Rising PSA after Proton Therapy

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sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted Today 5:42 AM (GMT -7)   
A friend of mine had proton therapy for PCa about a year ogo...in that time, his PSA has risen from .7 to over 1.   He went back to his urologist and asked about further treatment, including hormone therapy.   His doctor warned him not to go on hormone therapy, that it could cause heart problemns, unbearable hot flashes, and give him a PERMANENT loss of libido even if he were on it a short period of time.
 
Not sure where the doc is coming from --- I assured him my experience with HT was not permanent.  It did raise the question, what ARE the salvage treatment options from proton therapy?   He's going in to get more imaging to see if there is traceable residual disease.
 
Don't know any other of his stats.....any thoughts?
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
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
PSA as of November 25, 2008 undetectable


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted Today 6:05 AM (GMT -7)   

First of all get copies of those tests in hand, secondly go get another psa test and confirm numbers, too. Verify all you can is always a good thing. Next if failed therapy which it looks like it is on those prior psa tests, then:

Maybe he can or cannot go onto various therapies, but the uro-docs are not the ones whom know of off all the possible drugs that are useful and how to administer them. Tell your friend look for PCa oncologist specialists which will be able to give him the total truth on that front, sorry to say most uro-docs are limited in their knowledge of hormone therapy options and other drugs, they are not focused on such and were not trained on such, they might be somewhat knowledgable....but wrong expert for failed patients to be seeing, not my opinion but from books, and oncologist world, and patients results.

S.w.a.g. there are probably 100's+ of drug combo protocols possible, onco docs have used alot of them on different types of patients. See why uro-doc might not have that edge?? Of course the other option is doing nothing, including don't bother to see the old uro-doc too, he has nothing to add at this juncture. Other option is experiment on your own with herbs, etc., people have a right to do what they want, does not look like that stuff can do much...but some claims are made...perhaps a patient has to try in order to find out for themselves.

(I did heavy duty radiations and(hormone drugs) ADT3 and DES...drug protocols and without any complications, but I am healthy and started at age 51 back in 2002) still getting good results too.


 

Post Edited (zufus) : 2/21/2009 11:49:54 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted Today 6:22 AM (GMT -7)   
zufas, why don't you post your own stats right here on a regular basis? You give a lot of off-beat advice, treatment possibilities way outside the box, etc, and this is good, because it widens the arena of choices with people and their PC. But I think others, myself included, would feel more comfortable if they saw your own case, and how its affected you, and if any of these other methods are really helping or not. Just somethingto think about.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted Today 7:09 AM (GMT -7)   

Hello Sterd82,

My treatment and stats are in my signature. I am on HT and the side effects are mostly just a nuisance. ED is no fun but then I am single and not involved with anyone so it has not been a problem. The hot flashes just sort of come and go. I have had some weight gain and I admit it is hard to work off but it is coming off. As to the permanency of the ED my doctors tell me that function will return when the HT is stopped. In my case that is a 50/50 chance since I had radiation treatment. If not, no big deal. Sex lasts for about 60 minutes, four times a week ( my nose is growing  smilewinkgrin  ) so it is only a small aspect of my existence. I am doing everything I did prior to diagnosis and treatment with that one exception.

Tell your friend to seek advice from a more knowledgeable physician. HT is a viable treatment. He can also look at cryotherapy as treatment. It is done as salvage in the case where the site of recurrence is confined to the prostate. Has some side effects to consider. There is a good website that explains cryo as salvage. Just google "cryo and salvage and prostate cancer".

Good luck to you and your friend.

Don


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and 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
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.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
 
 
 
 


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted Today 7:12 AM (GMT -7)   
Sterd, this is an interesting post. I dont have an answer, because my husband had the salvage surgery after radiation, which I would NEVER suggest...but now his psa is rising again, two years later. We are sort of in the same predicament. Pete does not want to do anything at this point... I would be interested hearing what others would also say....

Zufus. We are going to need some outside of the box opinions very soon.. Petes PSA has risen since August from .4 to the latesta this month at .7. Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted Today 7:43 AM (GMT -7)   
Sterd,
Like any form of radiation therapy there are salvage treatments. Surgery is unlikely, but it is still possible. More preferential is cryotherapy and HIFU. Of course if a local therapy can work. But first, your friend needs to probably just monitor this. PSA bounce is not uncommon and does not require action. He should watchfully wait and see if this is trending upward. (You don't mention if the 0.7 was a rise from something else)

And as Bob mentions there are systemic treatments as well. While these can come with some nasty SE's, they can indeed be temorary once they stop. And there are plenty of options in the combinations that can limit these SE's.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 2/21/2009 11:51:12 AM (GMT-7)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted Today 11:02 AM (GMT -7)   
With you Tony, on the check and verify and see another doc like an onco-doc or even others, in case his psa has anyother probabilities, I am less inclined to believe it is radiation bounce as when that happens the rise seems to be alot higher than seen herein, plus his rad-doc probably would have said so too(seen bounce numbers that were fairly significant from others, followed by declines...thus it turns out to be bounce and not a rising psa...scary for the radiation patient when they see it) and happens they say about 30% of patients and usually is a bit over a year since treatment and some weird cases has turned out to be 4-5yrs. down the road on the other end of the spectrum (talk about wild duration wait to see).

Now brother Purg./Davids question: my ( tongue  ) non-main stream treatments you speak of are just because you have not heard much about them, you don't know much about the world of the leading onco-docs: Vogelzang, Sartor, Myers, Scholz, Strum, Leibowitz, Tucker, Barken, Labrie and others.
They have used a multitude of drug protocols, including the the ones I am doing or have done. Labrie is the father of the type of "casodex" per se and has been with around for many decades, he was considered non-main stream when he introduced its useage(lucky for many patients options the 'junk' worked for them)....today....it is one of the most commonly precribed drugs for PCa treatments. Their is data, journal articles, abstracts on the majority of these drugs in the PCa if you wish to look for them, we have options.....and I guess alot of us whom are in the non-curative realm, we don't like the idea of being a doormat and dying with PCa if we have choices, it seems we have some choices that can atleast prolong that ending. Also, David if you can produce a number of patients whom started out with total urinary blockage and the high end stats I started with that are: 1) alive to talk about it 2) doing fairly well with low psa numbers 3) without signs of mets or pains 4) feel very well and normal, no fatigue etc. 5) all this 7 yrs. from the emergency room blockage gig. I would like to see or talk to those others and also see what paths did they take, were they the 'norm'. I am familar with some of the cases on yananow.net and there are not many, especially with the blockage thing. I have seen patients with less stats or way less stats than I have, whom died within 3-5 yrs. even with treatments and ADT therapies. Cannot prove anything perhaps and especially to skeptics, even the onco-docs have trouble on that one, they do have alot of patients coming to them even as references from other patients cause something worked better. One of the reasons I don't post all my history, it is not for every patient and might not be for hardly anyone, but it is a choice, the people with no future hope seen in PCa, when going down the road are looking for anything of value, life is valuable to us and so we try. Here is Bob's history aka-neutrondbob and zufus:

Dx-2002 Total Urinary blockage (most painful) drove to emergency asap, bPsa 46.6 DRE-felt something, ultrasound non-definitive but suspecious, on flowmax immediately and catheter on for about 7-12 days (before I cut it off-and flushed it), biopsies 12 of 12 all cancerous at 80-95% levels , Gleason scores given as found 7,8,9's two sets about the same exact numbers on both sides of gland.
Gland size was close to normal range (go figure), overal I was given Gleason 8 which is unique (was done by considered expert-Grignon). Treatment: ADT3 combo hormone therapy 5-6 months prior to unique radiation protocol of Neutron 10-sessions(Cyclotron) & Photon 20-sessions (IMRT) machines used, contd. ADT3 for 2 yrs., psa started very small rises on ADT3 over 8 months(8-increases,too)..like .4 to .55 to .78 etc., somewhere before 1.0 dropped the ADT3 and started DES 1 mg., cancelled all side effects from ADT3 quickly, psa dropped quickly and stayed low around .4-.5 ranges(stabilized) for 1.5 yrs.(which was not the case with ADT3 at this juncture), so I decided to quit and see if psa would shoot up fast or not (had to know what the dragon was), I get psa tests often walkin testing here is $15 so I can monitor often, psa got to 1.4 in Nov. 2008, resumed DES ,the last 4-5 psas in the last couple months all downward and now psa is between .36 and .39 range, might even do better, we shall see.


 

Post Edited (zufus) : 2/23/2009 7:56:15 AM (GMT-7)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted Today 1:48 PM (GMT -7)   
As has already been mentioned there is no point to a further local treatment unless it can be demonstrated with scans and the surgical record that there remains tissue in the local area and no mets. I have remaining prostate following surgery and salvage radiation. At this point we are monitoring with PSA and biopsy as required. Should this reamining tissue prove to be cancer at some point in the future and I am still with out distant disease I will undergo HIFU, I think it is less invaisive, more precise and has a better prospect of getting the tissue with fewer potential side effects compared to Cryo.
 
Good luck to your friend.  Scott


Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted Today 3:10 PM (GMT -7)   
now zufas, don't like people putting words in my mouth, i never said or infered anything nutty about what you say or produce here, if you read my verbage closely, still being complimentary. I am looking at some of these posts from the point of view that most of us are exposed to the typical treatments of surgery, radiation, seeds, hormones, etc. I think the learning of all options is important, and I have repeatedly said that in my posts. Lots of things I haven't heard of, sure lots of things you haven't heard about either. I still find your contributions important and interesting.

david
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted Today 4:05 PM (GMT -7)   
We walk different walks in PCa so no problem, everyone has contributions to this from every angle hopefully as we need it. (zufus would be more correct for spelling I elected the name for fun)

Hey protocols and weird drugs yeah- it does seem ( tongue ), especially to someone whom never heard of it....I thought it was more fiction than fact when I heard it run by me the first time.

(short version): Dx-2002 urinary blockage/emergency room, bPsa 46.6 12/12 biop. 80-90%, Gleasons 7,8,9's...clear ct and bone scan (no warranty papers given), ADT3+Rad+ADT3, off, DES, off, DES resumed psa today .36


 

Post Edited (zufus) : 2/23/2009 7:56:54 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted Today 4:16 PM (GMT -7)   
To get your choice of word off the table, again, I never said any of it was nutty.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 2/22/2009 7:01 PM (GMT -7)   
Thanks all...I'll pass along these thoughts to my friend....
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
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
PSA as of November 25, 2008 undetectable


KenW
Regular Member


Date Joined Mar 2007
Total Posts : 74
   Posted 2/22/2009 8:53 PM (GMT -7)   
Tell your Proton friend not to panic. Some patients never get below 1.0 and bounces are common. I would talk to my proton Doc. Many Urologist don't know anything about Proton Beam Treatment. I would watch the psa carefully, perhaps every 3 month for awhile to see if this is a bounce.
Diagnosed with a Gleason 4X3. Second opinion at Stanford came back as 3X4, 1 out of 7 samples, Left Side. DRE showed Normal. Before Biopsy Psa gradually crept to 10. Dropped to 6.4 with Alt. suppliments.
Proton Beam Therapy at Loma Linda 11-06. 1st PSA 4 Months 3.4, PSA at 8 Mo. 1.7. - 1 Yr. PSA 1.8 ( Different Lab ) 4 th PSA Slightly up at 2.19- Free PSA at .33 probably due to BPH. 1 year and 11 mo. Urologist discovered Scar Tissue in the uretha causing frequent urination with burning. Bladder not emptying completely.
Scheduled ( 12/17/07 ) to have the scar tissue sliced to open up the restriction. Good news is PSA is down to 1.14.
Urethrotomy performed. Flow much improved. No more burning.
PSA bump to 3.1. being checked at 3 months now.
New test result 9/29 dropped to 1.03.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4017
   Posted 2/23/2009 7:22 AM (GMT -7)   

Dear sterd82:

In answer to your specific question, the most likely salvage treatments are cryotherapy, HIFU and/or hormone treatment.  Salvage surgery is done by some but I would not personally recommend it.

However, as KenW stated, this is very possibly a common post-radiation phenomenon known as "PSA Bounce".  It occurs in many radiation patients and is not something to be concerned about.  Your friend's uro may or may not be familiar with this if the doc is not involved in radiation treatments for his patients.  I have a friend who had brachytherapy and experienced the "bounce" about a year after treatment.  He had moved and his new uro was so alarmed that he was referring him for salvage surgery.  My friend chose a new uro who had radiation experience, and the diagnosis was PSA bounce.  The PSA came back down and all is well.

The point being, please tell your friend to call the proton facility where he had treatment and speak to them about this as it may be natural and nothing to worry about.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 2/23/2009 7:51 AM (GMT -7)   
Tudpock,

Is there an easy layman's way to explain the bounce you refer to, I had heard of it before, but still struggling to understand the "how" part of it.

David
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/23/2009 7:59 AM (GMT -7)   
Sure: the bounce is considered a type of radiation induced prostatitis, I supposed if one wanted to try gleaning through alot of information about the how it works on radiations you might find the science behind such.  I do understand that radiation is not normally a direct kill to prostate cancer cells(takes time), but helps ruin their DNA so down the line they end up not reproducing at some point.  This is what I have come to understand on it.
 
 
(see Dr. Strum's info on PCa)


 

Post Edited (zufus) : 2/23/2009 8:13:20 AM (GMT-7)

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