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What is the next treatment step?

Posted 07 Jul 2021 at 11:14

My husband (77) was diagnosed 4 years ago - initial PSA of 139 and a Gleason score of 9.  He has been on hormone therapy since then and also takes bicalutamide daily.  Initially, his PSA dropped to minus numbers, but it has gradually been creeping up since last year.  His new PSA level, as of today, is 12 and has doubled since March.  He will now be going for another bone scan and CT scan.  May I ask what is the next usual step in the treatment process?  He hasn't had radiotherapy or chemotherapy.   I've put this in the localised cancer topic as his first bone scan and CT scan, four years ago, was clear at that time, although we were told that with such a high PSA level it was highly likely that the cancer will have spread, but couldn't be seen yet. 

Posted 07 Jul 2021 at 14:55

I wonder if they should have been more radical in the treatment four years ago. It is true that putting someone through treatment which may not work is bad, but with no clear evidence that it had spread maybe it was an option. Anyway we can't change history, and I guess psa 139 was as much evidence as they needed. 

I don't know what the next treatment will be, a different HT might work, but maybe they will have to move to Enzalutamide or Abiraterone which may give him a few more years, then after that it might be chemo. With advanced PCa it is a case of slowing it down and holding it back as long as possible whilst still trying to have a quality of life. 


Posted 07 Jul 2021 at 15:04
Thank you for your reply, Dave. Yes, we're keeping our fingers crossed that whatever treatment he has will hold it back for a few years longer. We'll obviously know more after the scans have been done.
Posted 07 Jul 2021 at 17:18
I am assuming they added the bicalutimide tablets after the decapeptyl began to fail in 2018? If that is the case, it is amazing that the bical / decapeptyl combo has worked for this long! Many men only find that works for a few months. Is he still on decapeptyl or has the hormone been changed since 2018?

The next step might be that they stop the bicalutimide - sometimes prostate cancer learns how to use that as food so taking it away results in a drop in PSA, this is known as an anti-androgen withdrawal response or AAWR. They may also start talking about docetaxel, a form of chemotherapy. The next step is then usually abiraterone or enzalutimide but likely they will want to get him off the bicalutimide and see what happens before they rush to add another treatment.

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

Posted 07 Jul 2021 at 18:35
Thank you Lyn. Yes, the bicalutimide was begun when he was solely on the decapeptyl and his PSA began to rise again. I think that was about a year after he had been diagnosed and had begun treatment. And, yes, he's still on the three-monthly decapeptyl injections.

I didn't realise that stopping the bicalutimide could drop the PSA. That's definitely something we could mention at the next appointment if the consultant doesn't suggest it.

Thanks again.

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