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

sbj
sbj Member Posts: 24
in Prostate Cancer #1
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?

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #2
    Look for second opinions from oncologists
    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
    tarhoosier Member Posts: 195 Member
    #3
    Wait
    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.
  • tarhoosier
    tarhoosier Member Posts: 195 Member
    #4
    VascodaGama said:

    Look for second opinions from oncologists
    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

    Boa sorte
    Podem as férias vão bem

    tarhoosier (with help)
  • tarhoosier
    tarhoosier Member Posts: 195 Member
    #5
    VascodaGama said:

    Look for second opinions from oncologists
    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

    Boa sorte, Vasco da Gama
    Podem as férias vão bem

    tarhoosier (with help)
  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #6
    tarhoosier said:

    Boa sorte, Vasco da Gama
    Podem as férias vão bem

    tarhoosier (with help)

    Boa Sorte
    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
    sbj Member Posts: 24
    #7
    VascodaGama said:

    Look for second opinions from oncologists
    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

    Rising PSA after RP & Prostate Bed RT - when start HT?
    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

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