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Rising PSA, but low testosterone

User
Posted 07 Aug 2019 at 18:46

Hi,

my Dad has had prostate cancer for 20yrs now. It has been controlled with Zoladex injections every 3mths. He had a bone scan last year which showed no progression. He has stage 4 renal disease and has an indwelling catheter. He will be 90 this year. His recent PSA was 11.5. On discussion with his urologist we realised this was quite a big jump from his last result of 3.6, but that actually the level had been rising slowly for the last 4yrs. We assumed that the zoladex had stopped being effective, but testosterone blood tests were really low still. The urologist is now going to repeat all the staging scans to make sure the cancer hasn’t spread, but has said that if it hasn’t he wouldn’t suggest 2nd line treatment, and close monitoring. My question is - does anyone have an experience like this, and what should we expect if the cancer hasn’t spread but is not being controlled? Thanks for reading, any advice greatly appreciated

User
Posted 07 Aug 2019 at 20:57

Zoladex will eventually fail to keep the cancer in check, but it's not due to losing control of testosterone - normally Zoladex will keep the testosterone very low anyway. What happens is that cancer continually mutates, and eventually by chance it generates a variant which doesn't need testosterone to multiply, so the growth of these new cancer cells is not kept in check by the absence of testosterone. These cells are referred to as "castrate resistant", meaning they will grow even if the patient is castrated (the old treatment), or still on Zoladex (more commonly used today).

The oncologist will look at things like the staging and the length of time it takes the PSA to double to decide how quickly the cancer will spread and impact Quality of Life. It might well be that this is going to take sufficiently long that even unchecked, your father is likely to die from something else first, in which case there's no point adding PCa treatments from which your father will gain no benefit. On the other hand, it might be that adding another drug is necessary to slow the PCa down to the point where it's unlikely to be the cause of death.

User
Posted 07 Aug 2019 at 22:25

That’s really helpful, thank you. 

 
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