Dad starting radiotherapy treatment for locally advanced prostate cancer

User

Posted 10 Oct 2023 at 20:23

Dad was diagnosed with locally advanced prostate cancer in March 2023. T3a N0 M0. His PSA was 20.

He started hormone therapy in the March with courses of injections - he’s had three injections, with the third being most recent. PSA in July was 3.2. In September this jumped up slightly to 4.9. They did another test at the beginning of October and PSA has dropped slightly to 4.1.

Dad had his third injection today and ahead of the radiotherapy, which is booked w/c 16th October, they would like to do another PSA test and testosterone test to understand the fluctuations in his PSA scores. One of the nurses said to him last week, when he had his most recent PSA test, that they require his PSA to be lower than 1, but the radiologist confirmed they’re still happy to go ahead with the treatment.

Just looking for reassurances or similar experiences. Is it normal for PSA to fluctuate while on hormone treatment with courses of injections. Has anyone else had issues with getting PSA below 1 for radiotherapy? Is it a concern if it’s higher than 1?

thanks so much for the advice, really appreciate it,

Abigail x

User

Posted 10 Oct 2023 at 23:25

They are quite high PSA readings for someone on HT. Mine were over 20 at diagnosis, 0.8 at three months HT and <0.1 at six months HT.

So your dad's drop from over 20 to 4 is reasonable but it would be nice if it had got lower. A testosterone test to see if the HT is stopping testosterone is a good idea, I suspect that HT will be working otherwise the PSA would not have dropped at all.

So you may find your dad has a variety of cancer which is not responding well to HT. It cuts down future treatment options if that is the case, and it means going into RT the cancer has not been weakened as much as would be liked.

The cancer may be just as vulnerable to radiotherapy as any other cancer, so just because it is more resilient than most cancers to HT doesn't mean it is not going to be killed by RT.

Dave

User

Posted 11 Oct 2023 at 11:30

Hey Dave,

Thank you so much for your reply, it has provided me with some reassurance and comfort.

Do you know what results we should expect from a testosterone test? Like you say, it sounds as though the HT is working as it’s has reduced the PSA but not as powerfully as expected perhaps.

Abigail

User

Posted 11 Oct 2023 at 12:09

Normal testosterone is between about 7 and 17 it's quite a wide range. I can't remember the exact figures but HT takes it down to about 0.5 . So if his testosterone is below about 1.0 the HT is almost certainly controlling the testosterone, but that is not controlling the cancer very well. If his testosterone is above 5.0 then the HT isn't controlling his testosterone so it is no surprise the cancer is just growing as per normal.

I don't know if we have ever had anyone where the HT has not reduced the testosterone to below 1.0 ?

Dave

User

Posted 11 Oct 2023 at 12:46

If Testoserone doesn't drop below 1.2nmol/L, then they might switch hormone therapy injections. I have come across men in support groups who've had to change for this reason.

We did have someone in this group who ended up having the injections more frequently than the normal dosing period, to make them more effective.

User

Posted 11 Oct 2023 at 19:34

Thanks so much Dave, really appreciate your advice. It’s good to know what we should be benchmarking and hopefully his test results come back below 1.0, but preparing myself not to be surprised if it’s above.

He has recently had a bone scan and CT scan in prep for the RT, which he had feedback bone scan was clear. If the cancer has continued to grow, would they pick this up on his recent scans, if the growth is noticeable?

Abigail

User

Posted 11 Oct 2023 at 19:41

Thanks so much Andy - this is really good to know that they can change up Dad’s treatment possibly if the current HT isn’t performing as should against his cancer. The nurses/doctors haven’t raised any concern with regards to his previous PSA scores only the most recent one ahead of RT, which has got me worried, as I had thought this concern would have been picked up sooner, as his PSA has never got below 3.

Abigail

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