Recurrent Prostate Cancer??

[PCPatient]

Beginning of May 2019 I wrote below:

Quote...

I'm new here.

At a general health check end 2010, a PSA of 28 was detected. After MRI, CT scan and biopsy, cancer in prostate was detected with Gleason score of 8. I had hormone therapy with Casodex 150, followed by Radiation treatment for a 7 week period from March to August 2011.

After treatment, my PSA fell to a level around 1, and was constant at a level between 0.5 and 1.5 up to 2018. At a blood test in Feb 2019, it had suddenly increased to 4.5, and again to 8.5 in March 2019, and 8.7 in April 2019.

MRI and CT scan detected a small local tumor in one side of prostate.

I am very uncertain about what treatment to select:

- keep it at rest via hormone treatment, or

- surgery/prostate removed, or

- cryotherapy, or??

I have checked other options, such at Proton Therapy, or Cyber Knife therapy, but when they see my past Gleason score of 8 and radiology treatment, the do not recommend these treatment's.

Anybody who has had similar experiences or knowledge about recurrent prostate cancer, please add your comments/suggestions.

….unquote.

After many considerations and consultations, I evaluated Cryotherapy to be my best option, and prepared for this.

I had another MRI done, which came out negative. I then had a very detailed Biopsy done, 24 samples, and all came out negative. ??

I had a bone scan done, and this one also came out negative.;-)??

Could it be prostatitis instead? I just completed 6 weeks on antibiotics.

I had a blood test done end of May, and this had dropped from 8.75 to 7.9, so this week, after completion of the antibiotics, I was hoping for a "positive" blood test. The result just came back with an increase to 12.75!:-(???

Has anyone experienced anything similar? Your comments and advices would be appreciated.

[Magnus1964]

If your PSA is rising and scans come out negative then there is no way to know where the cancer is. Cryotherapy would not be the way to go. You have not mentioned your age or general health but your choices may be chemotherapy or if older you might get many years out of ADT drugs. There are some trials in Europe not available to us in the United States.

If you think this could be inflammation try daily low dose aspirin.

[PCPatient in reply to Magnus1964]

I am 61 years old.

I agree Cryotherapy is not a way to go - it only looked like this when my CT scan showed what was expected to be a small local tumor inside the prostate.

My "frustration" right now is a rising PSA despite a "clean" biopsy and bone scan. I do not know where else the cancer could hide, or whether something else could cause the rising PSA.

I just completed 6 weeks on antibiotics to catch a possible inflammation, so I wonder whether there it is worth taking aspirin?

[Tall_Allen]

I assume your pelvic lymph nodes were treated? If not, you can get an Axumin scan to see if you have any salvageable pelvic lymph nodes. Two years of hormone therapy are standard after radiation for a high risk patient - I'm not sure why you didn't get that - was there a medical reason that you could not take ADT? If not, that is your best alternative. It will now be lifelong, but it may be intermittent.

[PCPatient in reply to Tall_Allen]

I will have another PET scan done, I am just checking if using Axumin. MRI and CET scans done earlier in 2019 did not show any signs in lymph notes.

I do not know why hormone (casodex150) was not continued after the radiology treatment. Was that common also 8 to 9 years ago?

Beside of swollen breasts I had no side-effects with Casodex at that time.

[Tall_Allen in reply to PCPatient]

The problem with MRIs and CTs to detect LN mets is that they only raise suspicion when the size is greater than a centimeter. Many smaller LNs may harbor cancer. Take 10 mg/day of tamoxifen to prevent breast enlargement.

[Magnus1964]

If your cancer has not become resistant to casodex you could go back on it. If your cancer has become resistant to casodex you could try another ADT drug.

[Uxp_d]

I am in the same position I have had Radiotherapy ,and HIFU after radiotherapy failed, I am currently on Intermitent Casodex 150,I now have some Lyph node involvement, and my last PSA was 43 which is now 2,but I am now 79 and have had this for eleven years, most of my friends have died from other illness, Who knows how long before it becomes resistant to Casodex, enjoy life.my real name is Terry Allen, so I follow Tall Allens post with interest. and I live in England, right now I hope someone will be working on another drug.I wish you the best of luck but there are no garantees in this life.

[PCPatient in reply to Uxp_d]

Magnus, Tall_Allen and Uxp_d.

Thank you for your valuable replies.

I guess the most sensible thing for me to do, will be to start some hormone treatment, and see how this will impact my PSA reading.

My general health is very good, and I have had no signs of any of the typical symptoms related to PC.

But I guess it would be too risky to take a wait-n-see approach, based on my past record, and the present speed at which my PSA has been increasing.

Once again, thank you for your valuable help.

[depotdoug in reply to Uxp_d]

Interesting thought Terry A. 79yo with the next to last PSA 43. I’ve heard that comment before too; most of my friends have died from other illnesses. I’m 67 with recurrence PCa 3rd time. Get my 68Ga-PSMA-11 PET/CT scan next Thursday. My 3 weeks ago PSA was 16.7

[PCPatient in reply to Uxp_d]

Hi Uxp_d,

During the 11 years, have you been on/off Casodex during the whole period?

Typically, how long periods w Casodex before breaks?

[Uxp_d in reply to PCPatient]

I had radiotherapy,casodex,then HIFU the last 3Years Intermittent casodex once yearly over 3 months ,but for my age I Am otherwise fit,it will get me in the end but so could a car,plane, terrorism,or something else,I have a friend who is double incontinent,due to treatment after radiotherapy

[timotur]

If indeed this is a reoccurrence, you may think about HDR-Brachy even though you've already had external radiation, some RO's will consider a salvage tx using a lower dose spread out over two sessions over a week. I know this from a patient who had prior colon cancer tx with external radiation, then later got prostate cancer, and was treated with HDR-BT salvage radiation, but with a lower effective dose to prevent toxicity issues. You should also look into ADT with Lupron/Zytiga as well. Steadily rising PSA is usually a sign of reoccurrence.

ncbi.nlm.nih.gov/pubmed/288...

[tucker_man]

What kind of RT did you have that you still have a healthy prostate able to get a tumor? Since your PSA never went to undetectable levels, my assumption is that RT didn’t kill all the healthy and cancerous prostate tissue like it was designed to do?

[PCPatient in reply to tucker_man]

Hi tucker_man,

There was a tumor suspected during the latest CT-scan, but this was never confirmed during the biopsy (24 samples, and knowing the location of the possible tumor based on the CT-scan).

Well, yes. My PSA level was never undetectable, 0.5 to 1.5 from 2011 to end 2019, but will it ever become undetectable?

[Jeff85705]

I am frankly confused as to why prostate removal wasn't considered with your initial PSAs and biopsy, but in any case, prostate removal following radiation is generally not an option. I would say your PSAs show "chemical recurrence." That is all I know. I wish you the best of luck and the best of doctors. Hang in there.

[PCPatient in reply to Jeff85705]

Well, Jeff. I guess the treatment may often depend on which specialist you contact.

During the last few months, I have seeked "second opinion" from many specialists, and almost all of them seem to promote their area of expertise.

I guess you are right with your definition "chemical recurrence". The biggest question I pose myself is what treatment to go for. It would likely be a hormone treatment, but I also ask myself whether I should take a wait-n-see approach over a period of say 6 months. My only worry is my fast rising PSA, which has gone 4 - 8 - 12 within less than 6 months.

[Jeff85705 in reply to PCPatient]

Yes, treatment can depend on which specialist you contact, which is why I got opinions from 1) my urologist, 2) a radiation oncologist, and 3) a clinical oncologist specializing in PC. Your treatment actually depends on the patient and what research he is willing to do before deciding. I made my decision based upon the above 3 specialists (RALP), and have not regretted it.

Salvage prostatectomy is available for a select few following EBRT, but the ideal candidate is prostate-confined cancer before treatment, is still believed to have organ-confined disease, a Gleason of 6 or less, a low pretreatment PSA of 10 or less and a T1c or T2a (low) stage tumor. This is from "100 Questions & Answers About Prostate Cancer" by Pamela Ellsworth, MD. (A great resource by the way, given me by my urologist). It has a whole host of side effects and requires a very experienced urologist to perform it.

[diatom]

What about brachytherapy

I was diagnosed a year ago with PSA 42 and Gleasoon 9

[PCPatient]

Just a small up-date:

Had another PSA check a month ago, which came back at 12.5, i.e. no change.

So I started a 150 mg + 10 mg tamoxifen a day therapy. This has been going well so far, without any notable side effects.

I obviously hope this will keep possible PC at lymph notes at rest. I am scheduled to have a new PSA test in a months time, so we will see.

I have no idea how long I should continue the treatment? Initially, I have Casodex and tamoxifen for 3 months. Could it be an intermittent treatment, e.g. 3 months treatment, then wait and see with regular PSA check, or??

Anybody who could share experience from similar treatment?