Rising PSA after surgery, radiotherapy and Bicalutamide

Hi Jim
I am sure there will be others who can offer advice to you.

Out of interest though when you had the RP did the surgeon remove any lymph nodes to check for spread?

Hope all goes well

Bri

After surgery I was told no lymph nodes had been removed and that there was no lymph node involvement.

Jim

Hi all,

This is just an update - I saw my oncologist today, who said that although my PSA was still low it had doubled in 6 months so she thought it likely that this was not just a blip.

We agreed that I would carry on with Bicalutamide until the end of June when I'd have another PSA test. If that confirmed the same rate of increase I would then have more treatment. I asked about chemo as I'd read the encouraging results coming out of the Stampede trial and we agreed I could start Docetaxel if the PSA was up, then after that go on to Zoladex in addition to the Bicalutamide.

I was again told that my intermediate aggressive cancer with a Gleason of 4+3 was not behaving as expected.

Jim

hello jaypeeca,
my husband has had surgery, radiotherapy and hormones and like you his psa continued to rise albeit slowly. He went (last year July/August) to the Royal Marsden to see about Cyberknife treatment. After a choline pet scan they discovered a hotspot on one of his lymph nodes and agreed to treat this one node with the Cyberknife radiotherapy which he had in August last year. Three sessions 50 mins per session. On his review this year it was found that his psa had again risen (now about 2 ) which has caused concern as a scan showed the node treated had been well and truly hammered, but that same scan showed two more nodes affected plus one more suspicious site which had been there originally but they feel may not be cancer. I am sorry this is fairly rambling but it is difficult to do direct (or I find it so). He had been taken off of hormones one month after his original treatment so has been off them for 7 months now. He went back to have another consultation at the end of Feb this year and then has had a further planning scan (they can fund up to three treatments for Cyberknife on the NHS then if any more are needed it is a case of paying oneself) and they will be treating both affected nodes on the 20th, 22nd and the 25th of this month so we will see what happens after that.
I doubt this is of any help but who knows
Katrina

Hi Jim
This post is of great interest to me , as I am approaching further treatment choice roughly based on your journey and on Katrinas post above. After post op psa very quickly rising to 2.4 , my Onco has always been convinced there is spread elsewhere , and that the psa could not be being solely generated by anything left behind in the prostate bed. After my wife and I researched , and used various outside sources , it was clear that 35 sessions of RT wasn't going to fix the problem - it was merely going through the motions ( <18% chance of cure ). So we refused it based on that data and the fact I didn't want further side effects if unnecessary. So Bicalutamide it was , which is controlling psa at 0.13.
So where do we go from there ? Well , nowhere to be precise. I've not been offered cure , but I have been told I can come off HT and monitor psa frequently until it hits 5 or more before going for a second CholinePET scan. But here lies the problem noted in Katrina's post. The scanner can only pick up tumours bigger than 5 to 7 mm diameter. Someone could have a psa of 47 but nothing get picked up as it may be 16 small tumours generating it. Or someone could have a psa of 0.5 and the scan might pick up a single node which can be treated with cyber knife or something.
The reality in my situation is that they may find a couple of tumours which could be individually treated somehow , but there could be several others growing not yet large enough to be seen. So it would seem a losing battle and the reality is the person would need to remain on HT anyway. However I have been told that by doing this , survival rate would be better than just HT only and then the following treatments. I've not been offered any trials or early chemo , nor HIFU for the bit of seminal vessicle they left behind even though my surgeon has been on the local news for pioneering it between Southampton and UCLH.
Best wishes to everyone on the 'coaster
Chris

Sorry Jim you posted to Katrina whilst I was writing this

Edited by member 08 Apr 2016 at 11:51  | Reason: Not specified

Hi Jim
Yes slightly different in that in my case they found 5 lymph nodes cancerous out of 18 removed at surgery. With such a high psa post surgery it seems it's normally something worse than just a bit they left behind. I've been ' lucky ' in that I'd had no symptoms at all other than occasional ED. The op has left me fully impotent but I'm fully continent. I wasn't going to open myself up for further potentially life-changing / harmful / cancer inducing radiation on a whim. But I know we are all different in our outlooks. My Onco was very honest from the start saying that the RT would not be a cure, nor extend my life. He later said they were " throwing the kitchen sink at me " because of my youngish age. Obviously in your case you needed extra treatment to fix your plumbing !!
I was very negative about any sort of treatment on diagnosis. I've moved away from that and am enjoying life more in some areas , however I'm a huge supporter of QOL not necessarily quantity , and haven't bothered remotely with diets or extra exercise or supplements ( tried Turmeric but it wrecked my stomach ). Each to their own heh.

Thanks for your post.

I've realised what you say about there being no logical path of progression. I was told my cancer was contained and that surgery would be a cure. Then I was told the salvage radiation would be, too.

After that I was told Bicalutamide would control it, but with the proviso that they didn't know how long for. Turns out it's probably controlled it for less than a year.

I think my onco is creative. She's certainly open to ideas and discussion and we get on really well. I would say she definitely hasn't got an ego. At our request she looked at my scans again last year and from that came the second load of radiotherapy, that time to the pelvic lymph nodes. I was told there were too many to remove and that the second lot of RT combined with the Bicalutamide would hopefully delay progression before something else would need to be done. I know the Bicalutamide shrunk the nodes before the second load of RT because the planning scan showed that.

When I asked her about early chemo this week she said definitely, if my next blood test confirmed the last one was not just a blip. She didn't think it was, but wanted to make sure. I'm fine with a few months wait as I don't really want to have chemo if it's just a blip.

Read lots?!?! Bloody 'ell, I think I've read every friggin booklet on prostate cancer that PCUK and Macmillan have published. I go to two different monthly support groups and I try to keep up on developments generally.

I read your profile, too. Bloody 'ell.

Cheers

Jim