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Rise is PSA After Rest From Hormone Therapy

DougS
Posts: 11
Joined: Dec 2011

This is my first post after having just recently found this site - another member to the "reluctant club".
My wife and I found received the news about PC in February, 2008 when my PSA was measured at 29.7. I was 54 in 2008. The subsequent biopsy revealed 5 out of 10 biopsies were positive (left side of the prostate)with a morphology grade of gleason 9 (4+5). There was evidence of bulging within the left seminal vesicle abutting the tumor and the doctors could not rule out extension into the left vesicle. I also had benign prostatic hypertrophy. The doctors showed us the original MRI picture pointing out the several suspicious locations (i.e., scattered sigmoid diverticula)and can appreciate the difficulty in their interpreting small features.
Upon their original consultation, we agreed to radiation and hormone therapy. I received a total radiation equivalent to 73.8 gray to the prostate and lowered abdomen over a period of eight weeks. This I received with little discomfort. Beginning in July, 2008 I began receiving Luprone every three months.
My PSA steadily lowered to a minimum of level of 0.23 reached in November, 2010. Even before having read Dr. Myer's book 'Beating Prostate Cancer:Hormone Therapy & Diet' we were requesting that testosterone levels be measured. In March, 2010 we were told that the measured free and total testosterone levels were measured and had adequately lowered - but specifically the doctor said that dihydrotestosterone was not measured. I have been under the care mostly of a radiologist (one or two visits with an oncologist).
In March, 2011 I received my last Luprone injection and it wasn't until November, 2011 that the PSA jumped to 1.55. The radiologist immediately scheduled another CT and bone scan. The scans repeated the results from 2008 with no evidence of bone metastasis. I went on a pure vegetable juice diet for a month until December, 2011 when the PSA actually decreased to 1.40. Since 2010, I have lost almost 45 pounds of weight put on during the hormone therapy - which I still should take off another 20 pounds for my height.
I have since read Dr. Myer's book and have also been taking supplements along with exercising.
Thanks to everyone who takes the time to share their particular roads traveled.

VascodaGama's picture
VascodaGama
Posts: 1515
Joined: Nov 2010

DougS

Thanks for sharing your story. I took particular attention to the date of your first and that of your last Lupron shot.
You did not clarify if the protocol of the treatment was a combination of HT (hormonal) plus RT (radiation), or if it were just the single RT, which was followed later by adjuvant HT.
I make this question because the two modalities are similar but different, and that would lead to different conclusions. By other words, an important element in your treatment would have been to know the level of PSA at the start of the HT. Surely the testosterone level and DHT are elements to be considered too.

Most probably RT “killed” the whole cancer and the negative scans are proving the odds. However, the marker to take into account is a stable PSA level for a considerable period.
HT had some influence in lowering the PSA. Lupron caused lower levels of the testosterone that is feeding both, the cancerous and benign prostatic cells. Once the drug lost its effectiveness, the PSA can be assumed to vary and any increase would not mean a straight “recurrence”, but a return to normal/real values.

I believe that you will need more time to draw a definite conclusion on the results of the treatment. My suggestion is that you get PSA tests every three months and check for its behaviour.

The initial Gleason score of 9, PSA of 29. 7, positive MRI and involvement of seminal vesicles in a 5 of 10 positive biopsy samples, is for an aggressive form of cancer but you have done well so far in controlling your case. Let’s hope for the best.
At this moment you know that your prostatic cells are hormone sensitive and that you could seek again a return to HT if the situation so requires.

Diet and physical fitness is important in our lives as survivors of PCa. There are a series of foods that are friendly in fighting the enemy.

Wishing you a continuous good progress in your journey.
Welcome to the board.

Vgama

DougS
Posts: 11
Joined: Dec 2011

Thanks Vgama
The Luprone injections begain after completing the eight weeks of radiation treatment which occurred at the University of Iowa Medical Center, Iowa City. The first PSA measurement post radiation treatment was 1.66. Like I mentioned, the Luprone lowered the PSA to a minimum of 0.23 in November, 2010. I received my last injection in March, 2011. It was from July, 2011 to November, 2011 when the PSA really spiked from 0.25 to 1.55 and thus caused the doctors to request the dditional testing (CT and bone scans).
We are being told that as long as the spike does not exceed two points above the mimimum baseline of 0.23 AND there is a leveling of the PSA concentration that the radiation treatment is still considered effective.

ob66
Posts: 214
Joined: Apr 2010

I have been away from the forum lately, but returned to check this item of interest. What VascodaGama sez is exactly what my urologist has told me. Briefly, in June 2009 I had a daVinci procedure. Ten months later my ultra sensitive PSA rose ever so slightly (0.05 to 0.07). Went on lupron immediately and had RT in one month (had an AUS installed just prior to the RT). My pre surgery Gleason was 8 with seminal vesicle on one side involved and no lymph node involvement.

For 1 year, 8 months I have been 0.00 PSA on ultra sensitive and had my last lupron injection last week. So in four months the worry will begin again. I have gone on a no red meat, no dairy, low sugar diet as well, and exercise by walking at least 3 miles every day, plus aerobic exercise at the club along with weight lifting at least four days per week.

Interesting point is that I have told my docs every visit about my diet and exercise, and they have always commented positively about my exercise, and been very ho-hum about my diet. Well guess what, my urologist finally this last visit said that dietary info is coming in that is scientific and is showing that diet is important.

So now I have 4 months until I have to start worrying about possible PSA rises. But my PSA readings were not that high pre CA. Like about 4 or 4.5. So my doctor explained that we watch post lupron, which he said will take a lot longer than 4 months to clear my body. Then it is both the amount of rise and the speed of rise that will determine when or whether I go back on lupron again. I am one of those people who could stay on lupron forever. After all, I am alive, and have just the hot flashes (pain in the b*tt, but tolerable) as a noticeable side effect. He said that it is best to go off after two years. Will update as we go along.

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