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I'm reaching out to this forum for a friend who's husband has been diagnosed with prostate cancer. I'm a 14 year breast cancer survivor myself, and a board like this was a tremendous help to me when I was going through treatment. My friend isn't up to it herself, but I want to post on her behalf.
After prostatectomy, her husband's psa did not go down. I'm not sure where it was at initially. He has had radiation, and it has gone from 5.0 down to 2.1. He had a gleason score of 8, stage III as cancer had spread to the seminal vesicle only. He had no lymph node involvment; CT scan etc. for distant mets and there are none.
I've looked on lots of sites and am having a hard time finding out what psa 2.1 after treatment might mean. Their oncologist has them terrified as he has said its now not curable, so they feel that his death is imminent. I've told her that they rarely use the term "cured". Cancer usually turns out to be something that is chronic that we manage as best we can.
Any input would be so helpful! Her husband is 60 years old.
He should go to a prostate cancer centre if he isn't already going to one. The standard protocol for his case will be hormone treatment but a prostate cancer center might also try docetaxel. The response to hormone treatment is a good indicator as to how long he will live. If the PSA goes down below 1.0 and stays down for a year or so then he probably won't die from prostate cancer. This is assuming a few more good drugs and treatments come out over the next 5 years as have over the last five years.
It is important for him to be very fit, keep his weight at the high end of normal, eat a heart healthy diet and join a support group.
I had the same type of urologist to begin with and then I switched to a prostate cancer center and their attitude was more positive.
I started out with a similar situation and I now have an undetectable PSA seven years later after a prostatectomy, hormone and radiation treatment; but not cured.
Thank you! I just found out that he has been having radiation, and one hormone injection. His PSA had been 5.0, now dropped to 2.1. That would seem to indicate that the treatment is working. I'll make sure he's going to a prostate cancer specialist!
Jean; - You didn't say how long ago he had radiation. Radiation is not going to drop the PSA right away like surgery would but takes time as cancer cells die off and fail to reproduce. Also radiation does not destroy healthy prostate cells so he will get a PSA from healthy prostate cells that remain after radiation. Don't panic but yes, be aware that cancer is not curable but manageable is a better description. Hope that helps. Jon.
Your friend's husband should try to get any and all treatments available. You don't have to tell your friend this again (since the oncologist already has) but the rapidly rising PSA after a prostatectomy is a very bad sign and seldom seen. The hormone treatment will drive the PSA down but probably not for very long in his case.
He should try and get a DNA test in case he has a genetic issue causing the cancer, which is a 20% chance in these aggressive cancer cases. There might be a few drugs to try and attack the cancer that way.
There are also many new drugs available to treat the cancer after the initial hormone treatment fails. Staying as healthy as one can is the way to stay alive so your body can take the next drug when the last one fails.
WOW, that's discouraging, but I was afraid of that. In my own experience the oncologists are very negative, sometimes needlessly so. Seems here like the onc is right on. I'll encourage them to get him healthy; he is fairly overweight, but working on that. Thanks for the info.
Jean; - Yes, I agree with Frank that the numbers are not good. Didn't understand here that he had a surgery first. One always hopes that sort of PSA spike is from some other source - and anything is possible but the odds don't sound good. His Gleason score would be helpful in determining the seriousness also. Seems like anything over 7 is quite serious, not meaning to understate the seriousness of 7 and below but 8's and 9's are not good. Jon.
It's too bad his doc didn't inform him of the new molecular scans like C-11 choline, c-11 acetate, or PSMA. This scan would detect prostate cancer anywhere in his body. The radiation oncologist could then radiate any lesion that that was detected with this scan. He still may be able to do this, so he might want to look into this option.
Jean, I just want to add that all the advice given above is spot on and to add the thought that I think I'm the only man on this site who started out with Gleason 9 and a PSA of 62.3 and I'm still going strong after nine years, fully expecting to double that. So there is always hope. That coupled with a positive attitude and keeping fit should enable you friend's husband to follow my example. I hope so.