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PSA level 38-44 after 10 yrs watchful waiting

Sshmalan
Posts: 6
Joined: Jul 2011

Diagnosed in July 2011. Chose watchful waiting which was the right choice for me as it is now April 2021 (i'm now 65yo) and my only symptoms have been BPH type symptoms.

Recent PSA test shows PSA level at 38 (down from 44 due to using Finasteride, Urologist thinks). Finasteride can apparently shrink enlarged prostate a bit and it also can cause PSA test levels to go down some.

Currently planning to talk with urologist about the radioactive seed implants and urolift as BPH type symptoms have worsened some.  

Georges Calvez
Posts: 526
Joined: Sep 2018

Hi there,

Have you had a prostate biopsy recently?

Best wishes,

Georges

Sshmalan
Posts: 6
Joined: Jul 2011

Hello Georges,

    Thanks for the reply. 

    No.  I expect they'll want me to do that before treatments, eh?  I hope they've found ways to make that less unpleasant :).  

    Some of the reasons I went with waiting are that I had by my mid 50's already enjoyed a good healthy life, was recently divorced and had no offspring.  Nothing to squawk about...and by then I had lost a few friends to cancer that died much younger than I.  Also, family had told me that my father (did not know him well) had prostate cancer and lived into his 80's.  

    Hoping this info will help some people.

 

 

hopeful and opt...
Posts: 2327
Joined: Apr 2009

For completeness , here is your previous posts and responses

 https://csn.cancer.org/node/137707

Please note that a radiation oncologist treats with seeds, assi by a urologist  

There is a strong possibility that the cancer has escaped the capsule so it is best to see a medical oncologist who is an expert in hormone therapy and is the doctor who coordinates activities among other doctors such as a urologist and/or a radiation oncologist if needed  

I suggest that you ask for a PSMA pet scan  This PET scan is the state of the art and can detect cancers outside the prostate if they exist   The doctor may also wish another diagnostic test, a bone scan  

Best of luck

 

Old Salt
Posts: 803
Joined: Aug 2014

I second Hopeful's opinion that systemic therapy may well be required to suppress further advancement. It may be useful to see if  a metastasis can be localized by a scan and, if so, treat that with targeted radiation.

I also recommend, like Hopeful, that you see a medical oncologist with expertise in prostate cancer pronto.

Best wishes!

VascodaGama's picture
VascodaGama
Posts: 3356
Joined: Nov 2010

Sshmalan,

Welcome back to the forum. Congratulations for being alive and kicking after ten years with PCa. I wonder if you received any other drug (apart from the finasteride) along the ten years on WW.

According to your other thread, your 2011 PCa diagnosis was due to two positive cores out of 10, with 30 to 40% involvement of Gleason grade 7 (3+4). The negative bone scan set you in WW motion with a PSAdt (doubling) of 3 years since the start. I believe that back in 2011 you had a PSA=9 (18 in 2013) and PSA=44 in 2020, before starting finasteride. The PSA of 33 has no meaning in your cancer progression or regression judgement because it usually halves the real PSA value which makes doctors to double its number post one year of finasteride administration.

This 5-alfa reductase inhibitor is typically used to stop the growing of the prostate gland (hyperplasia). It is also used in ADT protocols (PCa advanced cases) as it manages to suppress the manufacturing of dihydrotestosterone (a tenfold powerful androgen) much wanted by the bandit. However, in terms of prostate cancer treatment it doesn't provide the punch one expects to deliver to knock down the bandit to the canvas.
Its benefit could be checked by measuring the gland volume before and after finasteride administration. Do you know the size of your gland?

I agree with above survivors. You should get this opportunity in your tenth year of survivorship to obtain more details of the present PCa status. Probably a series of image studies to check for any spread. I understand that you, as a veteran (VAMC), are tuff to this sort of circumstances but PCa can lead to nasty painful moments if it spreads to bone. You wouldn't find approval for the so called "Death with Dignity" as you pretended years ago. Surely you can try holding the bandit in its truck with simple hormonal treatment but you should do it following the advice of a medical oncologist and a proper protocol involving LHRH agonists and antiandrogens. The vegetarian diet is not enough. 

Best wishes in your continuing journey.

VGama

 

 

lighterwood67's picture
lighterwood67
Posts: 293
Joined: Feb 2018

Certainly, congratulations on the 10 years.  You planned your treatment based on quality of life.  Good for you.  Like the folks said above.  Time to take another look (the who, what, when, where), at the beast.  Best of luck on your journey.

 

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