Grateful for your help

User

Posted 26 May 2022 at 20:29

Hi. My husband (age 75) was diagnosed with advanced prostate cancer last June. Initial PSA was 75. Gleason 9. T3BN1M1.

He started with bicalutamide, followed by zoladex in July and in October commenced enzalutamide. He was doing well and PSA dropped to 0.6.

In November/ December he had a course of radiotherapy. 6 sessions of 6 Gy. It really knocked the stuffing out of him and his immunity was low leading to shingles in February, followed by a heavy cold and then labyrinthitis. Despite all of this he has continued an exercise regime of daily walks and twice weekly resistance work.

The lowest his PSA has been is 0.3. The last few results are 0.4 (March), 0.7 (April) and currently 1.0. His consultant says that although he would prefer his PSA to be lower, he is relatively happy with these results.

I feel anxious about the direction of these readings and so does OH although we try not to dwell on it. Wondering what others make of this and what you think should be our next course of action.

Grateful for your thoughts on this.

User

Posted 27 May 2022 at 20:53

Granite, looks like your post got missed, I can't help but sure someone can.

User

Posted 27 May 2022 at 22:12

Thanks for this Colwickchris. Not sure how the post got missed. It was probably "operator error" on my part. Anyway, looks like you've retrieved it for me.

User

Posted 28 May 2022 at 01:33

Does your husband's testosterone get measured when he has his PSA test? Do you know what his last couple of readings have been?

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

User

Posted 28 May 2022 at 05:56

Hi Lyn. Thanks for your reply.

As far as I'm aware, testosterone levels haven't been taken. Can you please outline the advantages of having these readings, or point me toward some literature explaining the importance?

User

Posted 28 May 2022 at 07:54

The purpose of the Zoladex is to stop the body producing testosterone. Measuring the level of testosterone in the blood shows whether or not the drug is working.

Best wishes,

Chris

User

Posted 28 May 2022 at 09:46

Yes, thanks Chris, that makes sense. I was assuming that the PSA was the marker of the effectiveness of the medication but I suppose infections can alter these readings. Is that what you're saying?

User

Posted 28 May 2022 at 10:24

PSA levels show how active PSA producing cells are, this will include the cancer cells and normal prostate cells. So it's an indicator of how well the treatment is working.

Testosterone stimulates PSA production (and growth) in cells that produce it. Zoladex suppresses testosterone production and hence removes the stimulation. For this reason it's important to ensure the zoladex is actually working. Measuring testosterone will demonstrate this. If it isn't other products may.

Illness can impact individual levels but won't impact a trend if their is one.

You are right to be concerned, make sure your oncologist addresses your issues, if you are not happy get a second opinion.

User

Posted 30 May 2022 at 16:59

Thanks for these insights. It helps when the mystery is taken out of things.

We have an appointment with the consultant next Thursday and can now have a more enlightened discussion.

User

Posted 30 May 2022 at 21:44

Testosterone is critical to working out why the HT isn't working. If he is below castrate level (0.69) but his PSA is rising, that means the cancer has become hormone independent.... it has learned to survive without testosterone so another treatment needs to be added. If the testosterone is above 0.69, the hormone isn't working efficiently so swapping to another hormone or adding bicalutimide should do the trick.

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

User

Posted 05 Jul 2022 at 21:17

We were hoping that our consultant would agree to swapping zoladex for a similar hormone treatment as recent testosterone levels have been 1.1 and 0.9. PSA continues to rise and is now 1.3 from 0.3 in Feb.

However, the consultant does not seem to be keen on this course of action. We then asked if bicalutamide could be added as you also suggested Lyn but this is not appropriate as OH is on enzalutamide.

So today OH had a CT scan to try to determine cause of PSA rise/?cancer spread. Apparently reporting is now taking 2-3 weeks due to the lack of staff and the upcoming holiday season. So the waiting continues.

Would welcome your views on this.

Thanks as always for your insight.

Edited by member 03 Sep 2022 at 12:18 | Reason: Not specified

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