Post-PC treatment: Rapid Rise in PSA

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glass guy
New Member


Date Joined Oct 2008
Total Posts : 18
   Posted 10/17/2008 9:40 PM (GMT -7)   
 
Have been online reading for two days now and have never found my situation.
 
Had proton treatment 2 years ago, gleason 7 (3+4) with PSA pretreatment at 13.5.
 
Since treatment PSA's have always been below 1: .01, .2, .7
Last April, negative DRE with .7 PSA.
Just had negative DRE but PSA came back 10.2.  Three days later repeated PSA and it came back 12.8.  I have no symptoms, either.
 
I keep reading about rapid rise in PSA but have never found one that was THAT rapid. 
Desparate for help in finding treatment sources, information, whatever.  Already have a CAT scan and Body scan scheduled for next week but don't know steps from there.
 
Anyone else ever encounter such a rise in 6 months?
 
Thanks.

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 10/18/2008 7:12 AM (GMT -7)   

Hi Guy,

I have not experienced such a rise but wanted to comment. Your PSA and Gleason were high prior to treatment and indicated some possibility of metastasis. You do not indicate whether or not you are on hormones or have had hormone therapy. I just completed radiation (IMRT) five weeks ago but I am on hormones beginning eight weeks prior to radiation. My physician thought this the best option for my pretreatment situation which is very similar to yours. You may want to talk with your physician about starting if you have not done so already.

You do not indicate if you had any IMRT to the pelvic area. I do not know if this can be done after a full course of proton beam but I believe it is done in conjunction with proton when local spread is suspected. There are some on this site who have had this done and can comment better than I.

I have investigated cryo ablation as a salvage course should it be required. There is a physician in Hilton Head, SC (Dr Scionti) who spent several hours and email exchanges with me prior to my treatment discussing pros and cons for cryo both as a primary and a salvage. If your PCa is back and organ confined this may be a potential treatment.

Guy, if you opt for hormones and have questions re side effects there are many here who can comment as well as myself.

Best of luck and sorry to hear that you are again having to deal with this disease. Do post again with an update.

Regards,

Don

 

 

 


Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/18/2008 8:28 AM (GMT -7)   
Sorry to hear about your PSA rise. The only somewhat similiar situation that I know of is "myman", but he had a RP and his PSA came back around 11 I believe. He had distant lymph nodes involved.
The good news is that he is on HT and his PSA is undetectable. His wife, is amazing and is always offering support and insight. I'm sure she would be willing to answer any questions. Keep us posted and stay strong!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/18/2008 8:31 AM (GMT -7)   
I have been here nearly two years and have only seen a couple guys who experienced sharp increases like yours and they were after surgery not PBRT. One gentleman had an 18 PSA in his first post op PSA, when his PSA wasn't close to being that high before surgery. You are likely headed to hormone therapy, and your scans will likely to tell the story. Like Don says, there are many guys who can share their experiences with HT. Good luck in the upcoming tests!

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


glass guy
New Member


Date Joined Oct 2008
Total Posts : 18
   Posted 10/18/2008 3:25 PM (GMT -7)   
thanks for answering.
 
more of my details.  i did have hormone therapy for a year.  had the shots.  and i had the full scale of proton 79.2 gy to the prostate and photon treatments, 45 gy to the pelvis.   there was perineural involvement and was assessed Stage T3b NX M0 = III.  i've read about an elevation of 2 - never an elevation of 10 or 12.  right after treatment my psa's were .01 and for as long as i was on hormone psa stayed .01.  about 4 months after last hormone shot effectiveness wore off i had a .02, then a .2, then the .7. 
 
tell me more about cryo and the guy in south carolina please, don.
 
thanks

Post Edited (glass guy) : 10/19/2008 12:48:51 PM (GMT-6)


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 10/18/2008 7:50 PM (GMT -7)   
Hi Guy,
Here is the contact information I have for Dr Scionti. You will most likely talk to a staff person first. I think the person I spoke to was named Eric. You will see the Dr. S. also does HIFU. I looked at that as well. I do not know where you are geographically but I believe there are other cryo centers around the country. Dr. S. was quite informative and spent some time with me on the phone.

Give him a call it won't hurt and may help. Good luck.

Best regards,
Don

Stephen M Scionti, MD
The International Prostate Cancer Center
Director: Minimally Invasive Prostate Cancer Program
Specializing in HIFU and Cryotherapy

www.hifucarecenter.com
www.cryocarecenter.com

843-342-7607 (office)
843-342-7640 ( FAX )
843-338-6615 (cell)
Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


debib
Regular Member


Date Joined Jun 2007
Total Posts : 35
   Posted 10/21/2008 7:45 AM (GMT -7)   
We are in the same boat wanted to mention that our oncologist tells us to schedule bone scan and he will start chemo when pain is bad!!?? ***? Urologist wants all Ron's care to be handled by oncologist...I am frustrated and can't help think if it were him or his father would he say the same thing? Do we start a new search for cutting edge treatment? Ron never did qualify for trials because he had a gleason score of 9, I will keep you in my thoughts and prayers !!
Deb
Age at DX 56 Good Health went for routine physical
PSA 49!
6/06 Biopsy Gleason 5+4=9
12 samples all positive
7/06 lymph node biopsy-3 samples all positve
Told surgery was not an option
8/06 started Zolodex and Cassodex
9/06 PSA 2.2
12/06 PSA 3.8
3/07 PSA 0.78
6/07 PSA 0.23
09/07 PSA 0.12
01/08 PSA 0.28
03/08 PSA 3.49
05/08 PSA 7.5
06/08 PSA 5.7
07/08 PSA 7.0
08/08 PSA 8.0
09/08 PSA 10.0
10/08 PSA 12.0 Stopped Cassodex


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 10/21/2008 10:19 AM (GMT -7)   

Deb,

Don't know where you're located, but there's a very good program (so I've been told) for advanced PCa at the University of Michigan Medical Center--- maybe you've already checked them out --- that would be my next stop if I were in your husband's shoes.  Just a thought.....


Sterd82
Age 47 - pre-surgery PSA 39
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
Next PSA November of 2008


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 10/21/2008 1:33 PM (GMT -7)   
Sterd / Glass

There are several names I could drop but someone else might well have a dozen more to add from someplace else (so many to choose from) so I'll just say, the University of Michigan Comprehensive Cancer Center (800-865-1125) is among the world's top shops. The entire Detroit area is one huge medical mecca. We may not have good Tigers and Lions but we have great medical facilities taking care of them every time they get whooped!

Seriously, there are some amazing cancer centers here. Karmanos, Henry Ford Medical Center, Beaumont, St. Joesph Mercy, to name a few. Even the famed Dr. Fred Lee (famous for his ultrasound techniques) is here (Providence or Crittenton I think). Glass, if you're near here, it's a choice. Hang in there. You'll find the right place for your care. It's often right out our back door.

swim
 


debib
Regular Member


Date Joined Jun 2007
Total Posts : 35
   Posted 10/21/2008 3:32 PM (GMT -7)   
Thank you for the info..we are located in TX and will contact them right away!! Thanks again!!
Age at DX 56 Good Health went for routine physical
PSA 49!
6/06 Biopsy Gleason 5+4=9
12 samples all positive
7/06 lymph node biopsy-3 samples all positve
Told surgery was not an option
8/06 started Zolodex and Cassodex
9/06 PSA 2.2
12/06 PSA 3.8
3/07 PSA 0.78
6/07 PSA 0.23
09/07 PSA 0.12
01/08 PSA 0.28
03/08 PSA 3.49
05/08 PSA 7.5
06/08 PSA 5.7
07/08 PSA 7.0
08/08 PSA 8.0
09/08 PSA 10.0
10/08 PSA 12.0 Stopped Cassodex


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 10/21/2008 3:42 PM (GMT -7)   
Hi Guy,

Me again. I found a website that is devoted to cryo and has a listing of doctors who perform the procedure by state. Dr Scionti is there as well he is a leader in the procedure and teachs it to other physicians. Here is the web address:

www.cryocarepca.org

There are some articles on the procedure at this site as well and a websearch will turn up studies on cryo used as salvage. I should note that it is effective when the reoccurrence is at the prostate which is the case in more than 50% of the reoccurrences according to my research.

Guy, I hope that this is helpful to you and wish you the best in determining a salvage procedure. Let us know how you are doing.

Regards,
Don
Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


glass guy
New Member


Date Joined Oct 2008
Total Posts : 18
   Posted 10/21/2008 6:47 PM (GMT -7)   

hi all

thanks for the support.  glass guy's wife here.

you know what is so disconcerting?  glass guy probably looks better and feels better than he has in a long time.  we thought he was coming along swimmingly - the extra weight and bloat from the lupron was gone, the indigestion was gone, everything working good.  heck, we even started having mexican food again.  and then the lousy psa.  then, all the gloom and doom i read just makes me want to cry and i didn't even cry the first time.  we just forged ahead and tackled the beast.

looking back, we should have acted when he got the .7 psa in april.  what did we know?  it was still below 1.  we both thought it was a rise and wondered about it but the dr. had no comment so what did we know?  maybe it was one of those kicks.

we are anxiously anticipating the scan results.  the pelvic cat scan is tomorrow and guy just had a berry smoothie barium drink.  the nuclear body/bone scan is friday and we do not get results until next week.  then we'll make our plans.  i told guy, what the heck we'll go bankrupt.  whatever it takes.  first time we packed up and went to california to loma linda.  whether we go to south carolina or michigan, we'll check out our options.  hey debbi, maybe our plans will cross!  don, thanks for the contact info.

glad to have the encouragement and sage advice of this group.

guy's better half :)


first psa ever 11/05 - 12.1, age 67
       what a dummy!  now a big advocate for early PSA's
gleason 7 (3&4)
Proton beam therapy - LLUMC -79.2 Gy to prostate
Photon - 45 Gy to pelvis
Lupron
Stage T3b NX M0
bilateral seminal vesicles and extracapsular extension
PSA's on Lupron - .02 range
off Lupron - .7 (4/08), now 12.8 (10/08)
testing currently (10/08)
researching salvage and options

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