Should I be concerned? My dad (stage four diagnosed June 2015 with a single met to a nearby lymph node: treated with six rounds of chemo and hormone therapy ever since) had a smallish upward movement in his PSA. From .07 to .13.
He had a similar movement back in 2017 and it dropped back down but will we be as fortunate this time? Should we be concerned now? And if so, what kind of questions should I ask his oncologist on Friday regarding the movement?
Thank you guys!
It's too early to know if he is becoming castrate resistant. The change may not be a trend, and it's fairly slow so that's positive. Until the PSA reaches 2 and has doubled at least once from there, most doctors would not consider additional treatment.
If it does continue to rise, there are excellent "second line" ADT agents available. Those can work for years.
I know it's difficult, but you just have to take one day at time, one test at a time and know that there are good treatments available if they are needed.
Has he had radiation in the past? That's something you could discuss with his Oncologist. It might be an option for him.
Thank you for the words of encouragement. I am very grateful that there are still many good meds available to him. It is just scary to put this one behind us when we’ve grown comfortable to it. It is also scary just to see the cancer raise its ugly head again! No he has not had radiation but it is something I am going to discuss with his oncologist today. Thank you for your reply and for the encouragement!
Even if the other shoe does fall, there are lots of shoes in the PC closet. Early days for you guys.
Thank you! I keep trying to remind myself of that very thing. It was good to hear it from you! Thanks so much.
I would not worry. These are small movements. And there are additional treatments if PSA does start to rise in an upward movement.
I keep telling myself the same thing. It’s hard not to get worked up when we see changes!
These are small changes. It's easy to get worked up over this. But consider the lab. It would be easy to miscalculate such a small change.
Remind me - Why wasn't he treated with brachy boost therapy?
You were the first to ever mention it to me! I plan on mentioning it to the oncologist tomorrow. Are there any studies that include men treated with chemo first?
You have to talk to a radiation oncologist who specializes in this, not an oncologist. Yeah - chemo first does little to nothing:
pcnrv.blogspot.com/2016/08/...
pcnrv.blogspot.com/2019/02/...
Thank you! The reason I asked for additional information was the last time I brought up research in support of additional treatments for my dad, his oncologist dismissed the research because the men in the study were not exactly the same as my dad. So I figured he would be looking for the same thing this time around. However today we are seeing one of his colleagues as my dad‘s oncologist is out of town, so he may be a bit more receptive. I was hoping to ask to talk with A radiation oncologist to see what his or her thoughts would be on the subject.
Was his prostate removed? No radiation? How old is your dad? Where did he get his treatment ?
No his prostate was not removed and no he did not have any radiation all he received four years ago was six rounds of chemo and the hormone therapy ever since. My dad is 78 and has been getting treatment at a branch of the Cleveland Clinic.
Hi- If he has only one identified metastasis, he may be a candidate for SBRT radiation therapy. This is a very percise radiation therpay given to patients with "oligometastatic prostate cancer" or prostate cancer with "few" (typically less than 5) metastatic lesions. The therapy is given with the intention to cure and is typically done at larger, more progressive cancer centers. Here is some more information:
As has been reflected these are small changes and there’s no reason to be concerned at this moment, however make sure that he continues to monitor his PSA.
If in fact the PSA goes up two more times before you panic just make sure that he is castrated. This would mean having a testosterone test to make sure that in fact still castrated.
Since the prostate is still present there are other things not cancer that can cause a temporary rise in psa. However a move from .07 to .13 is close to a doubling in three months so I think you are very wise to follow it so closely
My personal experience with an oncologist who dismissed published research offhand for the reason you report was not good and change of physician was very helpful long term
Glad you have another oncologist to discuss this with
Missing from all these positive comments are some "other" things that would help (or hinder). For instance, eating cakes and drinking rubbish with sugar is enough to shift the PSA to a spike like that. Is he on a raw food diet? Zero sugar? No bread or pizza? If he is still eating such things, giving them up may be all he needs to do to live a lot more years with a good quality of life. At least try this before adding poisons that are not needed, as he has some time to make changes. Read up about foods that have anti-cancer properties and/or help the immune system - they are small in themselves, but all help a little bit to add extra days and years. Do not expect most doctors to know much about these things - they get just about zero training in nutrition and few test for sub-par levels of simple things like Vitamin D3 (which is vital for a good immune system). Even the American Cancer Society makes no mention of diet as a major factor.
In the bigger picture, it is amazing how many cancer victims keep right on doing what got them into trouble in the first place, and they expect the medicine to make them better!
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