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Just general guidance please

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User
Posted 07 Jan 2023 at 17:59

Hi.

My husband was diagnosed 4yrs ago, aged 50. He had radiotherapy and 2yrs of hormone treatment. 

He finished hormones a year ago, and his PSA is climbing again. 

How worried should we be?

Thank you 

Edit.

His PSA was 28 prior to treatment. It went down to 0.1 after the radiotherapy and during hormones.

It's now 2.7 so not great I don't think. 3 months ago was 2.1.

 

EDIT: july 2023 My husband is about to start chemo. They found the prostate cancer has spread to the lymph nodes in the groin. No sign of bone mets etc.  I'm nervous about how the chemo will be, how to take care of him.

Edited by member 25 Jul 2023 at 05:49  | Reason: new symptoms, treatment plan

User
Posted 07 Jan 2023 at 18:26

You should not be worried. He still has a prostate and a healthy prostate will produce PSA unless it is being suppressed by HT.

If you tell us the number it is now, the lowest number it has every been, and what it was before treatment we can give more precise guidance. Without that information all I can say is if it is below 2 then don't worry at all. 

If he has had his prostate removed with surgery then it is a whole different ball game.

Dave

User
Posted 07 Jan 2023 at 21:12
What was his minimum PSA reading? What is the reading now? Some increase in PSA is entirely to be expected, since he still has a prostate. "Recurrence" is only considered to have occurred if the PSA exceeds the minimum value + 2.

Best wishes,

Chris

User
Posted 17 Jan 2023 at 07:50

In the absence of some other explanation such as a UTI, I think he should push for a PSMA PET scan.

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User
Posted 07 Jan 2023 at 18:26

You should not be worried. He still has a prostate and a healthy prostate will produce PSA unless it is being suppressed by HT.

If you tell us the number it is now, the lowest number it has every been, and what it was before treatment we can give more precise guidance. Without that information all I can say is if it is below 2 then don't worry at all. 

If he has had his prostate removed with surgery then it is a whole different ball game.

Dave

User
Posted 07 Jan 2023 at 21:12
What was his minimum PSA reading? What is the reading now? Some increase in PSA is entirely to be expected, since he still has a prostate. "Recurrence" is only considered to have occurred if the PSA exceeds the minimum value + 2.

Best wishes,

Chris

User
Posted 07 Jan 2023 at 22:26
I think it's the minimum value without hormone therapy isn't it?
User
Posted 07 Jan 2023 at 23:56
No, it is 2.0 + the lowest reading achieved while on HT
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 16 Jan 2023 at 00:32

Thank you 

His PSA was 28 prior to treatment. It went down to 0.1 after the radiotherapy and during hormones.

It's now 2.7 so not great I don't think. 3 months ago was 2.1.

User
Posted 16 Jan 2023 at 00:33

Thank you 

His PSA was 28 prior to treatment. It went down to 0.1 after the radiotherapy and during hormones.

It's now 2.7 so not great I don't think. 3 months ago was 2.1.

User
Posted 16 Jan 2023 at 02:19

I suppose the figure is normally taken as being with HT because the vast majority of men have adjuvant HT after RT. This does raise an interesting aspect though because the time for HT may be anywhere between nil (as in my case) upto three years (subject to individual case consideration). You don't really know by how much the HT is really depressing the PSA figure until after you come off it. But the nadir plus 2.0 gives a relative if, somewhat crude figure for biochemical failure.

The restraining effect of HT in the patient referred to in this thread would have long gone. Are the PSA tests done at the treating hospital so the Oncologist would be made aware or done by your husband's GP and if the latter is it the case that the PSA results are relayed to the Oncologist or left to the discretion of the GP? I would hope the former is the case, particularly with PSA increase.

Edited by member 16 Jan 2023 at 02:35  | Reason: Rephrase

Barry
User
Posted 17 Jan 2023 at 04:31

Thank you Barry.

The tests have been done at the docs surgery but relayed to the consultant at the hospital. My husband has now phoned them and has a hospital appt in a couple of weeks to discuss what is next.

Lorri

User
Posted 17 Jan 2023 at 07:50

In the absence of some other explanation such as a UTI, I think he should push for a PSMA PET scan.

User
Posted 17 Jan 2023 at 14:52

We are going to see his consultant in a couple of weeks.  I will go with him and get as much info as possible. 

My husband assumes he will be going back on hormone treatment.  I guess I'm worried it has spread.

User
Posted 18 Jan 2023 at 14:53

My husband has told me his PSA is actually 3.6. So it has gone up from 2.1 in 6 months.

Edit. He had RT Feb 2019 and HT for 2 yrs following this. 

Edited by member 18 Jan 2023 at 22:20  | Reason: New inf

User
Posted 18 Jan 2023 at 19:24

Ask for a PET scan before he starts the hormone therapy, as hormone therapy makes the PET scan less sensitive. If the scan shows just one or two hot spots, they might be able to be treated with SBRT if they're outside the original treatment area.

User
Posted 18 Jan 2023 at 19:51
I suppose the figure is normally taken as being with HT because the vast majority of men have adjuvant HT after RT. This does raise an interesting aspect though because the time for HT may be anywhere between nil (as in my case) upto three years (subject to individual case consideration).

Yes ,I also didn’t have any ht after rt ,I only had 3injections of zoladex in total , when I visited my doctor for a routine appointment a few months later , he immediately queried why I wasn’t on ht !and told me to have a psa test immediately , Luckily I remember it well, the meeting with the oncologist was on my 65th birthday ! When he told me psa reading 0.01 , 3months after rt finished ,and no need for anymore ht, I was pleased with that , but he never sent a letter to my doctor . Oncologist said your psa tests every 6 months and it will rise gradually , no spikes allowed and we will review things once /if ? it gets to 2. That was 4 yrs ago . Reading at last psa test 0.25 .

 
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