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Old 07-09-2013, 05:56 PM   #1
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Question PSA down to 3.2 from 22.2 during hormone treatment

Followed a course of radiation therapy when I was diagnosed with prostate cancer with a PSA level of 14.6. my PSA had gone up to 22.2.

Now having completed three months of hormone treatment my PSA has come down from 22.2 to 3.2
Can I be sure that this is not just a glitch in the process and the PSA will increase at an accelerated rate within the next 3 months.

 
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Old 07-10-2013, 05:08 PM   #2
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hormone therapy will force your PSA down.
I'm unclear - did you have the hormone therapy before, during and following the radiation? Or are you saying that you began hormone therapy after radiation failed?

 
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Old 07-11-2013, 03:59 AM   #3
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi,

I had the hormone therapy treatment prior to and during the radiotherapy.
I stopped the hormone therapy for three months and then had my PSA results to see if the treatment had worked. The result was the reverse of what was expected. My PSA had gone up from 14.6 to 22.2.


I hope this answers you question.

Cheers ADDN

 
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Old 07-11-2013, 10:01 AM   #4
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Sorry to hear that, Addn. It sounds like the cancer has escaped the prostate, and the hormone therapy is keeping it in check. I assume they did a bone scan while your PSA was high and found nothing?

There are several advanced imaging techniques, available at certain specialty centers, that may allow you to locate the mets and radiate them IF the mets are not in general circulation. Otherwise, you can keep it under control with hormone therapy, hopefully for a long time.

- Allen

 
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Old 07-12-2013, 06:10 PM   #5
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi Allan,

Thank you for your information,
I do hope that it will be quite some time before the PSA levels start to rise again.
I have had MRI scans, Bone scans and CT scans, but they were unable to see any tumours. They said the cancer cells are so small that they are unable to locate them.

Regards Addn

 
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Old 07-12-2013, 06:20 PM   #6
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Re: PSA down to 3.2 from 22.2 during hormone treatment

There are other kinds of scans like C11 Acetate PET scans that have much lower detection limits. Sometimes the cancer is in 5 or fewer places (called oligometastatic disease) that can still be treated with SBRT. More often, it is micrometastatic and only hormone therapy can keep it in check.

 
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Old 07-13-2013, 02:02 AM   #7
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Addn

Your shared information does not make much sense without times/dates of the PSA tests in regards to the phases of the combo treatment, and in regards to the protocol of HT. Typically the combo starts with an antiandrogen plus agonist administered for a period of two to three months, before starting the radiation. HT then continues concomitant with the RT, followed by a adjuvant period that could last three years dependent on the chosen protocol. I believe that this was your case.

Nevertheless, some doctors (and patients) do HT with only an antiandrogen before and during RT (neoadjuvant + concomitant) which does not assure castration levels. The results are an increase of PSA due to inflammation of the gland which can last several months even if one continues with a similar adjuvant HT. In such condition some doctors prefer to administer, then, a different HT protocol as a precautionary approach (in case of high risk patients).

I do not know how far back was your RT done but the decrease in the PSA (22.2 to 3.2 ng/ml) could also be due to the effect of the previous RT added to the manoeuvrings of the hormonal manipulations.
In conclusion, I think that you can trust the result. However, if you still think that as a “glitch in the process”, you can repeat the test in a different trustful laboratory now or in one month time. You do not need to wait for the 3-month periodical.

Can you share more info on your PCa case?

Best wishes in your journey.
Baptista

 
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Old 07-13-2013, 03:29 AM   #8
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi Baptista,

Thanks for your response.

I was first diagnosed with PC in April last year. 2012.
Due to the extent of the cancer surgery was not an option.
In May I started on a 3 months 'Cassodex' hormone treatment as a pre requisite to radiotherapy. Radiotherapy was 38 doses and finished 14th December 2012.
During the radiotherapy I continued with the 'Cassodex' and at the end of the radiotherapy I ceased all treatment. In March 2013. following blood tests I met with the consultant to discuss the results of the treatment and it was at this meeting I was informed that the PSA levels had gone up considerably. I mediately I went back on to hormone treatment and after 3 month period (July 5th) the result of further blood tests revealed that the PSA levels had fallen.

I am extremely happy about this but the uncertainty regarding the duration of such results remain, is it weeks, months or years.

Kind Regard Addn

 
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Old 07-15-2013, 03:45 AM   #9
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Addn

I do not know about the “extent” of your case as you set it but I would think that your treatment is working well in regards to the treatment protocol. These results are not a “glitch”.
Casodex does not set you on castration and is considered by most as “light weight” in hormonal manoeuvrings to treat PCa. Surely some influence was accomplished in the overall outcome but I would think that Radiation is the “one” to applaud for the decrease as much as the cause in the increase post RT. Inflammation of the prostate gland (and urethra) is typical (in RT) and sort lived, before one enters in the period of truthful results.

Because you got still your prostate in place, you may again experience a bounce in the trend of the PSA results. An increasing and decreasing curve before settling into a nadir. Just give time a chance to get a proper conclusion.
In spite of the above I agree with Allen’s opinion above, for you to obtain an image study if the PSA does not go down further. However, for the moment we all should celebrate the decreasing PSA.

Regards.
Baptista

Last edited by Baptista; 07-15-2013 at 04:46 AM. Reason: spell

 
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Old 07-16-2013, 05:36 PM   #10
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi Baptista,

Thanks for your guidance and support on this subject.
I will do as you say and celebrate the positive results.
I have an appointment with the consultants in mid October and I hope that the results are as you described.

Many thanks
I will inform you of progress following the meeting.

Cheers Addn

 
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Old 07-16-2013, 05:38 PM   #11
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi Baptista,

Thanks for your guidance and support on this subject.
I will do as you say and celebrate the positive results.
I have an appointment with the consultants in mid October and I hope that the results are as you described.

Many thanks
I will inform you of progress following the meeting.

Cheers Addn

 
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Old 07-16-2013, 05:44 PM   #12
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi Allen,

Thanks for your advice and support.
I will raise the issue of C11 Acetate PET scans when I next meet with the consultant.
For the moment I will do as Baptista suggests and celebrate the decrease in PSA levels

Cheers Addn

 
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Old 07-17-2013, 02:51 AM   #13
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Addn

We PCa survivors learn to shake off anxiety. This does not mean we get "loosed".
I would recommend you to take the time until the next PSA test and research about the C11 PET/CT image study. This is a test most recommended to locate the cancer in case one needs to radiate it again.
We know that the test got limitation in detecting small size's tumours, being more reliable if one got PSA levels above 3.
I think that you do not need the test now but should follow suit in case you experience recurrence in the future.

Good luck to you.

B

 
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Old 10-18-2013, 04:41 PM   #14
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Re: PSA down to 3.2 from 22.2 during hormone treatment

Hi Baptista,

Its been some months since I last gave you an update of my condition.
I thought things were going well when my PSA went down to 3.2 but last week the result was even better when it had came down to 2.8.
I then had a meeting with the consultant who tempered my delight by telling me that he thought that the hormone therapy could only be expected to control the PSA levels for about 2 years. He said that he was shocked at the rate of increase in my PSA levels after the radio therapy and for this reason he was not confident that the hormone therapy would be able to contain the cancer much beyond 2 years.
I did ask about the "C11 Acetate PET scan", as a possible method of detecting the source for the PSA readings. He said that they don't have access to this type of scanner. If they did there is no way they could treat such small cancer cells with radio therapy. The out come of the meeting is that I will be closely monitored and I will have further meetings with the consultant at 6 monthly intervals.
I am determined that this is not going to stop me living my life to the full and have booked my usual walking holiday's for next year.
I feel fine and I really don't mined the hot flushes.


Thats all for now

Cheers Addn

 
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Old 10-19-2013, 02:43 AM   #15
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Re: PSA down to 3.2 from 22.2 during hormone treatment

I am glad to know about your lower PSA. I hope the trend continues and it reaches the zeros.

I do not know what kind of doctor is your consultant but by your words he seems not to be highly experienced in PCa matters or you have mistaken his comments.
Radiation can kill microscopic cancerous cells if they are located in proper fields for the radiation. Finding them is the difficult part in PCa therapies. The contrast agent C11 choline or acetate has been successfully used to detect small colonies of metastases giving patients a chance to cure.
PCa usually leaves the prostate gland travelling to the lymph nodes and from there to other parts of the body before becoming systemic.
This is a period when cancer is termed as oligometastatic. This refers to a fewer number of spots that can be radiated and "destroyed".

Traditional ways of MRI or CT scans manage to detect sizes of 1.5 mm but these become illusive with the traditional contrast agents.
The C11 methodology is not available everywhere so that one must research for the facilities closer to the place where one resides.

Surely this is not yet your case as proven by the last PSA results. I believe you will see still a drop in the next tests. RT may have given you a cure.

Enjoy and "walk" as much as you can.

 
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