Raising PSA now 0.20 - Next Move?

Hello All: My name is Larry and I follow this site from time to time. A little background on me; 65 years old. Dx 12/21/15 psa 5.3 had 12 core biopsy, with all 12 cores cancereous. Gleason (6 cores 7) (4 cores 8) (2 cores 9). Bone, CT and PET scans all negative. Placed on Casodex 50 mg 1/1/16 and started lupron for 2/1/16 for 4 months to shrink prostate pre-surgery. DaVanci Surgery 6/9/16; cancer found in two lymph nodes out of 25 extracted. post psa undetectable until 6/20/17 with psa of 0.12. psa 9/19/17 psa now 0.20 Uro wants to take MRI and Axumin scan to identify location of cancer, then apply surgery, or radiation in an attempt to rid the cancer if not mestastized. Hormone therapy was also an option. Uro comments to the undectable psa post surgery possibly related to lupron still in system. All my care has been at MD Anderson - Houston. Looking for any comments and / or possibly someone else who has been in a similar situation.

19 Replies

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  • I'm no expert, but I think you want to google "treatment of oligometastases."

  • Yes, Yost is right on! Also, do you also have an oncologist at MDA given that the cancer metastasized to at least 2 lymph nodes? Scans sound like good idea; I hope that at least one of the scans (MRI and Axumin) checks for bone metastases in addition to other metastases -- I believe that MRI does (I don't know about Axumin). You want to get rid of all the cancer before any metastasizes to bones if at all possible, of course.

  • So far, they have not referred me to an Oncologist. Thanks for the input.

  • I will do just that. Thank you..

  • One word, Oncologist.

  • Your psa is still low.At 65 .If you have lived this long with psa low then very low chance of dying from prostate cancer.,10 per cent or less .You dont have to have any treatment.Possible treatment can cause you more suffering than doing nothing.How do you feel,not what your mind is telling you.Dont be pushed into tx by doctors,the cancer business industry and fear mongering.Do you have any actual symptoms of distress or is it your mind listening to everyone pushing you into treatment when you may be fine without it,even better without tx.

  • Symptoms rarely appear before late stage cancer, when the patient is likely to die from it. If I thought anyone was pushing me in any direction, I'd run away from them. I doubt his doctors at MD Anderson are the type you mention. Sorry, but I've had my fill of people trying to tell patients to do nothing, for fear of treatment side effects, when the patient has another 20 years of life ahead.

  • Larry! I agree with dharmabodhi. Just leave all the Oncologists, and PSA Tests alone, and enjoy life. The Oncologists will kill you with their kindness AND greed. In particular forget PSA. It is only a way to keep Labs buzzing, and extract money from your wallet.

    Sridhar

  • Larry, See an Oncologist, but in my opinion, the best next course of treatment should be chemo, (doxetaxel, then cabitaxzel) followed by abiraterone or enzalutimide. Your cancer is metasizing and spreading, it is now castration resistant. The chemo will get it before it spreads further. This is the reason, ASCO recommended this change in direction over the past year. Used to be ADT, followed by abiraterone or enzalutimide and then chemo. This was the standard course of action I followed over the past five years and now I have metastises to multiple bone locations, lymph nodes, and liver. I will be on chemo til the day I die, likely in 12-18 months. I wish you the best of luck and a long life!

  • Why do you say it is "now castration resistant"?

  • Because he has rising PSA after being treated with Casodex and Lupron. This is otherwise known as ADT. Both drugs stop the production of Testosterone by the testes. In general, when PSA rises when Testosterone is blocked, this is identified as Castration resistant. Taking these drugs has the same effect as being castrated. This is what they use, along with other drugs to chemically castrate severe sex offenders, who can not control themselves through any other means.

  • My prostatectomy in 2006 at age 54 indicated Gleason 4+3 with no cancer detected outside of prostate. When PSA went from undetectable to 0.12 to 0.20 about a year later, I had IMRT (37 treatments) that made PSA undetectable for 7.5 years. I just finished chemo, ADT, and more radiation after PSA went to 0.06 with 6 month doubling time.

    If you're going for a "cure" (i.e. long term remission) use every tool in the tool bag if you expect to live another 20 years. My side effects have not been bad. Giving cancer more than 10 years to grow and morph into an aggressive form is a big dice roll. Virtually no studies measure success beyond 10 years.

  • Interesting - the radiation was not harmful? I am potentially facing RT...but, am quite fearful of side-effects, damage, etc.

  • Every case is different, but my side effects from surgery and radiation have been minimal. No longer ignore the urge to urinate or defecate, but no need for pads. Viagra does a good job on ED. ADT side effects were worse for me than surgery, radiation, or taxotere.

    Make sure whoever you choose for a procedure has performed it at least 600 times.

  • Larry,

    I was diagnosed a Gleason7 (4+3) seventeen plus years ago. I’ve done a ton of treatments over the years and today, all things considered, I am doing very well. Many times along the way, I needlessly panicked. You need to take a deep breath and take things one day at a time. Prostate cancer is most often a manageable disease. You have a much brighter future than you realize at this point.

    You are using one of the best cancer centers in the country, and your doctor’s approach seems to be completely reasonable. If I were you, I would be pretty comfortable with that situation right now. Some have suggested that you move on to an oncologist. This is good advice. You may want to do this for a second opinion, and then decide if you want to move on. In the meantime, learn as much as you can about your disease so that you can participate in managing it. Start shopping for an oncologist that will respect your input. Your working relationship with him or her is critical. You will be managing your disease with this person for many years to come.

    Good luck on your journey!!

  • You're not castrate resistant. You stopped ADT and PSA started to rise. That's pretty normal for Gleason 8-9 . I agree that axumin scan should find where you have recurrence . Then you can decide how to treat. It surely will mean back on ADT for 18 months and SRT to prostate bed and/or pelvic lymph nodes . I don't think you need a MO yet just a good RO.

    Bob

  • I wish you the best in your fight. Why haven't you seen either or both, a Radiation Oncologist or Medical Oncologist. Recognizing that we are are different in disease progression, I left my Urologist at diagnosis and my Radiation Oncologist at mets. Note: I asked my RO, if he were in my shoes, what would he do. He reply was that he would find the best Meducal aomcologist that specialized in Prostate Cancer. I asked, do you know one? And he said that sits sits on the SPORE Committee with one. I am so happy that he was able to set me up.

    My story is told here and other places; simply search Gourd Dancer.

    MD Anderson is a fine place within the TMC, however, if you want to get real aggressive, I suggest that you walk across Main Street to Hermann Memorial and see Dr. Robert Amato for an evaluation. He specializes in Prostate Cancer in academia and research. If you don't like what he has to say, then no harm, no foul. But see a Medical Oncologist specializing in Prostate Cancer and not a generalist. You really one a guy who is on the cutting edge of research.

    Keep kicking the bastard.

    Gourd Dancer

  • IMO you need to add a Medical Oncologist, especially one who is integrative, and also subscribes to natural approaches along with medical technology. If I was you, and I am not suggesting you do anything, I am mentioning, as I am not a doctor. But I would add Avodart, along with Proscar, Metformin, 1500 mgs/day and DIM[Di-Indole Methane]. I would start Pectasol-C, BIRM, and Zyflamend, as a start, plus Liposomal C, by Sovereign Labs, and, consider 5-Loxin[Frankincense], and Turmeric with Curcumin 3 Complex.

    Of course this is only my opinion. You are not Castrate Resistant, so it is possible to put the Pca cells where ever they are to go to sleep, or into hibernation.

    Nalakrats

  • Good list. Also taling a statin along with Larry's good advise. Rocco

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