Do they test your testosterone level when they do your PSA test? The issue is not whether or not it has spread further, it is the fact that the cancer is active while supposedly being starved of testosterone.
There are two possibilities:-
- the Firmagon is not effectively stopping testosterone production so the cancer is still able to feed, or
- the cancer has learnt to survive without testosterone (this is also referred to as being castrate resistant or hormone independent)
A testosterone test would indicate which case applies to you. If your testosterone is above castrate level, it could just be that they need to change you to Prostap or Zoladex to see if they work better, or will add bicalutimide to disguise whatever testosterone is still floating around. Occasionally, a PSA rise is simply down to a problem with one injection .... it wasn’t injected correctly, or hadn’t been stored correctly or was just from a bad batch.
If you are below castrate level and have become castrate resistant, they will either add an extra hormone treatment (enzalutimide, Abiraterone, etc., or maybe bicalutimide) or they may suggest chemo. Chemo for prostate cancer is usually fairly well tolerated and for many men, makes the hormones work much better.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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