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Slight rise in PSA numbers

Lampman
Posts: 2
Joined: Oct 2020

Good afternoon, I was diagnosed 5/2006 with prostate cancer with a PSA of 22. Pca was scored 4+3 Gleason scale. Cancer had escaped the capsule. No invasion into seminal. Decided to go with radiation treatment (43), afterwards a regiment of Eligard injections every 6 months and a daily bicalutamide tablet. After 3 years, I talked my auto into taking a vacation from the regiment but the PSA levels spiked and I went. Ask on with only changes being a half pill of bicalutamid. Had been able to maintain a "undectsble" reading until 18 months ago. PSA rose from <0.04 in 4/2019 until today's reading of 0.11. (That's 18 month time span) I'm still taking a half dose of bicalutamide and the injection. 

Urologist did not seem too concerned as his statement was "it's still very much in a exceptable range." However looking at the "doubling time" it seems a little concerning to me. I have always had confidence in my physician but with the current medical crisis in the U.S., I'm not sure I am not being moved along so as to make room for other paitents. 

I did not have surgery to remove the prostate because indications were I was going to be a somewhat challenging case. I have done well so far with my decision but I'm wondering if I'm beginning to see a reoccurrenc. 

 

Anyone have thoughts or been through what I'm experiencing? Increase normal? Should I suggest looking into increasing the dosage back to a full pill of bicalutamide? 
Tell me your thoughts? 

~We all walk this road, just some have a few more puddles to jump~ 

VascodaGama's picture
VascodaGama
Posts: 3240
Joined: Nov 2010

Lampman,

Welcome to the board. I believe that you have been following the advice of your oncologist since 2006, but I can't understand why did he keep you on bicalutamide after the three years protocol on ADT.

At the end of ADT an increase of the PSA is common in guys who did RT. Typically it increases and bounces (ups and downs) during a period that can last two years. Once stable it declines to a real nadir.

RT guys will always have PSA because they have the gland in place producing the serum. PSA of 2.0 ng/ml is considered normal. RP guys without the gland in place have very low PSA levels being 0.05 the threshold indicating remission.

In your shoes I would stop the Hormonal and let the PSA increase freely during 1.5 years to verify if the radiation was successful.

Can you specify the name of the injection? Get second opinions before starting anything.

Best

VGama

Old Salt
Posts: 732
Joined: Aug 2014

The first post in this thread is a bit confusing, but I think that Lampman is still on Eligard + bicalutamide. I guess that the MD felt this was necessry becauses cancer had escaped the capsule. 

PS: More data are needed to get a meaningful doubling time. It would also be informative to know the testosterone level. 

Lampman
Posts: 2
Joined: Oct 2020

It is true that I'm still on a regiment of Eligard + Casodex. I tried a "vacation" from Casodex 3 years in and in a years time the PSA tripled. The Urologist put me back on both at that time. I decided to negotiate dropping the dosage from 50mg of Casodex to a half pill (25mg). I have successfully kept the PSA level to undectable levels until 1.5 year ago. 
My question was has anyone on the forum used this regiment and seen the results climb. I'm thinking it might be time to go back to the orginal dosage of 50mg. 
Thanks each for your responses and I'm looking forward to your input. 
STAY SAFE!!!

hewhositsoncushions
Posts: 367
Joined: Mar 2017

Basically it is a case of adjusting dosage until you get an effect. I am sure your onco can deal with that.

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