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Worried about PSA rise and options

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User
Posted 12 Feb 2022 at 14:13

Hi

I am 64 and was diagnosed in 2015 and had radiotherapy in 2016 followed by Zoladex injections. In 2020 had slight rise in PSA and had PET scan which showed tumour in a lymph node in left groin. This led to SABR and bicalutamide added. PSA came down to 0.15 last July but last week rose to 3.5. I’m now worried about where this leaves me and what options are left. Cheers.

User
Posted 12 Feb 2022 at 17:21
Unfortunately, you have not shown your diagnosis or progress under your bio but have put some info in threads that tend to become lost over time. Have you had a PSA test since July last year and the one last week and if so when was it and what was the result? Are you still having Zoladex and if not when was this discontinued? Have you had a urine test carried out which might account for increased PSA? Assuming rise in PSA is due to cancer spread, I suggest you seek meeting with your Oncologist asap and ask if a PSMA scan would be appropriate or at least an MRI scan. It may be that this identifies one or two remote spots of cancer that could be individually treated rather than treated systemically.
Barry
User
Posted 12 Feb 2022 at 17:30
Hi, no PSA tests between July and last week. I’m still on Zoladex, I’ve had no urine tests. I’m awaiting a call from the team on Monday. The weekend is a long time to sit worrying, hence my original post. Cheers
User
Posted 12 Feb 2022 at 18:08

OK. Rather surprised that there has not been a PSA test in the interim as this would have provided a useful reference point to help judge progress. I wouldn't rule out a urine test or another PSA test being done or a scan first and a way forward being determined after that but it depends on how your Oncologist, who has your detailed histology considers it. Not very long now before you know more. Do keep us informed.

Edited by member 13 Feb 2022 at 02:00  | Reason: simplification

Barry
User
Posted 12 Feb 2022 at 20:28

It may be that your cancer has learned how to survive without testosterone - this is known as being hormone refractory or castrate resistant. It is also possible that the cancer has started using the bicalutimide as food. Still lots of treatment options - the oncologist might begin by simply stopping the bicalutimide - the PSA might drop sharply. Next options include enzalutimide, abiraterone or chemotherapy but you will probably keep on having the Zoladex alongside. As Barry says, a scan to see where the active cells are would be very helpful

Edited by member 12 Feb 2022 at 23:06  | Reason: Not specified

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

User
Posted 12 Feb 2022 at 21:03
Thank you
User
Posted 22 Mar 2022 at 14:59

I have an update. My bone scan was clear but the CT showed a 14mm growth on a lymph node in my pelvic area. I was initially told I would start steroids but the consultant has decided to send me for another PET scan with a view to having another course of SABR if it is suitable. He also stopped my bicalutamide. A bit more waiting involved and a 110 mile round trip for the PET and again for each of the SABR sessions if they go ahead but I feel a lot better about it all now. Cheers. 

User
Posted 26 Apr 2022 at 12:32
The PET scan showed 3, possibly 4, lesions on lymph nodes in my lower abdomen. My consultant advises waiting another two months to see if stopping bicalutamide has an effect. He says SABR is unlikely now. Does this seem a reasonable course of action? Thanks
User
Posted 26 Apr 2022 at 13:11
Sometimes stopping a form of HT can produce a favourable response for a time but it may be your lesions are becoming too numerous to treat individually and I don't see stopping bicalutamide eradicating those lesions. You would need another Oncologist who is made fully aware of your case to give a professional opinion on whether the proposed way of dealing is best in his/her opinion but he/she may prefer a slightly different way forward. I don't think anybody here could say the present course is unreasonable.
Barry
User
Posted 26 Apr 2022 at 13:35
I'd certainly trust the opinion of your consultant over that of non medically-qualified people on an Internet forum! Perhaps speak to the PCUK nurses? They are extremely helpful and knowledgeable.

Best wishes,

Chris

 
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