What next??

[naples2021]

My father was diagnosed in April 2021 with advanced prostate cancer . His PSA was 6491 and 4 out of 12 cores were tested positive Gleason score 8. MRI dscovered 4 pelvic enlarged lymph nodes and two masses in prostate . He started Eligard in May 2021 and biculatamide for 30 days ; in June 2021 his PSA dropped to 78 while in September 2021 PSA dropped to 1.2. My father’s anxiety and phobia is getting worst, it took me 5 months to convince him to get CT Pet scan which only showed an enlarged prostate . PSA on 07/27/2023 was 0.78. On August 2023 , he had a surgery to remove a tumor in the bladder which was thought to be prostate cancer, however it turned to be a fibrous tumor. Oncologist said there is no need for chemo or radiation at that time. He has continued to take his 6 month eligard shot and for over 3 years PSA has lingered around 0.5-1.00 ( March 1st of this year) his latest blood work completed yesterday showed a PSA of 2. He has experienced some episodes where his heart rate goes higher than 100 while his BP lowers (110/60). The oncologist doesn’t seem concern over the PSA incraase as his blood work (alkaline phosphate , AST , ALT has always been normal even when he was first diagnosed).

Should he start a second ADT drug as there is a 1 point increase in a 7 month period?

[Tall_Allen]

Why didn't he have potentially curative whole pelvic radiation?

[naples2021 in reply to Tall_Allen]

Hello Tall_Allen and thank you for replying to my post. I believe the main reason is because he never did a bone scan to confirm there was no metastasis in the bones. I forgot to mention his testosterone is 5 while his PSA is 2. Should he continue getting eligard shots ?

[Tall_Allen in reply to naples2021]

Why didn'the have a bone scan?

[naples2021 in reply to Tall_Allen]

Because of his anxiety and doctor didn’t insist on completing one since he already had an MRI and PET/CAT scan .

[Tall_Allen in reply to naples2021]

He had a PSMA PET/CT? Did it reveal any bone metastases?

[naples2021 in reply to Tall_Allen]

No he never did, only PET/ CT scans

[DaughterOnAMission]

Radiation and Zytiga/Lupron is still working for my dad after 6 years. Your dad needs an MRI of the pelvis and a secondary treatment asap.

[SteveTheJ]

Bone scan is nothing to be afraid of. I understand claustrophobia and if that's the case see if they can prescribe him something to make him drowsy. The entire scan takes 20 minutes or so but the detection head clears his head in a few minutes. I close my eyes until the detection head is past my chin (I peek periodically).

There are far worse things in life that a bone scan. It's going to considerably help the treatment to find out what's going on in the skeleton.

[fast_eddie in reply to SteveTheJ]

A 1 mg lorazepam (Ativan) takes the edge off those like me who are prone to claustrophobia.

[Professorgary]

I’m totally baffled by the Psa over 6000 and a normal alp. I was on Lupron and after a year my Psa started to climb. I had a T of 13 on lupron. I went on abiraterone which brought my Psa down again and dropped mt T to <1. Gos bless.

[naples2021 in reply to Professorgary]

Thank you for your reply. I actually asked the oncologist the same question and he stated “ His tumor expresses a lot of PSA, but probably hasn’t been spread to the bones’.