PSA rising after seemingly effective Hormone Therapy only four months into treatment.

[marieluise]

Hello!

My father (73) was diagnosed with stage IV prostate cancer six months ago after having lost a lot of weight and suffering from a lot of back pain for some time. It already had spread to his lymph nodes and a big part of his bones, spine included. The psa count at time of first diagnosis was 2900. He suffered from a lot of pain in his hips and legs, got lymphoma in his legs, and hat a very bad hemoglobin count with a couple of blood transfusions following which helped only for a couple of days. The doctors gave him a couple of weeks to months.

UNTIL he started hormone therapy about four months ago.

The hormone therapy obviously worked well, since, after only two months, his psa count had dropped to 200. He feels a lot better and even stopped to take his morphine. Hemoglobin stays on an ok level.

We all were very happy and thought that everything went well. It seemed like a miracle.

NOW the psa count has risen again. It went from 200 (two months into the hormone therapy) up to 400 (around one month later). The doctors checked it before giving him the second hormone injection. His urologist decided that he should take an extra medication on top of the injection. Unfortunately I don't remember the name of the drug.

Now my question: Does the rising of the psa mean that the hormone therapy already stopped working, after only three months? Though it seemed to work that well in the beginning? Or might there be another reason for the rising up?

I'd appreciate every information concerning this topic. Could not find anything similar on the internet yet.

P.S.: Excuse me for my mistakes. I am from Europe.

[YostConner]

Your dad has a lot going on. Is the added drug oral? Casodex? You may want to start asking about abiraterone (Zytiga) and enzalutamide (Xtandi). Palliative radiation may help if bone pain returns and is relatively focused on one or two sites.

[marieluise in reply to YostConner]

Thank you very much for the info!

My father is getting Trenantone injections. I don't know if this is only another name for Lupron?

I'd be interested in the question if the psa count can vary during the hormone therapy or if a rising up is always a sign for resistant cancer cells and that the therapy stopped working? His count moved down from 2900 to 200 during the first two months after the first injection. Then up to 400 only one mlnth later.

Wishing you all the best for your health!

Marie

[AlanMeyer]

Unfortunately, your Dad's cancer appears to have been very far advanced before treatment started. Most of the treatments work best when the cancer is still small.

As Yost said, the next treatments are probably Zytiga or Xtandi. Both are hormone treatments but they are relatively newer and more powerful than the treatments that men usually begin with. It's possible that one of them will work to bring the PSA down and make your Dad more comfortable again, however they aren't likely to work for a very long period either. After that, or even while the Zytiga or Xtandi are still working, the doctor might recommend trying chemotherapy.

I wish the best of luck to him and to the family.

Alan

[marieluise in reply to AlanMeyer]

Hello Alan!

Thank you very much for your informative answer.

Yes, my father is already old and weak. So the 2900 Psa was a shock and the prognosis devastating.

That's why we put a big hope on the dropping of the psa count after the first cycle of the hormone therapy (from 2900 to 200 in only two months).

Unfortunately now it's rising up again. I am asking myself if that coul be normal or if it is a sign for the therapy already not working anymore?

Wishing you all the best!

Marie

[jonnycrouch in reply to marieluise]

check out lutetium 177 psma therapy

[WimS in reply to jonnycrouch]

Hi Jonny how has your journey with Lu-PSMA gone with theranostics? I am considering pursuing this treatment for early metastatic CRPC?

[Gecrellin]

PSA is not the only way to determine if treatments have stopped bring effective. You said he us feeling much better. That's good. How long has it been since his last scans. If it has been twoonths or longer, it would probably be Apodaca idea to get fresh ones before deciding on next steps. When the Lupron and bicludamide stoppedeing effective for me I went to Zytiga then Xtandi before chemo, but I sense that the current first choice between those drugs is Xtandi. I continue to feel well although it has been over 2 years since the hormones alone stoppedeing effective. In December my PSA had risen to nearly 5000 and as of 2 weeks ago it was down to 2500. Good luck on his journey through this horrible disease!

[marieluise in reply to Gecrellin]

Thank you very much for your answer and the information about your "journey".

I hope that everything will improve even more!

Do you know if changes (up and down) of the psa count (using a hormone therapy) may occur and not be a bad sign?

Best wishes from Germany!

Marie

[Gecrellin in reply to marieluise]

Increases are never a good sign, but PSA measurements are volatile and trends are the key. Last summer my PSA was either 300 points up or 300 points down with no trend and my doctor was not alarmed.

[marieluise in reply to Gecrellin]

Thank you so much for again taking time for replying.

I read about your battles with pc and wanted to send you allmy best wishes for the time to come!

For me, it's good to know that the psa level is not everything that counts, as you and your doctor says.

Thank you again!

Marie

[RonPavluvcik in reply to marieluise]

some docs believe that a rise in PSA is not always indicative of disease progression......the PSA count is very volatile...and sometimes not reliable......

[marieluise in reply to RonPavluvcik]

Thank you, Ron!

I hope that's also the case with my father.

He's waiting for his new psa results right now...

All the best for you!

Marie

[Scruffybut1]

Good morning MarieLuise, sorry to hear that your father has such problems, most of us on this excellent forum have similar if not the same experiences. I am 2 years younger and was Dxd Stage 4 metastatic at start (will be 3 years Nov ). Had Zoladex at start, still on this as backup. Chemo x ten cycles after eleven months. Then five months gap with only Zoladex. And now since last September Zytiga. My PSA is almost undetectable @ 0.03. Fantastic result. I don't like the fatigue but am prepared for a long fight with this horrible disease and have been helped so much already by our friends on this forum. It is good for your dad that you have joined with us for him. Well done.

Where in Europe are you? I am in London and have many friends and doctors here with many languages who may help. David

[marieluise]

Thank you very much for your replies!

I am very sorry that you all are suffering from this awful disease. And I wish you all the best!!

Yes, my father waited far too long with going to the doctors. I think the hormone therapy for him was and still is the only option because of his general weakness. No discussion about chemo yet.

I understand from your answers that it's not very likely that the hormone therapy he gets right now will go on working for itself. Is that right? I thought/hoped that maybe his ps count might go on dropping again despite rising.

He is getting Trenantone injections and now the doctor wants him to take bicalutamid on top of it since the psa has risen again.

Is Trenantone compareable to Lupron or already something "stronger"?

Sorry for asking all these questions, but I am really quite uninformed concerning this topic.

Marie

[JoelT]

You need to take your dad TODAY to an oncologist who specializes in the treatment of prostate cancer. The current standard of care for men like your dad who are newly diagnosed with aggressive prostate cancer is to receive a short course of chemotherapy along with hormone therapy.

GET THIS DONE TODAY

Joel

[marieluise in reply to JoelT]

Hello Joel,

thank you for your answer!

My father is in the hospital with a oncologist and urologist specialist on a regular basis. That is where they gave him the injection. He goes there every other week for hemoglobin and other blood tests. PSA is only tested every two to three months or so.

So he seems to be in good hands. Chemotherapy was not an option because of his weakness at the time of the diagnosis. He wasn't able to move upstairs anymore and had bad breathing problems due to very low hemoglobin, which has now improved A LOT since the hormone therapy put down the PSA from 2900 to 200 in two months. Now unfortunately it went up from 200 to 400. That is was concerns.

What I wanted to know, and that is why I logged in here, is, if the changing of the PSA might just be related to the reason that his initial count was incredibly high and that he just needs more time to "recover" from that. Or is a rising always a sign for the therapy not working?

Chemo right now, seems not to be on the agenda. As far as I am informed.

All the best for you!

Marie

[JoelT in reply to marieluise]

His rise in PSA could mean that the therapy is no longer working, or it might mean that he is not castrate. Ask the doctor to take his testosterone level (blood test) to confirm that he is castrate. If he is then it means that he is castrate resistant (the hormone therapy alone is not working adequately).

Joel

[marieluise in reply to JoelT]

OK, I will tell my parents to let that check.

Thank you!

Marie

[eggraj8]

I have PC which has spread through the lymph system to liver, lungs and bones. I am on on chemo (taxotere and carboplatin) along with ADT. This combination has stabilized my cancer including that in the bones. PSA with aggressive PC is not a great measure, I suggest you don't depend on it, use as one indicator and not necessarily the only one. CT scan is useful in seeing if cancer is spreading or stabilizing with treatment.

[Hazard]

Hi Marieluise, sorry to hear about your Dad, and in particular it is very sad that cancer got so far before it was diagnosed.

Now you will get plenty of good advice on this forum, but none of know for sure if the rise in PSA from 200 to 400 is indicative of disease progression or just an anomoly - but it is certainly possible that it is either of those.

As an example of early failure of hormone therapy - I started on Zolodex in Mayl this year, my PSA had risen to 7.5 nothig like your dad but after surgery and radiation treatment but going the wrong way quickly. After 3 months PSA had dropped to 2.1, even though doctor was expecting it to be 0.1. After 6 months PSA has rebiunded to 15. Doctor was not sure if this was an anomoly so he asked me to take 2 more tests - a week later PSA was 18, after anotherbweek 21.

I saw my urologist today, he said that about 8% of men have primary resistance to hormone therapy. I need to see medical oncologist next week and expect to start chemo very shortly. I know that your Dad is not well but if possible tou need to get him strong enough for some serious medicine.

Best of luck with your jouney. There are always plenty of people her if you need some help on the way.