PSA 15.2 after surgery, radiation and HT

mummafox

My husband had robotic surgery to remove prostate Dec 2013.  Within around 18 months, PSA was up around 2.0.  Referred to radiation oncologist and entered into a study where he got the most aggressive treatment of three choices- had 38 radiation treatments to prostate bed and area extended to pelvic lymph nodes, along with hormone therapy.  At conclusion of radiation his PSA was 1.2, 3 months later was 2.6, and 7 months later has jumped all the way to 15.2!  CT and bone scans are this week.  Just wondering what we should be expecting.  Doctor's plan is twofold- if scans show either a mass in pelvic area or bone mets, he will send him to another oncologist for chemo.  If nothing large enough to be detected, will do more HT.  Any suggestions would be most appreciated.  Thanks

Rakendra

what to do

To better help you, more information is needed.  Age is a major factor in determining treatment. Also, what is his lifestyle like?  His diet?  His exercise program?  Is he depressed or confident?  There are so many factors outside of the Pca. The more information you can supply, the better.  In any case it is difficult to know what to expect, except the fact that there seems to be a problem.  The good news is that no matter how bad the indicators are,  many good things can still come about.  I am an example of that.  40 months ago, Psa of 300 with massive widespread bone matastasis.  Now, Psa 1.17, and doing great.  I mention this to prove that all the bad stats do not necessarily mean a doomed future, and that your husband may still do well. And, even in any case, you have come to the right place to share your experience.  There are a lot of great survivors here who can and will help.  I am sorry about your husband's problem.  With more information, there will be more help.  Love, Swami Rakendra

VascodaGama

Second-line Hormonal therapies may be an alternative to chemo

Mum,

Welcome to the board.

I guess from the info you provide that your husband did radiation one year ago (Dec 2013 + 18 months = Aug 2015). Most probably the hormonal started around the same time but I wonder if he is still under HT therapy. The worrisome in your description is that his PSA has increased fast in spite of the hormonal therapy.

Can you tell what types of hormonal drugs were used, the length period in treatment and the PSA histology (before starting HT, during and at the end).
I also wonder if he has done any image study (CT, MRI, Bone scan) during the diagnosis period some time before surgery (Dec 2013) and its results.

What is his age? Were there any particular symptom he experienced before surgery and now? What about his Gleason score?

I am sorry to say that chemo therapy for prostate cancer is not curative and has associated side effects not pleasant to the patient. Many guys report to have given up in the middle of sections.

Treatments after failure of RP (surgery), SRT (salvage RT) and hormonal, are Chemo or Immunotherapy based. However, many patients do well with second line hormonal therapies (HT) which are more refined than the traditional ones. All the above are palliative prolonging life. Other hopeful treatment for those who recurred but with cancer concentrated in fewer number of spots (oligometastases) is spot radiation of areas not previously radiated; however, this requires efforts to locate the hideaways of the cancer with PET scans.
Traditional Bone scan and CT are not enough and barely mange to detect cancer lesions if these are small in size . At present the most reliable image exam to identify and locate prostate cancer are scans using contrast agents like C11 choline, F18 choline and PSMA radio-tracers (Ga68, LU177, etc). You can read details on the matter googling the terms. I recommend you to read the links in these posts;

https://csn.cancer.org/comment/1553545#comment-1553545

https://csn.cancer.org/node/305239

 

You can try discussing the above with his new doctor.

Best wishes and luck in his journey.

VGama