PSA rising on hormone therapy

User

Posted 05 Nov 2018 at 19:34

My husband was diagnosed with prostate cancer in October last year. His Gleason score was 10 and the cancer is in the prostate and the lymph nodes in the abdomen. We were told it was incurable.

He has been on hormone therapy for about a year and had a course of chemotherapy that finished at the end of June.

We went for a routine appointment with the consultant today and his PSA has risen from 0.01 which is what it had dropped to after the chemotherapy to 2.97 on his test last week.

We are terrified this could mean the hormone therapy is no longer working after such a short time and they are sending him for scans to see what is happening.

Has anyone else had PSA rise and fall again? Is it possible that the PSA is just levelling out after the chemotherapy?

User

Posted 05 Nov 2018 at 21:16

It seems either the HT isn't working as well as it should or the cancer has learned to survive without it. It is hard to know which unless you have had his testosterone reading?

On HT he should be at or below castrate level so if his T is 0.69 or below, then the HT is effective but he has become hormone independent (the cancer is feeding without testosterone). If the T is higher than 0.69 then it might be that his last hormone injection was given incorrectly (sometime the 1 month dose is given when it should have been the 3 month dose or it is injected badly and misses the muscle or similar) or was stored incorrectly (too cold or too warm) or was simply from a bad batch.

Either way, they may suggest adding bicalutimide to support the Zoladex - while zoladex stops testosterone from being produced, the bicalutimide disguises any testosterone floating around his body so that the cancer can't find it. Adding bicalutimide can solve the problem for anything from a few months to a couple of years. Alternatively, they may suggest adding enzalutimide or abiraterone, two kinds of hormone treatment that are particularly good with cancer that has become castrate resistant.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 06 Nov 2018 at 08:00

Hi Helen

We attach so much importance to our PSA scores, my next blood test is Saturday and I'm waiting with bated breath in the hope my PSA will have dropped further.

Lyn makes some interesting observations, when I went for my last Prostap jab the district nurse said jokingly lets just double check I'm giving you the 3 month injection so I made a mental note to myself to double check next time that I'm getting the right one.

I haven't a clue what my testosterone level is so thanks to your post, on Friday, when I next see my Onco I'm going to ask him to amend my blood request form to include a reading for it.

According to Dr Google the testosterone level in healthy males ranges from 270 to 1070 ng/dl (nanograms per deciliter) averaging out at 679 ng/dl.

Chemical castration level is below 50 ng/dl though some experts regard 20ng/dl as more accurate. Probably, like me, it will be worth asking for a T figure when your husband next does his bloods.

John

User

Posted 06 Nov 2018 at 11:05

Hello Helen my PSA started to rise after about 18 months after starting Prostap.My onco ordered a scan which i had yesterday so she can see any changes in tumours and she says she will probably start another Ht to boost theProstap.Onco has also written a letter to GP to see if they have changed the supplier of Prostap as they can vary slightly the same as other drugs do sometimes.Onco did say it may be Enzalutimide in tablet form.All the best Geoff

User

Posted 06 Nov 2018 at 15:56

Helen, it is possible that you are seeing a PSA wobble (I had this years ago after RT), but even if a rise is confirmed, there are loads of treatment options so try not to worry until the road ahead is clear.

User

Posted 06 Nov 2018 at 18:15

Originally Posted by: Online Community Member

According to Dr Google the testosterone level in healthy males ranges from 270 to 1070 ng/dl (nanograms per deciliter) averaging out at 679 ng/dl.

Chemical castration level is below 50 ng/dl though some experts regard 20ng/dl as more accurate.

Hi Jasper, these measurements are most often used in the US rather than the UK. Here, testosterone is measured in nmol/l so the 'normal' range that you quote of 270-1,000 ng/dl would be reported in the NHS as 9-32 nmol/l

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 07 Nov 2018 at 08:13

Okay Lyn thanks very much for the UK/US clarification, I've just looked it all up, nmol/l = nanomoles per litre so for chemical castration purposes I'm looking for a reading around 0.7 nmol/l.

User

Posted 07 Nov 2018 at 11:24

Yes, as I posted above you are looking for a T reading of 0.69 or below.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Notification

Join the online community now.