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PSA still rising after RP and RT - when start HT?

sbj
Posts: 24
Joined: Jan 2011

After RP in 2003 (Gleason 3+4) PSA was zero for about 3 years. Then started rising. At 0.15 had RT of prostate bed. Treatment had absolutely no affect on PSA rise. Today reading is 0.5, rising at a rate of about 5% per month. Oncologist says HT is now needed, but suggests delaying until PSA gets higher - to around 5.0. I'm unsure as what course to take. Should I undertake HT immediately or wait, thus trading risk of metastazing in favor of delaying HT and its side effects?

VascodaGama's picture
VascodaGama
Posts: 1518
Joined: Nov 2010

Hi SBJ

In January 2011 you posted an increasing PSA since surgery (2003) with a PSADT of 17 month. That was indicative of a low growth type of cancer more likely as the presence of micrometastases.
Here is the link; http://csn.cancer.org/node/210470

You are now at the one year mark since the end of SRT with a PSA 0.5 and I wonder what has been the increasing pattern along this year. Why is your doctor suggesting recurrence so soon and why doesn’t he recommend other protocols?

I recall that your SRT protocol did not include radiation of close lymph nodes neither the ones at the iliac area. It seems that you have still other possibilities of caching the bandit with focal radiation.
This is done in cases of oligometastatic cancer (a few spots of cancer colonies). I recommend you to investigate on the matter because if such is your case you could follow that route. The modality involves a combination of focal radiation and hormonal treatment for handling any systemic. You could discuss the matter with your radiologist or get second opinions from specialists. You will need to get the isodose plans used at your RT of January 2011.

You can find in the net many articles related to the matter and medical information related to the treatment. Here is an explanation of oligometastatic cancer.

http://scienceindex.com/stories/441384/Oligometastases_and_Oligorecurrence_The_New_Era_of_Cancer_Therapy.html
http://scienceindex.com/stories/1013187/Clinical_Outcome_of_Hypofractionated_Stereotactic_Radiotherapy_for_Abdominal_Lymph_Node_Metastases.html
http://jco.ascopubs.org/content/13/1/8.full.pdf+html?ijkey=b9d607c42c78c6cec55dc3a38c480dcd5aced5dd&keytype2=tf_ipsecsha

In my case of 12 years with failed RP and SRT, and diagnosed initially with micrometastases, the threshold PSA level to trigger HT was PSA= 1.0 ng/ml.
Similar to your case, the PSADT along these years has been on the 14 months and after SRT (therefore judged to be systemic) the PSADT become 9.5 months. Though, I got to a nadir of 0.05 on the 13th month post SRT.
My progress under HT (since Nov 2010) is in these links;

http://csn.cancer.org/node/224641
http://csn.cancer.org/node/215330
http://csn.cancer.org/node/236528

I would recommend you to have your testosterone checked before starting HT , as well to have a bone densitometry done to check for bone health. Lipids should also be checked. HT will lead you to low levels of circulating T causing hypogonadism, and that has influence in many other body functions.

Hope for the best.
VGama

tarhoosier
Posts: 181
Joined: Aug 2006

Podem as férias vão bem

tarhoosier (with help)

tarhoosier
Posts: 181
Joined: Aug 2006

Podem as férias vão bem

tarhoosier (with help)

VascodaGama's picture
VascodaGama
Posts: 1518
Joined: Nov 2010

Tarhoosier

If my English could be that good as your Portuguese I would be very happy. But I am concerned. Thanks for the dedication.
The holidays will continue until the PSA gets to 2.5 ng/ml.
This is my doctor's threshold to my case. My next test is at the end of May. I am curious about the levels of testosterone. I bet that T will get normal at 3.50 ng/mL (350 ng/dL) at the end of summer.

Wishing you too "Boa Sorte" in your journey.
VG

sbj
Posts: 24
Joined: Jan 2011

Thank you for your response VGama & Tarhoosier.

For your review, my complete case history:

PSA reading before surgery: 5.5
2003 March Gleason from needle biopsy 3+4 = 7

2003 May 7 Surgical Removal of Prostate
Post Surgery Gleason score 3+4 = 7
Negative surgical margins, no extra capsular extension, no cancer in seminal vesicles.

Post Surgery PSA History:

2003 0.003
2004 0.003
2005 0.002
2006 September 0.07
2008 January 0.07
2009 February: 0.11
2009 October: 0.11
2010 March 18: 0.15
2010 June 14: 0.15
2010 Sept 17: 0.17
2011 January 17: 0.20

2011 Radiation Therapy 35 sessions (prostate bed only) Feb 07 thru Mar 29

2011 July 06: 0.24
2011 November 4: 0.30
2012 March 17 0.51

Long term PSA rate of increase: approximately 5% per month

sbj

tarhoosier
Posts: 181
Joined: Aug 2006

As earlier, your psa doubling time is slow. Your risk of metastasis is low. Your age is about 76. Your chance of death by prostate cancer is near zero. If in your situation (I wish!) I would delay treatment until psa of 5, or more. I could elect a mild form of treatment such as Dutasteride now. This has minimal side effects. I would also be certain that vitamin D was in high normal area, and maintain a low-no animal fat diet. These effects alone may slow your psa even more. At higher psa bicalutimide could maintain testosterone for bone health and general health while avoiding the larger side effects of stronger treatment. I would also be certain I was treated by an oncologist experienced with PCa and one I accepted and respected. I would not leave treatment decisions to strangers on a board.

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