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PSA 1550

Sidtippy2
Posts: 23
Joined: Aug 2018

My husband was diagnosed about 8 months ago with stage IV prostate cancer.  He was having typical prostate symptoms but we were stunned at how far along the disease had progressed.  PSA was 1550, gleason score of 9, mets to bone, lymph nodes and lung.  He's responded very well to hormone therapy and his PSA has come down every month, most recently to 30.  Other than extreme fatigue, he's feeling relatively ok.  We've been married forever and so we're both reeling with this diagnosis and anticipated decrease in life expectency.  He is 58 and has been in good health.  

Anyone have similar situation?  Words of wisdom or insights into future/life expectancy?

 

appreciate any insight

 

RobLee's picture
RobLee
Posts: 259
Joined: Feb 2017

I'm so sorry to read about your husband's cancer. There's really not much that can be done at this point.  Once it has spread to the bones and organs there's really no way to get rid of it.  So you are looking at how long he can be kept alive and how comfortable he will be.  You haven't meantioned any treatments other than HT, but there are new therapies being developed all the time.  Eventually PCa becomes castrate resistant and HT no longer works, but for some that doesn't happen for a decade or even longer.  Every case is different.  Be sure to take good care of yourself, as his caregiver and loving spouse.  Ultimately this will be very hard on both of you.

Sidtippy2
Posts: 23
Joined: Aug 2018

Thank you for your support.  I know no one can really predict life expectancy, but I keep reading such conflicting information, its very difficult.  We're happy that he's responding well to the HT, but his PSA was up a couple points last month, so we're nervous about the next result. He seems to be having more bone pain too, it's hard to tell what's just general discomfort and what's bone pain.  What a scary journey.

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

Welcome to the board. I hope he manages to get the longest life expectancy possible but with quality of life.

Can you share more details on his diagnosis and treatment protocol? What is the Gleason score?

You said that his PSA has risen from a nadir. Can you tell more about the PSA histology?

The worrisome goes to the metastases in organs, the liver in particular, but you comment these to be in the lungs. I know of several patients that have dissected the metastases in lung successfully. This is treatable if only a fewer number of spots are involved.

The hormonal treatment is palliative but in the hands of good oncologists these can hold the bandit for long periods of time. There are he so called second-line ADT to replace the ones that stop working or immune therapies to extend their effectiveness. You need to be vigilant not just with the cancer but with any deterioration of other functional organs like the heart, kidneys and liver that will be affected by ADT drugs and manipulations.

Your husband needs to set a sort of monitoring program to avoid deterioration, involving diet, physical exercises and periodical tests (testosterone, estrogens, bone densitometry, vitamin D, etc) along with the PSA to check for the functionality of other systems and to verify the effectiveness of the ADT before it becomes refractory. Intermittent approaches may be useful to prolong the period of the hormonal treatment.

Doctors typically, in stage 4 patients, treat the pain in bone with spot radiation. This cannot be done at the same area twice so that one must choose the most affected areas.

A good book for you to read is;

“Beating Prostate Cancer: Hormonal Therapy & Diet”, by Dr. Charles “Snuffy” Myers.

Tell us more and will try helping you with comments based on our own experiences.

Best wishes and luck in his/your journey.

VGama

 

Sidtippy2
Posts: 23
Joined: Aug 2018

So first PSA was 1550, drawn after he was having frank blood in his urine.  His GP immediately ordered abd CT which showed significant cancer in prostate and other suspicious areas.  Bone scan showed ca throughout his pelvis and upper right femur, also in his shoulder blade, and a few spots on ribs.  CT showed significant lymph node invovlement throughout, esp mediastinal area, and several spots in lungs.  We have an excellent urological oncologist and he did a cystoscopy and transrectal ultrasound an biopsy (took 12 sample, all were positive).  Gleason score of 9.

Started with Lupron every 6 months, Xgeva monthly and casodex.  See urological oncologist every month and have a PSA each month.  While PSA is still really high, it has come down each month from 1550 to 422 to 212 to 71 to 32 to 28 to 22.3 but now up to 24.  He has a PSA this week and if it's up again, will look to change meds.

Anticipate radiation for bone pain, but dr doesn't want to use this too soon, as you mentioned it can only be used for one series in each area and he wants to wait until pain is worse.

Doesn't talk much about chemo, made it sound like that is a bit of a last ditch effort and my husband isn't overly interested in that.  

Also saw a medical oncologist who agrees with current plan.

He has general discomfort but not intense bone pain yet.  He has extreme fatigue, though it is better than it was in the winter.  Luckily he is retired, so can rest when tired.  He does try to stay active and does some light weight lifting, but not able to do much more.  Can't walk long distances, etc.  This is a man who has been incredibly active all his life.  

Apprexpiate the book recommendation, will definitely get this one. 

 

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

I am sorry to hear about the extent of the disease as you describe it. I was thinking on the possibility in debulking some spots to alleviate the burthen of the whole cancer but due to the extent of the spread at the mediastinum area (that contains some of the most vital organs of the body), I think it better for your husband to just try holding the bandit with the present treatment.

The last PSA increase could signify the start of refractory or it could be due to a moment of unbalanced hormonal biorhythm. Lupron should drive your husband into chemical castration but any movement that could massage or squeeze the prostate (or sex) the day before drawing blood for the test can influence the level of the PSA. Casodex works by interfering with the absorption of androgens at cell's receptors (AR).  It works well until mutation of AR occurs rending down this drug’s capabilities. At this time oncologists try increasing the dose from 50/daily to 100 or 150 mg. if by doing so the PSA increase continues then they call it refractory and substitute Casodex with other more refined antiandrogen, like Xtandi. I recommend your husband to do a testosterone test to check Lupron's effectiveness. It should be lower than 25 ng/dL

Famous oncologists in aggressive cases similar to your husband use other means of blockades too. For instance, they use 5-ARI like Avodart and Finasteride to avoid refinement of the androgens. They also tend to use Crestor (a statin) because cells produce their own androgens from cholesterol. Surely each drug will add more side effects so that oncologists usually add medication to improve/boost the immune system such as Leukine (taken intermittently).

This is something you will understand by reading the above book and that you can discuss with his present doctor, which can be added in your monitoring program. The book author, Dr. Myers is a retired medical oncologist that dedicated his professional life in investigations and treating prostate cancer patients. He worked as an Integrative Oncologist overseeing all aspects of the treatment and balancing life style. You can see several of his videos in this link;

http://askdrmyers.wordpress.com/2012/02/01/memory-adt-for-pca/

Fatigue was probably my worse symptom when on ADT. The wide spread of cancer may also cause fatigue but it is the hipogonadism status that drives us to a series of unpleasant symptoms. Mood-changes are also terrifying and our partners must be prepared to understand it as occasional. It has led some couples to divorce for no particular reason. Physical exercises and a change in life tactics are good to balance things. Walking seems to be the best but one will need to rest along the way. Afternoon naps and earlier dinners are also good.

Here is a comprehensive introduction on Hormonal Treatment;

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-hormone-therapy

Here is a link on nutrition;

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

Try being positive. How about a trip to visit that place you both wanted but never did.

Best wishes,

VGama

 

Sidtippy2
Posts: 23
Joined: Aug 2018

Many many thanks for your input and information.  Much more detail than I have heard before and much appreciated.

rdw453
Posts: 2
Joined: Aug 2018

so sorry to hear this. my wife and i was hit with the same diagnosis. my psa was 4.61, gleason score of 7. i had surgery last week to have prostate removed. two lymph nodes where sent to pathology. results came back with a gleason score of 9. so now i guess it is a wait and see. But i can tell you one thing. cancer is not going to ruel my life.my wife and i are going to enjoy every day to the fullest. Good luck on this journey

 

Sidtippy2
Posts: 23
Joined: Aug 2018

Very sorry to hear of your diagnosis, what a miserable thing cancer is, turns your world upside down.

We have said the same thing, my husbands goal is to keep things as "normal" as possible.  There are a few silver linings, a little easier to keep things in perspective, we're very intentional about how we spend our time. And people are so kind...family and friends alike.

This site is very helpful, wish I'd found it sooner.  I do wonder if others have had a PSA as high as my husbands...when they first told us it was 1550, I thought it must have been a mistake.  Have you heard of such a high level and would you interpret that as a bad sign.  We do realize that he has probably been sick (had ca) for a couple years and we just missed the signs and symptoms.  Hind sight :(

G53
Posts: 33
Joined: Jul 2018

In a different forum there was a patient with a PSA value of 6700 at diagnosis. Gleason 9 and mets everywhere. He was treated with ADT plus Docetaxel (Chemo). After one year the PSA value got down to 1.1 and then started to rise again.

I would recommend to add Docetaxel to the current hormone therapy.

Sidtippy2
Posts: 23
Joined: Aug 2018

Thanks G53, it's helpful to hear other extremely high values. 

PSA drawn yesterday and is up again.  So had been coming down steadily to a low of 22.3, then up to 24 and yesterday was up to 26.3. We see dr Tuesday.

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

I am sorry to hear about the increase. I would recommend you to discuss with his doctor next week about the need in stopping the Casodex straight, substituting it by another antiandrogen.

The matter regards what is called "Antiandrogen Withdrawal Response" or "Androgen Withdrawal Syndrome" that occurs when the cancer has mutated the AR and starts feeding on the Casodex itself. The issue is seen initially with an increase in the PSA (refractory) that starts to fall once the Casodex is stoped. Casodex is made up of a similar biostructure as the real stuff so provoke absorption by the cancerous cell, faking the real androgen. The syndrome can last 4 to 6 months with lower PSA results. After that one must start taking another antiandrogen or change to the second-line ones like Xtandi.

Here are some materials for you to read and prepare the questions for your next meeting;

https://pcri.org/-aawr-the-anti-androgen-withdrawal-response

https://jhoonline.biomedcentral.com/articles/10.1186/1756-8722-1-21

https://www.researchgate.net/publication/257461567_No_Androgen_Withdra

wal_Syndrome_for_Enzalutamide_A_Report_of_Disease_Dynamic

s_in_the_Postchemotherapy_Setting

Best of lucks.

VGama

Sidtippy2
Posts: 23
Joined: Aug 2018

Appreciate the suggestions.  Saw the dr yesterday, ordered a repeat bone scan (due to additional bone pain husband is experiencing), will do a prostate specific PET scan when the technology comes to our hospital (November) and moving from Casodex to Xtandi.  

Chuckect's picture
Chuckect
Posts: 45
Joined: Jan 2018

my PSA was 550 when I was dxd,, chemo was the first treatment I had, and that got me down to PSA 50.. Then I went on zytiga, prednisone, lupron, xgeva, oxycodone, zoloft and this got me down to PSA 7.5, and i am PSA 24 now.. That all took place from Jan, 2017 to present day.. i'm 81 yrs old and looking fwd to a long cold winter and then a beautyful spring.. keep posting and enjoy all the time you and your spouse have together.. also, check out the chat-room there are some interesting folks there.. good luck and enjoy life !!

Sidtippy2
Posts: 23
Joined: Aug 2018

Thanks for sharing your background, very helpful.  What type of chemo did you start on? 

We did see urologist this week and he will start him on Xtandi, once approved by insurance, and take off Casodex.  He had a repeat bone scan which thankfully showed no new spots.  We knew his PSA would start going up again, oncologist told him it would not get down to normal, but we were hoping the firs treatment would last longer.  He was on casodex for 6 months of monthly injections, and he's also on Lupron every 6 months.

I sure appreciate this site, I've learned far more about Lupron here than from dr.  I was getting so worried about hubbys confusion and forgetfulness, he's 58 but some days seems much older.  He is amazingly positive most days, though he's hitting most of the side effects I've read about...extreme fatigue, weight gain, breast tenderness, and of course the total loss of libido etc.  But overall, it could be worse and we are so relieved that bone scan wasn't worse even with increased PSA.

Always appreciate any insights or wisdom!

Georges Calvez
Posts: 305
Joined: Sep 2018

The forgetfulness is weird and it happens with Firmagon as well, I have to make a list before I go shopping even if it is only for less than a few things or I might forget completely why I am there, but I can add up the till roll easily so that bit of my brain is completely unaffected.
I can do dates, etc but it is a bit hit and miss on what I had for dinner.

Sidtippy2
Posts: 23
Joined: Aug 2018

We're still waiting to get started on the Xtandi.  I forgot to ask the dr about the Lupron, I assume he will stay on it...any opinions on that?

 

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

I read your other thread but I prefer to give you my opinion in this your initial post where you shared details of your husband's case. Resuming; the PSA "started at 1550 and over 6 months of tx with Casodex and Lupron came down to 22.  then went up to 24, then 26 and yestready was 96".

In my opinion, the last increase certifies the refractory status. We have discussed the matter in above post. Your husband should stop the Casodex the soonest and look for a substitute such as Xtandi. Lupron should be taken continuously with the newer antiandrogen.

Best wishes,

VG

Sidtippy2
Posts: 23
Joined: Aug 2018

Thank you for responding, I didn't realize the refractory impact could cause such a significant increase.

Sidtippy2
Posts: 23
Joined: Aug 2018

Saw physician yesterday, does not believe increasing PSA is refractory, believes there is new cancer.  CT of chest, abd and pelvis scheduled for Monday.  I asked about Casodex, keeping him on it until post scans. If scans aren't much worse, will change from casodex to Xtandi.  If it is much worse, will move to chemo.  Will update with results

Georges Calvez
Posts: 305
Joined: Sep 2018

Hi Sidtippy2,

Best of luck, both of you are doing all that you can.
I am not a believer in prayers but fingers crossed for you.

Best wishes,

Georges

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

Thanks for the update. Your post is ambiguous. Is the "new cancer", you refer above, another sort of cancer (like colon cancer, pancreatic cancer, etc) or the doctor is referring to newer PCa metastases at other organ?
Surely he is not referring to a newer type like the small cell prostate cancer as this, apart from not producing PSA (your husband had 1550) the pathologist did not diagnosed it. The CT scan would not differentiate on the type of cancers too.

Prostate cancer metastases in bone, lymph nodes and lungs, etc, (stage 4 patients) are treated equally no matter where it hides and the therapy should follow working equally too. As far as I know at present there are only two ways to control wide spread cases which include manipulations with hormonal and chemo drugs, both palliative. Radiation cannot be used widely so that doctors reserve it to treat pain in bone when it becomes required. This increase in the PSA is confirming that the present treatment is not working. It is necessary to change it to something proper and powerful the soonest, independently if newer metastases exist.

Cancer in lungs is serious and a bad signal because it is close to our vital organs. Chemo or a combination of it with hormonal may work well but the side effects will be nasty. His quality of life will deteriorate as time goes by. I hope the treatment manages to stop the spreading. You should think in enjoying life the best you can while he is asymptomatic.

Best of lucks to you both.

VG

 

Georges Calvez
Posts: 305
Joined: Sep 2018

Hi there,

I think he must have been referring to a suspicion that new metastases have become large enough to be visible on a scan.
Prostate cancer grows and metastases at very different rates depending on the type, we have to hope that this is one of the more indolent types.
May I suggest asking your doctor if your husband can be changed from Lupron to Firmagon as it seems to be more effective in lowering PSA and maybe controlling the rate of growth of metastases.

Best wishes,

Georges

Sidtippy2
Posts: 23
Joined: Aug 2018

Thank you for responses and recommendations.  And yes, I meant new metastases of prostate cancer. Spent some time talking to his case manager on Friday, first time I have talked to this RN who spoke to just how poor his prognosis was from beginning, I guess we just didn't realize how bad it was/is.  So glad to have CTs ordered and very anxious to get results to know what we're facing at this time. 

Sidtippy2
Posts: 23
Joined: Aug 2018

Hubby had CT of chest, abd and pelvis on Monday, results show a number of new lesions and several tumors that are larger from last scans, 2 are smaller.  New growth is in the bones (where there were already a number of tumors) and a suspicious spot on bladder.  Recommended a cystoscopy, hubby said no thanks for now, won't impact treatment if bladder is involved.  starting Xtandi for at least a couple months and will follow PSA closely.  If it doesn't respond will rescan and start traditional chemo, Taxotere.  Much more aggressive and fast growing than we anticipated.  Last two weks have been hard, feels like getting diagnosed all over again.  This week is a bit better, at least we know what we're facing.  

Georges Calvez
Posts: 305
Joined: Sep 2018

Hi Sid,
That does sound like bad news but fingers crossed for the best
I guess that you have already done this but here is some brief information on Xtandi, as you would expect for a potent drug it can have some strong effects apart from the desired ones;

https://en.wikipedia.org/wiki/Enzalutamide
https://www.drugs.com/pro/xtandi.html

Best wishes,

Georges

Sidtippy2
Posts: 23
Joined: Aug 2018

Thank you Georges, I'd seen the wikipedia site but not the second one.  Scary potential side effects.  

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

Changing to Xtandi is your best step for the moment. Your doctor is wise in waiting for the results before starting chemo. Two or three months without Taxotere don't make any difference from the results of the chemo if started now. Lupron + Xtandi plus Taxotere is a multimodal approach that is showing good results. The side effects from each treatment are added so that your husband may expect to get more symptoms. I would take the opportunity of this period before chemo to get a total lipids panel to check the immune system (try improving it to better counter the effects of the chemo) and get a cardio exam (ECG + etc) as it will be affected by the above drugs. Stopping Casodex will help in understanding the work of Xtandi.

I agree with your husband's opinion on skipping the cystoscopy this time. He got the results of the previous one which wouldn't have much different findings. He must now focus on measures to take to counter the expected side effects. Something regarding diet and life style changes. I wonder his age.

You are wonderful for being so involved in his problem. You may convince him in going out for a long drive outing. A week-end at some place or visit another country.

Let's hope for the best.

VG

Sidtippy2
Posts: 23
Joined: Aug 2018

As many of you know, my husband is having a rough winter.  His PSA has gone up month after month and was 911 on 1/11.  He was enrolled in a study and started new regime almost 4 weeks ago, now on Zytiga 1000mg daily, prednisone 10 mg daily, and either ollparib 300 mg bid or a placebo.  He started feeling a lot better 2-3 weeks ago but is feeling really bad the last 5 days.  extreme fatigue, worse than he already was experiencing, achy, chllled, dizzy, nausea, vomiting and diarrhea, no appetite but drinking water fine.  I know these are all possible side effects of his meds, but am surprised it took almost 4 weeks to hit him and that it came on so strong.  Any experience with these meds and/or side effects?  We see dr Friday and get PSA and other labs drawn then.  

kidclutch
Posts: 56
Joined: Oct 2017

My dad had advanced cancer with bone mets, and is on Zytiga which he tolerates pretty well, though it is recently failing (developed new tumor in the shoulder blade). I wanted to ask about the olaparib--did your husband have Foundation One testing done to get enrolled? It's the genome sequencing biopsy to test for over 300 mutations. My dad is having it done this Friday, would love to talk to someone else going through drug trials to treat potential tumor mutations. So sorry to hear about your husband's difficulty with the regimen.

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

Sid,

I also believe that the side effects are from the treatment but the surge of the symptoms at four weeks makes me think that your husband is taking the Olaparib inhibitor for real. This sort of medication takes time in starting its effects (depleting the body from those enzymes along its action) which alters in time the body response to what is missed. Olaparib attacks one of those switches in the DNA that provides survival to the cells we are trying to destroy. This resists and acts against the treatment. Pulling down these switches allows free access to Zytiga to act fully. Surely the immune system reacts trigging along a series of symptoms until the situation stabilizes. I wonder what his doctors will tell you but you may inquire what you can do to counter the effects and if the treatment can be stoped earlier in case the situation doesn't improve.

I am sorry for the occurrence. I hope things get better.

Here are details on the drug and possible side effects. There is a note of caution that you should consider because the treatment will pull down some of our natural defenses;
http://chemocare.com/chemotherapy/drug-info/Olaparib.aspx

Best wishes.

VGama 

Sidtippy2
Posts: 23
Joined: Aug 2018

Ineresting update...I mentioned last week that my husband was feeling worse than ever the last week or 2.   He ended up getting admitted to the hospital for a perirectal abscess and had surgery yesterday.  We couldn't visualize the abscess until thursday night, saw dr friday and got admitted.  He was really really sick, surgery saturday and is much better.   The abscess was even larger internally than externally, and called it a horseshoe abscess which means it went up both sides of the pelvic cavity, only happens in 5% of abscesses.  He is MUCH better post op, has 2 rectal drains that he will go home with, home in a couple days.  At first we were afraid the abscess was related to the cancer in his pelvis, but it looks like it was a random abscess, not related to cancer.  Perhaps such a fast growing infection is related to him being more immunocompromised than we realized.  

They are holding all study drugs until he is over this infection, so probably 4 weeks or so.  We are disappointed ok but totally understand the need to heal first.  

We did get good news, his PSA is down to 300, and it was 911 last month.  So the new meds and/or study drug was working. 

And sorry to not answer sooner Kidclutch, I'm not aware of the genome sequencing series being done, though he did have many labs done before being approved.  Interestingly my hubby was initially on Casodex and that worked for about 6 months.  When it stopped working is when they realized he might qualify for this study.   His meds now are Zytiga and prednisone, plus either Olaparib or placebo med.  He's now off all 3 of those for now.  I hope your father is doing well. 

kidclutch
Posts: 56
Joined: Oct 2017

No apology necessary, so happy to hear your husband is on the mend and there was a PSA response. Hope he gets back on those medicines soon to get even better!

Sidtippy2
Posts: 23
Joined: Aug 2018

Quick update, hubby continues to improve from recent illness.  We was approved to go back on study with 2 days to spare, whew, that was way too close.  More great news, his PSA is down to 70, even though he was off meds for 3 weeks.  

Now for the not great news, he also had bone scan and full CTs scans.  He had a nodule on rib, it is now much larger.  He also had one nodule in right lung, now he has multiple lesions.

We were shocked there is new growth given his PSA had decreased.  Any perspectives or opinions?

thanks, as always

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3325
Joined: May 2012

sid,

The nodules can probably be killed via spot radiation. Doing this is somewhat common agains PCa on the bone or other organs.  Radiation might beat it back far enough to significanly improve prognosis.

ma

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

I am sorry for the news on the additional findings. As Max comments above metastases in bone can be treated with spot radiation for the intent of cure, if these lesions stand at propitious locations, but the clinical trial your husband is in may not permit to do it now. You will have to wait till the end of the trial. Apart from that, he should have additional scans to confirm if this spot is the only one. Bone scintigraphy scans do not detect small lesions lesser than 5mm.

As you know, ADT is palliative and do not kill the bandit. It manages to get a grip on the issue and hold control during a period that can last years. Your husband's case is extensive and considered systemic for the mets at other organs. This is a condition standing close to the end of available curable therapies. Any added treatment will add more side effects and prejudice his quality of life. The events you have experienced are common in similar PCa patients. The PSA may continue to decline but somehow the more aggressive grade 5 cancer never dies. In fact these types produce little PSA.

I wonder if your husband would do well with a more defined targeted therapy using radiopharmaceuticals like the LU177. This is a treatment in action since 2011 that have shown success in systemic patients, in particular in aggressive forms of cancer. They call it "Theranostics" and it is in practiced in several clinics arround the world but the LU177 can be obtained in Europe (Germany) and Australia. The following links got the details. You can also see the video by Dr. Richard Baum of his symposium at Johns Hopkins. This is very promising means of treatment in the future to all of us independently of where the cancer is located (contained, localized or at far places). LU177 used the now common enzyme/protein PSMA to deliver the blow at cellular level as a stealth missile.

I was diagnosed when I was 50 years old. I am also systemic but the type of the cancerous cells in my case are sort of indolent (Gleason 2+3; score 6) that allowed me already 18 years of continuous fighting. I feel sorry for your husband that is so young but with such an aggressive bandit.

Here are the links for your reference only;

http://www.prrtinfo.org/

https://vimeo.com/124232213

https://www.youtube.com/watch?v=9Rl6hBCpf7g

https://www.youtube.com/watch?v=46rYKxsq-a4

https://www.carcinoid.org/doctor/richard-p-baum-md-phd-nuclear-medicine/

http://theranostics.com.au/what-is-theranostics/

https://pubs.acs.org/doi/10.1021/bc200151q

 

Best wishes,

VGama

Georges Calvez
Posts: 305
Joined: Sep 2018

Hi Sid,

I think that I have written elsewhere on this subject but maybe it was eaten in the great data loss.
There is a close to direct relationship between the size of the tumour and the amount of PSA produced in the earlier stages of prostate cancer eg the bigger and more extensive the tumour the more PSA it will produce. It should be noted that some tumours can be very small but produce a lot of PSA, the process for making PSA is in overdrive in these cells.
There is also a relationship between PSA and Gleason number. There is a grading between Gleason 3, 4, and 5. Gleason stage 3 cells are really very like normal prostate cancer cells, 4 is in the middle and 5 are only very poorly like prostate cancer cells. Men with cancers with low Gleason grades will often have high PSA scores and those with high grades will have lower PSA scores for the same size of tumour activity. This is because low grade prostate cancer cells are still trying to be prostate cells to a certain extent while higher grade cells have given up on that.
It is also the reason that low scores like Vasco and myself have local invasion, usually in the prostate bed but it can be in adjacent tissues. The cells do not metastase easily and they do not go far, even when they get there they still try to be prostate cells, making PSA, and crucially in some cases continuing to require stimulation by testosterone, etc to grow for a long time so various ADT strategies can be used to teat it almost like diabetes. It might get you in the end but it will take some time.
A high score like your husband has cancer cells that are very unlike normal prostate cancer cells, they tend to metastase quite fast so he had quite extensive mets, they also tend to adapt quite quickly to the absence of androgens. So his PSA fell on the start of treatment and then rose again as the cancer adapted to the new environment. I would guess that the treatment is affecting some of the cancer so his PSA has fallen but the most aggressive cells in the mets are not making much PSA and they do not seem to need a lot of androgens to grow either.
If there are relatively few mets then maybe spot radiation will help.
You need some luck now!

Best wishes,

Georges

 

Sidtippy2
Posts: 23
Joined: Aug 2018

Thank you all, I always appreciate your input.  Talked to oncologist and he's not making any changes for now.  CT of chest, abd and pelvis as well as bone scan again in 2 months and will go from there.  what a roller coaster of emotions.

Georges Calvez
Posts: 305
Joined: Sep 2018

Hi Sid,

Good luck, these things can turn and get better.
You never really know with prostate cancer.

Best wishes,

Georges

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