Concerned Wife, Psa Rising

My husband had prostate removal 1 year ago. His post op psa's have been .07-.07.- and now .14. Our family Dr. was not concerned, he said its fine and recheck in 3 months. I was not comfortable with this so asked for a referral to the cancer center. The Dr. there re-checked it and it was .2. He recommended hormone therapy. Lupron shots every 3 months. Does any one have any experience with this therapy. The Dr. said he will also consider radiation after 2 months of the lupron. Do we just assume that the cancer is back or that it was never "all gone" as the surgeon assured us. We get so many conflicting recommendations from different Drs. that it drives a person crazy sometimes. My husband is 50 yrs old and his psa was 28 prior to surgery and supposedly confined to the prostate. Is the hormorne therapy usually for the rest of his life or just for a period of time. Thanks in advance for any of your replies. I am finding that the best recommendations or advice comes from someone who has been through the experience, they seem to know best. Rose

Rosie:

You do not provide other relevant information about your husband's case. You mention the surgeon said he removed all of the cancer, therefore I assume there were negative margins and the remaining cancer cells are microscopic. If you have the pathology report from surgery, as I strongly urge you to do, it may make mention of capsular penetration, extra capsular extension, or other terms referring to potential risk of spread from the tissue examination. Even if it does not say so, a serial rise in psa is a strong indicator of recurrent disease. There are a few clinical trials for men in such a position, though only a few. Yale has a Phenoxodiol trial currently.

Nonetheless, your oncologist will be a key team member. If  he recommends salvage RT (radio therapy) then it may be considered. There are side effects from such therapy and most often manifest in urinary and sexual areas. This risk must be considered. A psa recurrence within a year or two after surgery, treated with RT, is less often curative than when the psa returns two years or more later. Even so, RT may provide some time until subsequent treatment decisions. It is true that the combination of therapies, in this case hormones and RT, often is more successful than the RT alone. Something about weakening the cells and making them subject to the effects of the radiation. If radiation is considered, then the decision must be made as to where to aim the beam. The prostatic fossa, or prostate bed is the most common area, though some radiologists add the draining lymph nodes as well. Your husband's case may suggest the latter.

He is a good candidate for intermittent hormone therapy, which has the chance to offer siginficant off-treatment times to some men.

There are many current research trials which suggest that in the future this disease will become more of a chronic condition like hypertension, diabetes or asthma. I hope to see such a time. 

Hi Rose,

In reply to your question.....I had davinci surgery April 24 after a biopsy indicating that I had 12 of 24 probes containing adenocarcinoma a psa score of 4.62 and had a gleason score of 8. (High Grade).  After surgery the pathology was even worse, gleason 9 (4+5), positive surgical margin and seminal vesicle involvement.  I had my first post op psa test in early June which was .62 which came as no surprise to me or my surgeon.  Another test about three weeks later indicated a psa of .59.  I was referred to a radiation oncologist and also a medical oncologist for further consultation.  It was decided that I would start on ADTherapy immediately (lupron) a shot every three months which would continue for two years and as soon as I was reasonably continent would start IMRT radiation treatments.  I started IMRT on September 13 and had my next psa checked September 26 which resulted in a reading of .08.  This was after three months of hormone therapy and just a few days of rad treatment.  As of today I have had very few side effects from either rad or ht therapys.  I do have hot flashes but they are what I consider to be minor and short lived.  I apparently suffered no ill effects from the radiation treatments.  I am scheduled for my next psa in early January and hope that it will be undetectable.  I hope this dialog of my course of treatment will give you some guidance of what to expect and maybe what medical regimen to follow.   JMHO.....jwb.

Hi Rosie, My husband has the same problem. (I'm new at this,my first message is out there somwhere). PSA 3 months after surgery was .4. it's now 15 months later,and it's up to .8. The urologist suggested radiation,but since the radiation oncologist can't pinpoint the location of the stray cancer cells,he doesn't want to radiate the prostate area if it could be for nothing. I'd wondered about hormone injections,if they'd bring down the PSA. We were told by the oncologsit that this is very rare: my husband had negative margins,negative pathology, stage T2ca and a Gleason of 3+4=7,and yet he has a rising PSA. The onc. also told him that the PSA could be coming from somewhere else in his body. I'd never heard of such a thing,but...I never knew much about prostate cancer at all,until NOW! As a wife,I feel your pain,and your helplessness. Right now I could care less abut his erections. I just want him better.

Katie

On 12/18/2007 megsmum wrote:

Hi Rosie, My husband has the same problem. (I'm new at this,my first message is out there somwhere). PSA 3 months after surgery was .4. it's now 15 months later,and it's up to .8. The urologist suggested radiation,but since the radiation oncologist can't pinpoint the location of the stray cancer cells,he doesn't want to radiate the prostate area if it could be for nothing. I'd wondered about hormone injections,if they'd bring down the PSA. We were told by the oncologsit that this is very rare: my husband had negative margins,negative pathology, stage T2ca and a Gleason of 3+4=7,and yet he has a rising PSA. The onc. also told him that the PSA could be coming from somewhere else in his body. I'd never heard of such a thing,but...I never knew much about prostate cancer at all,until NOW! As a wife,I feel your pain,and your helplessness. Right now I could care less abut his erections. I just want him better.

Katie

 

 

My husband had a prostectomy 6 yrs ago and then had radiation,then went on HT after his psa spiked to 11(from .03) Now his psa has been going up again,to spite being on hormone treatment since 9/05(once every 4 months)The Doctor says there are cancer cells in the system that may be starting to grow and is going to start him on Casadex(think it is also a hormone.The doctor says he will be on this rest of his life.We are praying this combo works.It is a scary thing.,I know how you feel.My husband is 67.

Carol Mac 

Hi Katie, Sounds like your situation is the same as ours except that the onc. Drs. wanted to treat immediatly!! I sure wouldnt wait with your husbands psa rising. Mine gets his first hormone shot today and then will start radiation in 2 months with another shot after that. Its so frustrating hearing so  many conflicting recommendations isnt it? I cant believe your Dr.s are telling you to wait. From what I understand is that the longer you wait the higher the psa climbs and then can spread to the other areas. Maybe we can get some other questions answered here with guys that have gone through similar situations. Please keep me posted. you can email me directly to

Rose

Dear Rosie ---

I STRONGLY agree with other replies - do NOT let your doctors wait to start combination hormone AND radiation treatments....

I had a RP operation 4 years ago. For first two years my PSA readings were modest 0.05, 0.05, 0.05, 0.09, 0.09. However in last 2 years have gone 0.10, 0.15, 0.16....  I am already concerned as for Best Results (better chance of a CURE, not just stalling the progress of prostate cancer) the patient should start radiation treatments after unsuccessful surgery while his PSA readings are still in the 0.20 to 0.40 zone...  So your husband should DEFINITELTY (as anyone can guess, no absolutely sure answers !) be starting radiation treatments NOW or VERY SOON. Please do not let any one or two doctors convince you otherwise. YOU want to maximize your husband's chance for as many years as possible - take control of this situation now !      Let us know, Dick

Hi -

My message to Rosie has my medical record to date.

As with her, PLEASE DON'T LET YOUR RADIATION ONCOLOGIST STALL THE BEGINNING OF THOSE TREATMENTS --- IT IS YOUR HUSBAND'S LAST CHANCE FOR A CURE....!    Hormone Therapy only slows the disease FOR A WHILE !   Radiate the prostate bed - that is where most recurrences exist because the surgeon didn't remove all the cancer cells....               Good luck...                Dick

On 12/17/2007 jwb187 wrote:

Hi Rose,

In reply to your question.....I had davinci surgery April 24 after a biopsy indicating that I had 12 of 24 probes containing adenocarcinoma a psa score of 4.62 and had a gleason score of 8. (High Grade).  After surgery the pathology was even worse, gleason 9 (4+5), positive surgical margin and seminal vesicle involvement.  I had my first post op psa test in early June which was .62 which came as no surprise to me or my surgeon.  Another test about three weeks later indicated a psa of .59.  I was referred to a radiation oncologist and also a medical oncologist for further consultation.  It was decided that I would start on ADTherapy immediately (lupron) a shot every three months which would continue for two years and as soon as I was reasonably continent would start IMRT radiation treatments.  I started IMRT on September 13 and had my next psa checked September 26 which resulted in a reading of .08.  This was after three months of hormone therapy and just a few days of rad treatment.  As of today I have had very few side effects from either rad or ht therapys.  I do have hot flashes but they are what I consider to be minor and short lived.  I apparently suffered no ill effects from the radiation treatments.  I am scheduled for my next psa in early January and hope that it will be undetectable.  I hope this dialog of my course of treatment will give you some guidance of what to expect and maybe what medical regimen to follow.   JMHO.....jwb.

Dear jwb ---

Thanks so much for giving your history. I also had prostate surgery, mine 4 years ago and conventional RP done. Prior PSA was 14, only one biopsy stick of ultimately 16 done showed cancer, but high grade 8-9. My PSA readings have been modest BUT rising last two years from 0.09 to 0.16 most recently over those two years. So now considering radiation while chance for salvage therapy cure is still maybe decent (20-30% ?). 

My concerns are : (a) side effects of radiation - rectal bleeding, urinary tract pain, etc. Also likely to do concurrent hormone therapy as you to somewhat improve the odds. (b) If I do nothing, will I see my PSA spread to bones and kill me in 5, 10, 15 years ?  (Now age 68, age 64 at cancer diagnosis...)                 Any thoughts ?           THANK YOU !   Dick