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Unexpectedly bad PSA

User
Posted 25 Nov 2019 at 22:36

My husband was diagnosed with advanced prostate cancer in mid Sept. Bolt from the blue as no urinary symptoms, no family history. Gleason score of 7, spread to bones including spine, not in lymph or other organs, opening PSA of 654. Hormone therapy started immediately. Tablets for 3 weeks, injection of  Prostap after about a fortnight. Decision taken to also go for early chemo, based on Stampede research. PSA fell to 403 then 196, so we felt hormone therapy was beginning to work. First cycle of chemo (plus steroids) happened three weeks ago. Went back today for blood tests prior to second cycle. Consultation all quite positive until we happened to ask, towards the end of the conversation what the last PSA figure was. This was the test from 3 weeks ago, before chemo started, so based on hormone treatment only.


Doctor told us it was 400 ..that’s double what it was a fortnight before...but didn’t  offer any explanation or comment. We were so surprised and disappointed we didn’t manage to ask effectively what this really means. Do PSA results fluctuate that much for no reason? Does it mean hormone therapy isn’t doing any good? That would seem like seriously bad news. But if so, how could it be delivered so casually, and only in response to us pressing for the info? Doc seemed a bit confused/distracted..hadn’t seen notes recording recent episode of neutrophenia...but surely an upwards lurch in PSA after consistent falls should have merited some comment and careful consideration? I’m now plagued by doubts that she might possibly have read the wrong number from his notes. How can I find out the actual PSA result?

User
Posted 25 Nov 2019 at 23:33

It's terrible when you have an appointment and feel there are a dozen things you should have asked.  I've found doctors are very different.  Some settle you, some unsettle you and some only tell you the simplest thing they can. I often feel there's more I should know but to be honest I don't want to know a lot of it.  I think I've seen about 5 different doctors at my post op clinics and now have a named Macmillan nurse who I can ring.


You could ask for another appointment or perhaps ring a Macmillan nurse if there is one for you at the hospital, or even ring a PCUK nurse for general advice.  It's often better to talk to someone and formulate a plan.


I know little about hormones but there are different types and some people adapt better to different ones.  Also it's useful to know the dates of the tests for anyone commenting.  It sounds like 3 psa tests with big changes between Sept and early November which seems quite a short time.


Regards

User
Posted 25 Nov 2019 at 23:41

When I think of things after the consultation, I ask the clinical nurse specialist (CNS, or Macmillan nurse in my case). If it's something specifically for the consultant, I email the nurse and ask them pass it on, which they always have.

User
Posted 26 Nov 2019 at 00:01
Annie, the onco should have written to the GP with the results, or the GP should be able to access them online. Your OH can ask at the GP practice whether the receptionist can access and print off the test results for him. It is not what would be expected at this point in his treatment, the PSA would usually continue to fall although chemo can make it rise (think of it as the cancer screaming as it dies).

It strikes me that you haven't mentioned a second hormone injection which presumably was due round about the same time as the most recent PSA test? If so, my first thought would be was he late having the injection / did he get a dud batch / did the nurse definitely inject it correctly? My second thought (if the doctor was distracted) is that she read to you his old result rather than his most recent one :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 Nov 2019 at 19:00
I would also go back to the GP practice and ask them to confirm that he definitely had the 11.25g injection and not the 3.75mg injection :-/

Where was it injected?

'Mildly surprised us' may be the biggest understatement we have ever had on this forum!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 25 Nov 2019 at 23:33

It's terrible when you have an appointment and feel there are a dozen things you should have asked.  I've found doctors are very different.  Some settle you, some unsettle you and some only tell you the simplest thing they can. I often feel there's more I should know but to be honest I don't want to know a lot of it.  I think I've seen about 5 different doctors at my post op clinics and now have a named Macmillan nurse who I can ring.


You could ask for another appointment or perhaps ring a Macmillan nurse if there is one for you at the hospital, or even ring a PCUK nurse for general advice.  It's often better to talk to someone and formulate a plan.


I know little about hormones but there are different types and some people adapt better to different ones.  Also it's useful to know the dates of the tests for anyone commenting.  It sounds like 3 psa tests with big changes between Sept and early November which seems quite a short time.


Regards

User
Posted 25 Nov 2019 at 23:41

When I think of things after the consultation, I ask the clinical nurse specialist (CNS, or Macmillan nurse in my case). If it's something specifically for the consultant, I email the nurse and ask them pass it on, which they always have.

User
Posted 26 Nov 2019 at 00:01
Annie, the onco should have written to the GP with the results, or the GP should be able to access them online. Your OH can ask at the GP practice whether the receptionist can access and print off the test results for him. It is not what would be expected at this point in his treatment, the PSA would usually continue to fall although chemo can make it rise (think of it as the cancer screaming as it dies).

It strikes me that you haven't mentioned a second hormone injection which presumably was due round about the same time as the most recent PSA test? If so, my first thought would be was he late having the injection / did he get a dud batch / did the nurse definitely inject it correctly? My second thought (if the doctor was distracted) is that she read to you his old result rather than his most recent one :-/
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 Nov 2019 at 14:58

Thanks Lyn, it’s reassuring to get someone else’s take on this. I try really hard to stay calm and not overreact but sometimes I want to scream!


We felt this sudden psa rise wasn’t what would be expected at this stage, but that realisation only began to dawn as we walked to the car park! That’s partly what I’m so shocked about, getting what looks on the face of it as unexpected and bad news without any conversation or support.
As it happens we had to go to GP surgery this morning to arrange next Prostap injection (they are three monthly, so not overdue yet, tho thanks for thinking of that possibility ) so we took the opportunity to ask if they had the run of PSA results and could we see them. Answer was a clear No. The hospital apparently don’t report back to the GP ...which mildly surprised us. I asked if the surgery could ask for a report for us but the receptionist declined to do that.
We are due back at the hospital tomorrow for second chemo cycle so will see whether anyone can confirm the PSA results from his notes. 
When we started all this with a urologist at Bridgend Hospital we were put in touch with a specialist prostate nurse who we could ring for support or clarification. Now we have been transferred to Velindre Cancer hospital in Cardiff we don’t seem to have an equivalent, so there’s no clear communication channel. I’m feeling distinctly out on a limb at the moment, but trying desperately not to fuss!

User
Posted 26 Nov 2019 at 19:00
I would also go back to the GP practice and ask them to confirm that he definitely had the 11.25g injection and not the 3.75mg injection :-/

Where was it injected?

'Mildly surprised us' may be the biggest understatement we have ever had on this forum!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 28 Nov 2019 at 13:15

Thanks. We too had begun to wonder whether the Prostap administered was the one month rather than three month dose. My guess is that, whatever it actually was, it will be recorded as the larger one because that’s definitely what she intended to give. It went in his arm. We thought we would press on with trying to get the authoritative PSA results before we started querying the competence of the practice nurse. But we will follow that up if necessary.


Yesterday he had his second chemo cycle, dose reduced by 20% because the first lot wiped out all his neutrophils. We got confirmation that Monday’s blood test showed neutrophils were back up to a healthy 7.5 but the nursing staff said they couldn’t access his PSA results on their computer system.


So it looks like we have to ring the consultant’s secretary and try to get the information from her. With a bit of luck she will have Monday’s result back as well as the 4 Nov one that we are so concerned about. OH has agreed to do that tomorrow if I promise to not mention it again for at least 24 hours! 


One bit of good news, I just got checked over by ENT specialist and I don’t have throat cancer (which is what my GP had clearly suspected). I don’t think I could have coped with two of us being ill at the same time.


I so wish we had a nominated key worker/specialist nurse that I could talk to. But you guys are helping loads.

User
Posted 29 Nov 2019 at 21:17
Update. Unfortunately we have today got confirmation that the PSA reading of 400 was accurate. So having fallen steadily for two months, under the influence of bicultamide for three weeks and a Prostap 3 injection, the PSA went up sharply. Before the start of chemo.
GP surgery are adamant they gave the right 3 month dose of Prostap, saying they don’t stock the one month version.

Does anyone out there have experience of developing hormone resistance in such a short time?
 
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