CSN Login
Members Online: 4

You are here

PSA rises sharply in 5 months

cjzhang
Posts: 4
Joined: Dec 2010

My dad has radical prostate surgery in June, 2009 and received radiation theraphy 4 months after that. He has been doing well in terms of PSA (<0.1) till July, 2010. We went back on Dec. 10, 2010 for a routine bloodwork and detected his PSA had a huge jump to 4.1. To verify it, we did another test on Dec. 13, 2010. It becomes 4.5. We are very worried. Has anyone has similar experience? What will happen next? My father is 70 now and has T3a cancer. PSA was 12.3 before surgery and Gleason score 4+3. Any experience you can share will be greatly appreciated! - Jessie

VascodaGama's picture
VascodaGama
Posts: 3224
Joined: Nov 2010

Hi Jessie
I am sorry to your dad’s diagnosis. Many of us experience identical situation as that of a sudden increase in the PSA. 4.5 is high but there are protocols appropriated for cases like that. For example he may have to start hormonal therapy.
The first thing to do is to try to find a reason for the increase perhaps doing some tests to verify the presence of metastasis, like a bone scan or MRI, however these tests are negative in most of the cases of PSAs lower than 7.0. Nevertheless, it is good to try. You should get an appointment with an oncologist specialized in prostate cancer the soonest.
Hope you find a good solution to monitor that increase.

Take care
VGama

cjzhang
Posts: 4
Joined: Dec 2010

Hi VGama

Thank you so much for the information. The oncologist requested bone scan and CT. The result should come back early next week. Like you said, 4.5 is very high for a patient had radical prostate surgery. But his oncologist seems to not worry at all. She prefers to start hormonal therapy when there is presense of metastasis. She said the life span is same comparing starting the hormonal therapy after the 1st rise of PSA and after the presense of metastasis. Is that true?

Jessie

mrspjd
Posts: 694
Joined: Apr 2010

Jessie,
Hormone therapy, or ADT (Androgen Deprivation Therapy), is a PCa treatment option/choice usually proposed for men with intermediate to high risk stage PCa (T3-T4). It can be used as a primary (or primary + adjuvant) tx option, or during salvage RT tx, or, as is possible in your dad’s case, as the next choice for men where there is evidence of biochemical recurrence (significant PSA rise) after primary + adjuvant/salvage tx. ADT may be effective in shrinking PCa tumors/cells by starving or depriving them of the testosterone and DHT which feed PCa cell growth. A combination of 2 or 3 ADT drugs are often used and may be more effective by reducing T & DHT from several “production sites” in the body. As do most all PCa treatments, hormone therapy comes with side effects. Each man is different in the way the ADT drugs will affect him and the range & intensity of side effects he may experience, not only because of each man’s PCa differences and biochemical make up, but also as factor of combinations of a variety of different ADT drugs themselves.

It is assumed from your post that your dad’s PSA began a rise in July 2010. What was the July reading and were there any PSA tests between July and Dec, when testing indicated 4.5? In most cases, this would signal a “next step action plan” by your doctor. IMHO, the “advice” your dad’s oncologist provided: “She prefers to start hormonal therapy when there is presence of metastasis” is akin to saying “The house is on fire, but we’ll wait until it burns down to put the fire out.” While this may be a drastic analogy/comparison, if the doctor doesn’t consider the rise as PCa recurrence, then what does he/she believe is causing the rise? Is the doctor providing any treatment options/suggestions to address the rising PSA now?

We all hope for negative results of the scan and CT but, either way, your dad should be consulting a knowledgeable oncologist that specializes in PCa. I strongly urge you and dad to immediately seek several 2nd opinions about potential next tx options, including hormones. Be sure to ask questions and fully understand all aspects & possible side effects from ADT, especially if he elects to begin this treatment. Your dad is lucky to have your support and caring concern on this journey. Wishing you both all the best.

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

Your father will be encouraged to start hormone therapy at some point and though it may lower his psa somewhat, that is not the same as extending his life. I was told I had to take one Lupron shot to shrink the prostate enough to start radiation, (psa 24). Looking back and if I had it to do again I would have done nothing. Thankfully I'm still alive 7 years later but it is more aboout attitude and getting the stress out of life than any treatment. If quality of life is the main concern, and it should be, then hormone therapy is about the last thing I would ever advise someone to begin. This is my opinion but I have outlived my 50% chance to survive 2 years by over 5 years now and still work part time and play golf every chance I get. I will be 60 years old in April.

VascodaGama's picture
VascodaGama
Posts: 3224
Joined: Nov 2010

Hi Jessie,

It is not unusual to get a negative result from the tests you are waiting for (as commented in my post above). Those image studies indicate lesions when cancer has formed a tumor of a significant size. In a case of micro metastasis (like my case), PSA can be high but cancer cells cannot be identified. I hope your oncologist will take that into consideration, instead of waiting for apparent metastasis.

The majority of doctors follow the protocol that requests one or two rises in PSA before starting the next treatment. PSA after RT is very unstable, and in some patients it is quite high (PSA= 2,3,4, etc). Once nadir PSA (the lowest reading after treatment) is identified, the Oncology group considers biochemical recurrence on the third rise of PSA after nadir. Those are PSAs taken at least one month apart. Once confirmed BR, the trigger for treatment is set.
In my case the trigger to start ADT was the PSADT (doubling time) and PSAv (velocity), after BR. The marker of my doctor was PSA=1.0.

However, after failure of the two major treatments (RP + RT) the case is considered as systemic which in theory leads to the start of the next treatment the soonest. Here is an abstract from the American Society of Clinical Oncology you may read; http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confID=74&abstractID=51964

Hormonal and chemo therapies are the standard for systemic cancer. Hormonal has much lesser side effects than chemo. You can investigate in the net with the string “prostate cancer treatments side effects”.

I am a ten years survivor of RT plus RP, and now I am in hormonal treatment (ADT). It is well tolerated and I believe that I will hung on over ten more years with the ADT. After that I can expect a second-line treatment in ADT before entering the chemo therapy.
Hope this information will answer your quest.

I wish a peaceful Christmas to your father and all the family.
VGama

VascodaGama's picture
VascodaGama
Posts: 3224
Joined: Nov 2010

Hi 2ndbase,
I believe you have second bases for your negative opinion in recommending hormonal (ADT) treatment. However, if some patients can avoid it, for many others ADT is the best alternative to control the advance of the prostate cancer. You may know that hormonal treatment makes part of the treatment protocols advised by all recognised institutions handling prostate cancer, around the world.

In May of 2000 after being diagnosed with PCa (50 years old) I researched about treatments and came across ADT for the first time, its principles and results in treatments. At the time there was little information on its benefits, but I recall been attracted to the possibility of having it intermittently (on/off periods). That approach was based in reinstituting to the patient the quality of life he had before treatment, when on off-period.
I have chosen surgery (RP) as my first attempt to cure, and 6 years later (2006) I did SRT. These treatments as you know cause side effects, threatening the initial quality of life, and to which we have to adapt.
My experience in ADT (2 months) is still superficial but so far so good. My body testosterone is low and that has given me a sensation of fatigue (now almost gone). Most probably I will experience other symptoms related to the treatment however I decided to handle it exactly as you say, with some changes in attitude. Fitness is my choice and it is working.

I wish you the best in your case.
VGama

mrspjd
Posts: 694
Joined: Apr 2010

The game of baseball might make another (sorry) good analogy to the “game” (apologies again as not meant to diminish the seriousness of personal choice) of personal choices/options when it comes to PCa. Everyone plays the game to the best of his (her) ability. And while some who have previously made it around the bases to home plate may now be content on second base, others are trying to hit the ball out of the park and go for a home run. I thank those on this site who have shared their viewpoints on, and their less than positive experiences with, ADT/hormones. It puts things in perspective (for me). But I’ve also heard and read (and posted) about men on ADT, including my husband, who have successfully tolerated & coped well with the wide range and intensity of side effects from ADT. IMHO, those men are in the trenches fighting, and still in the game.

Just as certain drugs are available to combat some side effects from ADT, other drugs, such as narcotic pain killers, are available to treat the side effects of end stage PCa, which is another, very somber, matter entirely, with its own set of issues and painful side effects.

All PCa, no matter what stage, is serious. T3 and T4 stage PCa is a higher level game. My husband & I fully understand the “quality of life vs quantity of life” issues related to PCa choices when it comes to critical decisions about when and whether to start txs such as ADT, Chemo, Immunosuppressants, etc. (Fortunately, his numbers are still declining as a result of his tx choices, including ADT). In my mind, age alone is never the sole determining factor in any tx decision process--personal PCa staging/stats & history, life style, potential tx side effects, overall physical & mental health/fitness, including whether there are possible extenuating pre-existing serious health conditions, all need to considered when making tx decisions. I think we all agree, these decision processes are very very personal, not the least of which also includes life philosophy/spirituality.

I respect the decisions of those who have opted out of the game (and perhaps, in a sense, even won) and who are able to still pursue other interests/games. I also respect those players still in the game, because, not only do they have a chance of winning, but, as new drugs and treatments (on the horizon, perhaps now in clinical trial) become available, those players have a better chance of winning future games, maybe even the World Series. Just MHO.

ob66
Posts: 227
Joined: Apr 2010

You have to respect everyone's decisions, for they are all so personal. I happen to believe as you and your husband. I will do everything in my power to fight the evils of PCa as long as I can. So far so good. My numbers did not start good. I have had glitches along the way, but 19 months after surgery, 5 months after RT, and 9 months into lupron, I feel great. My numbers are great ( they could be bad, but could also be a false positive). I do everything I can to fight my Gleason post op 8, and so far so good. I am realistic enough to know it may not always be that, and my chances are less than many others, but for now, all is wonderful. Other than the 6-9 times a day hot flashes, I feel totally normal, whatever normal is. Workout 4-5 times a week at the same level as pre-PCa. Have gone on a no red meat, no dairy, sugar reduction diet, and my only regret would be if all this did not work, that I would regret the diet I am on. But who knows right now. I would rather be pro-active at this time. Merry Christmas to all, and I wish you all a great New Year coming up.

cjzhang
Posts: 4
Joined: Dec 2010

Thank you all so much for the encouragement. Me and my dad really need that and I am deeply appreciated! Thanks god, my dad's bone scan and CT scan all came back clear. We have visited two oncologists since then. Both said my dad's case is biochemical failure. One recommends to start standard hormone theraphy now using Lupron. The other wants to enroll my dad in a clinical trial (this oncologist is also a professor). I discussed with my dad and we both are hesitating to get on the clinical trial which could have many unknown side effects. We are now scheduled to meet with Dr. Mario Eisenbeger at John Hopkins in early January. I heard he is a famous oncologist specialized in prostate cancer treatment. Hopefully he can help us to make a better decision. What do you think about clinical trial? Have any of you joined any clinical trial? How does that work? Is Lupron the only medicine used for hormone theoraphy? Is there a better one? What if my dad does not respond to Lupron, what else medicine available? I also read recently that Soy Isofavones is a great help to lower the PSA. Have any of you tried that? I know I always have too many questions simply because I am very worried. I love my dad very much and I want to have him around for as long as possible, to watch me aging and watch my son grow up and graduate from college... I really should not think too much. I should focus on today, focus on fighting the cancer with my dad and all of you together.

Merry Christmas to all of you and wish you a very happy new year and most importantly, a healthy 2011!

VascodaGama's picture
VascodaGama
Posts: 3224
Joined: Nov 2010

Hi Jessie
You are in good hands. Dr. Mario Eisenbeger is an excellent prostate cancer expert with many years in the trade, from research to treatment. He makes part of Dr. Walsh team at John Hopkins, who has guided my case since 2001. That surely is a great Christmas gift you gave to your father.

Clinical trials are not for everybody. Only specific patients are chosen and participate. Usually the treatment is well followed-up by a team of specialists so that no one gets hurt. Of course, this is a private choice, and you should not get involved if your father is not fully confident with the practice.
Hormonal treatment involves several drugs. Their work is to lower the testosterone circulating in our bodies (cancer feed on testosterone). Lupron is a LHRH agonist, acting by stopping the production of testosterone at the testis. There are many similar drugs like Eligard, Zoladex, Firmagon, etc. for the same purposes. Another two groups of drugs called anti-androgens and 5-alfa reductase inhibitors, act to avoid feeding of cancer cells. These three type of drugs are taken separately (single) or together (double or triple) to give a bigger blow to the cancer.

Take a good list of questions to Eisenbeger. He is the best person to answer your entire quest. You can find typical questionnaires in several sites in the net by googleing “questions to your doctor about prostate cancer treatment”.
With so much care and a daughter so close, your father has been assured that he will see your son growing and growing.

Have a Merry Christmas
VGama

Subscribe to Comments for "PSA rises sharply in 5 months"