Question - PSA level without surgery..

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gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 1/7/2010 9:49 AM (GMT -6)   
Hi all, with regards to PSA level...
If you are stage 3 (seminal involvement), and thus do -not- have surgery to remove the prostate, and are put on hormone therapy......prior to radiation, what would you expect the PSA level to drop to?
If you don't have the prostate removed, you are still going to have PSA, yes?
I read a lot of folks here have undetectable PSA levels after treatment, but I assume that is only if the prostate was actually removed?

Thanks!

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 1/7/2010 11:48 AM (GMT -6)   
gibson00,
 
The hormone injections could very well take your psa down to undectectible both before and after radiation, up until the time that you stop the injections. That does NOT mean your cancer is gone. PCa, in its early stages feeds off testosterone. If the testosterone is reduced to castration levels, the PCa will go into sort of a remission. While I don't want to get too lenghthy here, eventually, at some point, the cancer cells learn to divide without testosterone and there is some thought (backed by evidence) that PCa cells actually begin to produce their OWN testosterone (there is a drug in trial that attacks the testosterone produced by the cancer cells themselves).
 
Going futher, after radiation and after you stop the injections, your psa may continue to be detectible. What you need to know is that it takes sometimes two years following radiation for psa to reach its nadir, so I would not immediately worry about the spike. You will need to work closely with your doctor to ensure that movements in psa are within expectations.
 
Forum Brothers...please add to this if I haven't hit everything or if I am incorrect.
 
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 212
   Posted 1/7/2010 12:40 PM (GMT -6)   
There was no spike, after a month+ of hormone therapy, the PSA went from about 10 to 2, and testosterone level dropped to just over 1.
I just wasn't sure if it was a problem that the PSA hasn't dropped even further.

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 1/7/2010 2:59 PM (GMT -6)   
The spike would come after you go off the hormones and the full affect of the radiation has not yet occurred.
 
As to the amount of time that it would take hormone ablation to lower the psa to zero or close to zero, I cannot say. Others here, who have been on hormone ablation, or your doctor, may have a better answer.
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Todd1963
Veteran Member


Date Joined Oct 2008
Total Posts : 3257
   Posted 1/7/2010 8:34 PM (GMT -6)   
Keep in mind that psa has about a 6 week half life
dx:06/03/06
Age at dx: 42 age now 45
Treated for sciatic nerve pain 6 months prior to dx.
Heavy amount of blood in urine Unable to urinate 
Lung x-ray for pnumonia revealed multiple lesions in each lung
P.S.A. at time of dx. 3216.14
Began lupron and casodex
Cat scan showed large mass in the pelvic area affecting the bladder multiple nodules in both lungs and lymph node envolvement.
Bone scan revealed possible bone involvment in the pelvic area
Biopsy 12 of 12 cores positive gleason 3+4=7
P.S.A.s since lupron 2946, 1274, 532, 5.01 1.23, .09
Begining jan 08 psa .o9, .25, .44, .86, .73, 1.34, 1.49. Doubling time is a little over 3 months
Cat Scan 12/12/08 Prostate normal size and shape. No tumors detected. Left lung clear of all nodules right lung showing only benign scar tissue. Lymph nodes normal
Bone Scan 12/24/08. Clean!!! went off casodex January 4 2009
Current psa 2/13/09 .16
Latest P.S.A. 0.05 newest P.S.A. undetectable


Hopeful in MD
Regular Member


Date Joined Apr 2009
Total Posts : 66
   Posted 1/7/2010 8:53 PM (GMT -6)   

Hi Gibson00,

My PSA went from 3.9 down to .5 in 4 mos after one Lupron shot (4 mos dose).  4 mos after 2nd shot, it was .7.  Just to give you an idea of MY experience.

Gene in Md


Age 70.
Dx Dec 07. PSA 8.4. DRE confirmed tumor. Three of six positive. Gleason: 6 (3+3). Seeds Iodine 125 Jan 08. PSA's 3.9, 1.7. Rising PSA's: 2.3, 3.4, 3.9, indicating  seeds not working.  April 09 began Lupron 30 MG ea. 4 mos.  Side effects hot flashes. Aug 09 - PSA 0.5!!!  Lupron working! Aug. 21 - 2nd Lupron shot.  Aug. 31 - began hyperbaric oxygen for rectal bleeding (radiation proctitis).  50 sessions as of Nov. 24 helped. 10 sessions saved in case they are needed later on.  Dec. 9, PSA 0.7.  Onco DRE negative. Says not to worry about 0.2 rise in PSA.  So far, so good. 3rd Lupron shot Dec. 23, 09.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/7/2010 10:55 PM (GMT -6)   
According to Strum if HT is working psa should drop to .05 in 3 months and remain there for at least 3 months. If it does not do this then it means you have a population of androgen independent cells. Radiation may kill these. But it HT alone is used it means that it will not work for a long time period as the androgen independent cells will continue to grow.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT

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