Re: PSA jumped to 2.6 after Bi-Lateral Orchiectomy 2 years ago
Quote:
Originally Posted by neozion
Hi, All,
My father had Bi-Lateral Orchiectomy done about 2 years ago to fight his prostate cancer. Soon after the operation, his PSA was less than 0.2.
But a new lab he did last month showed his PSA has jumped to 2.6. Is this to be alarmed?
He is 78 yrs old and hates visiting his doctor.
Thanks a lot!
Neo
Surely the alarm is there. However the seriousness of this PSA jump depends on his cancer history and past diagnosis.
The increase indicates that cancer found newer ways to survive and that more control on its advancement is required. In similar cases it is common to block the action of the low but still existent testosterone in the body, taking an anti-androgen drug similar to Casodex. If his case needs still additional drugs for an improvement, I would suggest your father to have a check-up for other illnesses typical in patients at his age, because some of the drugs for the treatment of PCa interact with other medicines.
You will receive better replies to your post if you describe his previous diagnosis and status. Oncologists are still the better choice to consult about your father’s present PSA level and PCa problem.
Re: PSA jumped to 2.6 after Bi-Lateral Orchiectomy 2 years ago
neozion
It is concerning. What was his highest PSA? Did he have a biopsy? Has he had a bone scan? Has he had any treatment other than the Bi-Lateral Orchiectomy?
Bob
Re: PSA jumped to 2.6 after Bi-Lateral Orchiectomy 2 years ago
Thank you very much for both replies.
I got more accurate information about my father's PCa:
2006 - diagnosed PCa, PSA level: 26.
2006 - had 7 tissues examined, 4 confirmed having cancer
2006 - had bi-lateral ochiectomy done
2007 - PSA level: near 0, a year after surgery
2011 - PSA level: 2.6
Right now, he is on medication for 3 illnesses: diabetes, high blood pressure and constipation.
Re: PSA jumped to 2.6 after Bi-Lateral Orchiectomy 2 years ago
Quote:
Originally Posted by neozion
Thank you very much for both replies.
I got more accurate information about my father's PCa:
2006 - diagnosed PCa, PSA level: 26.
2006 - had 7 tissues examined, 4 confirmed having cancer
2006 - had bi-lateral ochiectomy done
2007 - PSA level: near 0, a year after surgery
2011 - PSA level: 2.6
Right now, he is on medication for 3 illnesses: diabetes, high blood pressure and constipation.
Any more comments?
Thanks a lot again.
Neo
From the info you share about your father’s past PCa history, it all indicates that he never attempted to cure. I presume that his doctor have not suggested treatments to “kill” the cancer because of his age or for any other findings during diagnosis or still due to other illness interfering with such possibility.
You do not indicate his cancer’s aggressivity grade (Gleason) which is important in the decision of his next phase of treatment. However, the rise in PSA from 0 to 2.6 in 3 years is significant and your father should consult his oncologist the soonest.
He is in biochemical failure. Additional tests are required including image studies to have a proper diagnosis of his present case.
An infection could be also considered as a cause for the PSA. Nevertheless only through additional tests (DRE, PAP, etc.) can you know if he is in recurrence.
Hope for the best.
Baptista
The Following User Says Thank You to Baptista For This Useful Post: neozion (08-09-2011)
Re: PSA jumped to 2.6 after Bi-Lateral Orchiectomy 2 years ago
Hi neozion,
You have already had some useful replies. I'll add some thoughts in green. Welcome to the board!
(The published version of this post may show a string of asterisks where it should say f i n a s t e r i d e. I'm separating the letters so the software glitch does not substitute asterisks here too. There is no reason this drug name should be blocked per the Board's rules; it must be a glitch.
Quote:
Originally Posted by neozion
Thank you very much for both replies.
I got more accurate information about my father's PCa:
2006 - diagnosed PCa, PSA level: 26.
2006 - had 7 tissues examined, 4 confirmed having cancer
2006 - had bi-lateral ochiectomy done
2007 - PSA level: near 0, a year after surgery
2011 - PSA level: 2.6
Right now, he is on medication for 3 illnesses: diabetes, high blood pressure and constipation.
Any more comments?
Thanks a lot again.
Your father had single hormonal therapy (the orchiectomy) that eliminated the main, but not the only source of testosterone, which is the most prominent but secondary fuel for prostate cancer cells. Many men on such single therapy, which is often achieved with a drug instead of surgry, will do well for several years, but then experience a substantial downturn. In a major Japanese study of men with somewhat advanced cases on hormonal therapy (including orchiectomy), men on single therapy did fairly well for about four years, but many started failing after that, including death for a disturbing proportion of these men.
Your dad could still go for a cure, as has been pointed out, based on additional tests to make sure an attempt at cure would have a reasonable chance of success. On the other hand, adding a second and third level of hormonal therapy could also be effective in providing long-term control but not a cure. Baptista mentioned Casodex, now available less expensively as a generic known as bicalutamide. That drug goes a long way toward blocking any remaining testosterone (usually from the adrenal glands that are not affected by the orchiectomy) from docking with and fueling the prostate cancer cells. However, DHT (dihydrotestosterone - effectively a more potent refinement of testosterone) is able to muscle out the bicalutamide at the cell docking sites and still fuel the cancer. That's where the weakest drug - in the 5-alpha reductase inhibitor class (5-ARI) - comes in. They are not very strong on their own, but they go a long way toward stopping the conversion of testosterone to DHT, and you can see how that would make the bicalutamide much more effective. There are two drugs in the 5-ARI class. The oldest, Proscar, is now available generically as finasteride. The newer one, Avodart, is generically known as dutasteride but is not available as a generic. I have been on hormonal therapy intermittently as a sole therapy for a challenging case for 11 1/2 years now. I get Lupron shots for the testosterone, and I take bicalutamide and finasteride in support, plus a bone density medication (now Boniva) to keep up my bone density when I'm taking the Lupron. With that approach, I drove my PSA from 113.6 to <0.01 twice before going "off therapy" (maintaining during the interval with continued finasteride), and I drove my PSA down to 0.02 the third time. Many of us have had similar success with a three drug (or ochiectomy plus two drugs) approach.
However, these drugs have some side effects, and men on hormonal therapy fairly often find diabetes and blood pressure more challenging. I've done very well avoiding these issues myself, but they are unfortunately not uncommon for hormonal therapy patients. The chance of such side effects does not rule out adding the drugs, but it is a factor to consider. I believe the main impact is from the orchiectomy (or equivalent drug, the LHRH inhibitor) rather than from the bicalutamide or 5-ARI drug, so my layman's impression is that adding those drugs would not add much if anything to your dad's current problems.
About constipation - I'm facing that challenge myself at this time as I'm taking the drug thalidomide at a low dose (50 mg) to extend my "off therapy" vacation from the heavier duty drugs (Lupron and bicalutamide). Thalidomide tends to be constipating. I use several lifestyle tactics that clearly help. One is to get in some aerobic exercise. Running or fast walking probably work best, but even moderate walking will probably help. Another is to get some fiber in the diet; I do that with bran in cereal, and vegetables and fruits daily, including an apple. I also take a gram or two of vitamin C to help avoid constipation, but the dose is an individual thing, and too much can cause stomach distress. I also consume over 100 ounces of liquid daily (much of it green tea); however, increasing liquid may take some getting used to. I'm convinced that all of this helps. I'm not happy when I fall of this program.
I'll add a final point here. The fairly recent book "Beating Prostate Cancer: Hormonal Therapy & Diet," has great advice about using nutrition to help beat prostate cancer. It's by a leading medical oncologist, Dr. Charles "Snuffy" Myers, MD, who specializes in prostate cancer and who is surviving his own challenging case of prostate cancer. He is quite mindful of diabetes and blood pressure as important side issues.
I hope this helps, and good luck to you and your dad.
Jim
Last edited by IADT3since2000; 08-06-2011 at 03:08 PM.
The Following 2 Users Say Thank You to IADT3since2000 For This Useful Post: Baptista (08-06-2011), neozion (08-09-2011)
Re: PSA jumped to 2.6 after Bi-Lateral Orchiectomy 2 years ago
Thank you so much for the helpful replies!!! I will definitely be more aggressive with my father in terms of getting him back to the doctors. Thanks again!
