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Rising PSA after HT

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User
Posted 17 Aug 2021 at 21:19

We're worried about a significant rise in my husband's PSA after finishing Decapetyl in March 2020.


PSA Jan 2021 >0.01    19/05/2021 0.18  and 05/07/2021 0.47


Please see profile for history of Gleason, RP and SRT.


The consultant has mentioned continuing intermittent HT, possibly Bicalutamide, after next PSA test in Sept. 


We would welcome any thoughts/advice please.


Thank you.

User
Posted 17 Aug 2021 at 23:10

I can't offer much help. Clearly there are some prostate cells somewhere and they are active. A few people on here now talk about PSMA scans to try and find where the cells are. It seems that now some hospitals will treat a distant metastatic tumour with SBRT. I think once you have one met you will probably develop more, but maybe SBRT can keep knocking them on the head for a few years. If the tumour is in the prostate bed the SRT didn't work, and that area of his body can't be treated again with RT.


I guess it might be worth asking for a PSMA scan to see if a more focused treatment can be used rather than HT. The scan will have to be done before resuming HT as if he is on HT the prostate cells will be dormant and not show up. 

Dave

User
Posted 18 Aug 2021 at 08:18

Agree - next thing should be a PSMA PET scan to find where the cancer is. This needs to be done before starting on HT. Depending on the scanner, they might want PSA to be at least 0.5 for that, which it should be by the next PSA test. (Some of the newest PSMA PET scans can work from a PSA of 0.2.)

User
Posted 19 Aug 2021 at 08:30
Because he started HT at 1.5 his PSA will return to that level at least now he has stopped HT without having any other treatment since starting HT.

Further scans to see what is going on seems sensible.

It sounds like your onco has you pencilled in for intermittent HT I would ask why this has been chosen over HT with chemo, HT with Enzo etc and don't forget to ask about further scanning.
User
Posted 14 Sep 2021 at 12:11

Sorry to read this. My oncologist told me intermittent HT would be likely when he wouldn’t agree to SRT, I subsequently had SRT alongside HT. With a doubling time less than two months full time HT might be suggested. I would be asking for a bone scan, MRI and PET scans to try and identify where the active cancer is. I know some people don’t see anything on a scan with PSA below a certain value but I had cancer showing up in seminal vesicle remnants with a Choline PET scan and also showing up on the prostate bed with an mpMRI. This was with a PSA around 0.8.


What do others think?

Ido4

User
Posted 14 Sep 2021 at 15:24
A Gallium 68 PET-PSMA scan is more accurate than a scan using Choline as a tracer, but is more expensive, the radioactive isotope more difficult to produce, and only available in a few centres in the UK, unless you pay £2600 privately.

See what your oncologist says.

Best of luck.

Cheers, John.
User
Posted 17 Sep 2021 at 14:55

That all seems very sensible. I hadn’t registered he had an intraductal element, I had that too. Hope he gets the PSMA scan very soon.


 

Ido4

User
Posted 12 Dec 2021 at 07:47
You could try early Chemo as I have done
Please see my profile
User
Posted 12 Dec 2021 at 21:51

Thank you Barry. Wow you've had a rough time! We will research chemo & see what oncologist suggests. Thanks again x

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User
Posted 17 Aug 2021 at 23:10

I can't offer much help. Clearly there are some prostate cells somewhere and they are active. A few people on here now talk about PSMA scans to try and find where the cells are. It seems that now some hospitals will treat a distant metastatic tumour with SBRT. I think once you have one met you will probably develop more, but maybe SBRT can keep knocking them on the head for a few years. If the tumour is in the prostate bed the SRT didn't work, and that area of his body can't be treated again with RT.


I guess it might be worth asking for a PSMA scan to see if a more focused treatment can be used rather than HT. The scan will have to be done before resuming HT as if he is on HT the prostate cells will be dormant and not show up. 

Dave

User
Posted 18 Aug 2021 at 08:18

Agree - next thing should be a PSMA PET scan to find where the cancer is. This needs to be done before starting on HT. Depending on the scanner, they might want PSA to be at least 0.5 for that, which it should be by the next PSA test. (Some of the newest PSMA PET scans can work from a PSA of 0.2.)

User
Posted 19 Aug 2021 at 08:30
Because he started HT at 1.5 his PSA will return to that level at least now he has stopped HT without having any other treatment since starting HT.

Further scans to see what is going on seems sensible.

It sounds like your onco has you pencilled in for intermittent HT I would ask why this has been chosen over HT with chemo, HT with Enzo etc and don't forget to ask about further scanning.
User
Posted 14 Sep 2021 at 01:08

Unfortunately PSA now 1.09, doubling time of under 2 months. Looking for advice and thoughts before speaking to Onco on Weds please, what do people suggest? 

User
Posted 14 Sep 2021 at 12:11

Sorry to read this. My oncologist told me intermittent HT would be likely when he wouldn’t agree to SRT, I subsequently had SRT alongside HT. With a doubling time less than two months full time HT might be suggested. I would be asking for a bone scan, MRI and PET scans to try and identify where the active cancer is. I know some people don’t see anything on a scan with PSA below a certain value but I had cancer showing up in seminal vesicle remnants with a Choline PET scan and also showing up on the prostate bed with an mpMRI. This was with a PSA around 0.8.


What do others think?

Ido4

User
Posted 14 Sep 2021 at 15:02

Thank you for your thoughts. We're both v worried. It was good to get PSA reading before tomorrow, giving us chance to do some research & get our heads around this. Going to push for a PSMA scan rather than ct/bone scans,  but not sure which is best for him, using dyes etc. Hubby's kidney function is less than it should be, & on blood pressure tablets as has an ascending aorta aneurysm. Just a horrible time, don't want to compromise his kidneys but need to keep the cancer at bay. 

User
Posted 14 Sep 2021 at 15:24
A Gallium 68 PET-PSMA scan is more accurate than a scan using Choline as a tracer, but is more expensive, the radioactive isotope more difficult to produce, and only available in a few centres in the UK, unless you pay £2600 privately.

See what your oncologist says.

Best of luck.

Cheers, John.
User
Posted 14 Sep 2021 at 17:54

Thank you John, that's what we thought, fingers xd oncologist thinks so too x

User
Posted 16 Sep 2021 at 21:47

Thanks everyone for your advice.


Onco told husband (D) he would go back on HT. D said that because doubling time under 2 months & intraductal element, could he have a scan? No problem, PET scan in a couple weeks, don't think it will be PSMA, it will be at Taunton or Plymouth. Onco said that must be done ASAP as doesn't want PSA to rise to 3 or 4. 


So pleased D got the PSA result prior to the consultation.  gave us time to look at the options, & get over shock of rising PSA  

User
Posted 17 Sep 2021 at 14:55

That all seems very sensible. I hadn’t registered he had an intraductal element, I had that too. Hope he gets the PSMA scan very soon.


 

Ido4

User
Posted 11 Dec 2021 at 19:33

Just had results via nurse of PSMA on 28th Oct. No bone mets, phew, looks like 2 or 3 lymph node mets, in bladder/perineum areas. We're without an oncologist as ours retired & replacement decided not to accept at last min. Apparently oncologist from Exeter is reviewing the scan this week. Possibility of SABR if areas not previously treated with salvage radiotherapy. If not, back on hormone therapy.
PSA doubling time is 7 weeks, so we're thinking the cancer is quite aggressive, not sure if the intraductal element noticed at prostatectomy is relevant?
We welcome people's thoughts & advice, we're v concerned that the delays are resulting in the PSA to rise more - it must currently be about 4-5, & will be as high as 8-9 by the end of January. 
Thank you. 

Edited by member 11 Dec 2021 at 21:40  | Reason: Not specified

User
Posted 12 Dec 2021 at 07:47
You could try early Chemo as I have done
Please see my profile
User
Posted 12 Dec 2021 at 21:51

Thank you Barry. Wow you've had a rough time! We will research chemo & see what oncologist suggests. Thanks again x

 
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