Last year I was diagnosed with PC, Gleason's of 9, stage 2. I underwent External Beam Radiation Therapy (EBRT) and a bunch of Lupron shots, one year and a quarter's worth. All seemed very positive. PSA went from 80 to 0.9 and I thought we were on the road to recovery. I had had two negative biopsies prior to diagnosis with a PSA of 16 at the second, so somehow this developed without being caught - maybe. Anyway, it WAS caught and we zapped it.
Two PSAs this year were 1.something and then 0.9. The Lupron has not been repeated since February when I had the last 4-month shot. I am STILL having the occasional hot flash but it is much improved. The testosterone is clearly returning for which I am utterly delighted.
For two months last year I needed to self-cathetarize due to enlargement, this requirement passed a few months after I started EBRT, however I have found that there has been a reoccurence of urination difficulty and I have had to return to catheters on occasions; some days are fine and no catheter needed, some days I need two or three. The doctor says that this is a result of the enlarged prostate coupled with the results of EBRT. We are thinking TURP at this point.
Today my PSA is 3, so it has climbed from 0.9 to 3 over a three month period. My question is why? Is this a recurrence, a metastasization or something called PSA bounce. I have asked to see my Urologist as soon as possible as the nurse told me this is a typical occurrence and the usual response is more Lupron - oh please no! But if it must be then so it must. Yet PSA bounce says maybe not! Could the obvious enlargement have anything to do with this maybe as well?
Does anyone have any experience with this or know of any further data.
Thanks - Lawrence
Last edited by moderator2; 08-14-2008 at 03:56 PM.
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I suggest that you see a medical oncologist, rather than relying solely upon the advice of a urologist. Without knowing more, your numbers suggest a high likelihood of systemic disease -- that is, p ca that has spread beyond the prostate. Try to find an oncologist with particular expertise in prostate cancer.
Hi, the first biopsy was a 10-core and the second a 12. Both negative. There was evidence of stones but it did not look abnormal. Since the last PSA a month ago, when I was using a catheter and considering a TURP, things have markedly improved. I am very much improved and returning almost to pre-everything status. I have decided against any further surgery as it is clearly not warranted. Your comment medved though upsets me considerably as so far, all consultation seems positive. Do you disagree with the fact that the PSA rise is related to testosterone restoration? Testosterone was extremely low and only now is coming back to something approaching normal, although the equipment is still quite below previous dimensions. All indications are good this last month yet you think there is cause for concern?
I cannot say why your PSA is rising. However, with an initial diagnosis of Gleason 9 and PSA of 80, is there was a pretty good chance that the cancer penetrated beyond the prostate. Not a certainty, but a pretty good chance. [Have a look at the Partin tables -- one of the factors in the analysis is the staging at time of diagnosis -- you said "stage 2" - maybe you meant T2?]. The fact that your doc put you on Lupron suggests that he also thought there was at least a chance - and perhaps more than a chance - of systemic disease. I don't want to cause you unnecessary concern, and I am not saying that you have a recurrence or metastatic cancer. All I am saying is that if my initial diagnosis was Gleason 9 and psa 80 and after radiation treatment and Lupron my psa started to increase in some material way, I would not rely solely on the advice of a urologist but would instead consult with a medical oncologist -- and preferably one with substantial experience in prostate cancer.
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