prove it but likely there is some kind of link between early prostate cancer (early 50's like my dad) and breast cancer in daughters. So I'm not a carrier but could my dad be and we don't know it? That's why I want my dad to get tested for the gene b/c maybe it skipped me but my brother might be a carrier? My big concern is my brother and his girls. That's why it's IMPERATIVE to know your family history.

I guess with a PET scan they can see organs and more areas of cancer vs. a bone scan that only shows the cancer in bones and I would figure by the time its in your bones it's late. :(

Thanks for your reply and all the best!

mrspjd
Posts: 688
Joined: Apr 2010

You may find this factsheet about the brca 1 and 2 genes in both men and women informative. It's from the National Cancer Institute at the National Institutes of Health:
http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA

Good luck to you and your family.

lsugirl
Posts: 10
Joined: Jul 2011

Hi everyone! Wanted to let you all know what is going on with my father. His PSA went from 2.4 to 4.0 from July to last week so clearly not a good sign. A MRI and bone scan confirmed metastasis to his lumber/back (L1 and T9 to be exact. He was having leg pain and thought it was his siatica acting up again and as you know, they require MRI's before any type of injection shots for the pain and that's when the neurologist found the lesions on the MRI and bone scan confirmed.

As you can imagine we are crushed but most of all ANGRY (at least my mom and I are)! I'm angry that his urologist farted around since February when his PSA was above 1.0, he's not in "BATTLE MODE" with my father to start treatments and his attitude towards my parents and their concerns is less than desirable.....especially since my dad has been seeing him for over 15 years! Fortunately my mom has stayed on top of this and got his records sent to his oncologist and he has a meeting with him on Friday to discuss next steps.

If it has metastaized to his back - is that a death sentence or is it possible that hormone treatment can shut the cancer down and radiation can eleviate the lesions on the back and help with pain? Any advice, suggestions, or whatever you can give is most appreciated as my father isn't really "going to battle" with this like we want him to.

Thank you so much!

Kim

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Kim

Your dad has several options of treatment. Metastasis to bone is common in prostate cancer cases, and there are proper medications to tackle the cancer in bone.
His case is systemic to which hormonal or chemo therapies are the norm. You never indicated his Gleason grade (aggressivity of his type of cancer), but if not of pattern 5, he may do well with a combination of HT and a bisphosphonate, to manage the two spots at L1 and T9. He should start the treatment the soonest, and he should get advice from a proper physician. I would recommend him to consult an oncologist specialized in targeted treatments and give up with his urologist.

The typical in HT is the combi of an androgen (LHRH agonist like Lupron) plus an anti-androgen (like Casodex). For the bone metastases he may be given a bisphosphonate of the type of Zometa which are known to reverse the bone mets.

He could also try to engage in a trial where he may avail of newer drugs proven to be beneficial for bone metastasis cases. The only problem is if he is grouped in the placebo group. He should only accept if they assure him that he would get the drug. His case is advanced and he has no spare time to be without a treatment.

Some trials have finished and the drugs have been approved so that your dad could inquire with his (new) doctor about them. The most recent tested drug is Alpharadin, a radiopharmaceutical that kills cancer in bone and relieves any pain associated with the lesion. An approved drug named Xgeva (denosumab) prevents and cures bone mets. You can read details on these drugs in these links;
http://csn.cancer.org/node/227012
http://oncozine.ning.com/profiles/blogs/denosumab-xgevar-approved-to

For the trials you can check about the type of medications using this site search engine. Just type “bone metastasis and prostate cancer”;
http://clinicaltrials.gov/ct2/results?term=prostate+cancer+with+bone+metastasis

All medications got side effects and may interact with other drugs taken for other health problems. Your dad should inquire about details if he is taking any.
Prepare a List of Questions before visiting the doctor.

Hope you find that peace of mind.

VGama

tac0213
Posts: 2
Joined: Oct 2011

Almost 19years ago I had my prostste removed. I was 44 years old. I had a very agressive form and took three rounds of adriamycin. Two years ago my PSA began rising and has stayed at .7 since Sept. 2010. I have been going every 6 months for the past 3 years for PSA readings. Three weeks ago it had jumped to 1.7. I am now being told I'll need 7 weeks of radiation. The bone scan was clear. He also mentioned about the possibility of hormone therapy. I am angry and scared. My wife has rheumatoid arthritis and I really need to stay around for her. Any advice from others who have experienced this would be helpful. Thanks.
Terry

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Terry

Let me welcome you on the board. Your case is extraordinary. A 19-years veteran survivor of prostate cancer. There are not many of you posting here.
Your case is indicative of recurrence even in the presence of a negative bone scan. 7-weeks of radiation is the typical protocol for salvage radiotherapy. The hormonal portion in the treatment is usually recommended in advanced cases which by the info you share here does not seem to be your case. Do you still have the contents of the pathologist report of surgery?

You can be confident that you will be there for your wife. Radiotherapy got its own risks and side effects but is tolerated by most of us. Hormonal therapy is a palliative type treatment which got its own side effects which in some guys are more assentuated then in others, but once one stops the treatment all returns to normalcy. I am doing fine on ADT. Fatigue is the most apparent symptom even if I have experienced many of them.
You will do fine too.

I also had surgery eleven years ago but soon after I experienced recurrence. Was on WW until 2006 and did salvage radiotherapy (IMRT, 68Gys in 37 fractions). RT drove the PSA down from 3.6 to 0.05, but again my cancer recurred 3 years later. I am now on hormonal therapy (since November 2010) and that is controlling any advanced of the cancer, driving the PSA down from 1 to 0.03. I have experienced some side effects but luckily never got any that impaired my normal way of living. I am now retired, I feel fine and life is great, at this corner of Europe where I live.

This book may help you in your journey. It helped me a lot.
“Beating Prostate Cancer – Hormonal therapy and Diet” by Dr. Charles Myers.

I wish you peace of mind.
VGama

hunter49
Posts: 199
Joined: Oct 2011

what was you Gleason score and combination (4+ 3) etc?

shell1972
Posts: 2
Joined: Nov 2011

All I can say is keep your head up.I'm going through it at this moment with my husband and he is only 49 nobody knows his time but God, so stay prayed up that's all we can do and God Bless you

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