PSA rise during hormone treatment

User

Posted 19 Aug 2020 at 20:12

Hello,

My 84 year old dad was diagnosed with metastatic prostate cancer which had spread to the pelvis and right femur, in January. There was no biopsy so we have no Gleason score.

His PSA was 31 in the beginning, however it could actually really have been double this as he was taking Combodart for a long time before.

He was put on hormone treatment immediately and his PSA dropped to 1.97 three months after the first injection.

Today he went for his second injection (six months after the start of treatment) and his PSA has risen to 4.9.

I'm really worried about a 3ng/ml rise in such a short space of time and wonder what it means.

We're waiting for an oncology appointment now.

Has anyone else had this type of experience where their PSA rose significantly in a short period? And what did that mean for you?

Many thanks.

Rosalie.

User

Posted 19 Aug 2020 at 22:12

It could be a number of things:-

- he was given the wrong dose at the first injection and shouldn't have waited 6 months for the next one

- the injection was stored or given incorrectly

- the cancer hasn't responded to that hormone and they need to try a different one

- his cancer is already hormone independent (it can survive without testosterone) and they need to add another hormone to the mix

Ask the GP practice or nurse to confirm which injection was given the first time and at what dose. Also, ask the oncologist whether his testosterone level has been or will be tested to check that the HT is working

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

User

Posted 20 Aug 2020 at 18:55

Hi LynEyre,

Thanks for your reply. I know that the Decapeptyl dose given was 22.5mg but as to how it was stored, I'm not sure.

It's my impression that a 3ng/ml rise in the space of less than three months is a lot, but I have no experience in this field so I'm just really going on what I've read about PSA doubling times, etc.

Regarding your suggestion that perhaps "the cancer hasn't responded to that hormone and they need to try a different one." Do you know if that sometimes happens and if another hormone drug might work? In this case it wouldn't mean that the cancer was hormone independent, right?

Also, when you suggest asking the oncologist whether his testosterone level has been or will be tested to check that the HT is working. Are you referring to another PSA test here?

And lastly, do you have any idea if a PSA rise might occur towards the end of the treatment cycle before the next injection is administered?

Thank you again for your help.

User

Posted 20 Aug 2020 at 22:16

It doesn't really matter whether the rise is big or small, it is the fact that it has risen already that is worrying.

I wouldn't have suggested that it may be the hormone that needs changing if that didn't happen sometimes, although it is more likely that the cancer has become hormone independent already. The only way to know which is your dad's case is to have the testosterone checked.

No, a testosterone test is not a PSA test although some doctors will automatically request a T level at the same time as the PSA.

If his T is 0.69 or below then it suggests his cancer has become hormone independent; if it is above 0.69 the hormone isn't working effectively yet.

There isn't meant to be a rise towards the end of the cycle - the depot is supposed to release an even amount of medication over the 6 months. However, we have had members here in the past who needed the 3 monthly injection every 2 months so that's another possibility.

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

User

Posted 20 Aug 2020 at 23:01

Thanks LynEyre,

That's all really helpful. I'll request a testosterone test when we see the oncologist. That should be the week after next.

For now it's just a waiting game. I really hope it'll be ok.

Thanks again.

User

Posted 20 Aug 2020 at 23:53

not sure I would wait to see the onco - you could ask whoever does the PSA tests (his GP?) to confirm whether testosterone was measured at this most recent test and if not, get one done before you see the onco. Otherwise, you will see the onco and be making decisions without necessarily having all the information to hand.

The onco may say that a rise of 3 is insignificant and suggest waiting for the next test - ask at what PSA level the onco would deem the treatment to be failing. Some say 5, some say 10 or even 20.

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

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