Hoping for some information or answer to question please

[katie1971]

My Brother in Law just called to tell my husband and I that my Father in Law has a PSA of 10. He was diagnosed a few years ago and they figured the cancer would outlive him, he is 85 and in somewhat good health. Last year he was surgically castrated?? and his PSAs went down to less than 1. Now it is 10 and they will know more when they go back Thursday.

My husband says that when there is a significant change in PSA like that esp after castration it means that the cancer has mastisized?? Is this a correct assumption or are we putting ourselves through unnecessary fear.

I know that noone obviously diagnose him based on what I have written but any insight would be appreciated.

Thanks so much,

Katie

[IADT3since2000]

Hi Katie,

There is a solid possibility that the increase in PSA is due to continued production of testosterone by an indirect route involving the adrenal glands, rather than by metastasis. The adrenals produce a minor amount of testosterone in most men, typically 5% as I understand it, little enough that many doctors don't give it much thought. However, the body has a sensing mechanism that can ramp up testosterone via the adrenals when a shortage is sensed, and I've read that in some men it can be as high as 40%. That can wreck a hormone blockade program unless counteracted with a drug like flutamide or Casodex, known as antiandrogens, which block the androgen receptor socket so that testosterone can't continue to fuel the cancer (simplified version of what happens). Also, surprisingly, sometimes DHT (dihydrotestosterone) is not reduced much at all by the orchiectomy surgery, and DHT is far more potent at fueling the cancer than is testosterone. A drug like generic finasteride (formerly known as Proscar), or Avodart (both are 5-alpha reductase inhibitor drugs) blocks most of the conversion of any remaining testosterone into the far more potent DHT.

The doctors I follow would want testosterone and DHT measured by a blood test in your father-in-law's situation, possibly some other hormones too, and they would probably want to put your father-in-law on an antiandrogen and perhaps on finasteride or Avodart too and monitor what happens.

By the way, is he on a bisphosphonate drug, coupled with calcium and vitamin D3 supplementation, to protect bone density, and help reduce the risk of bone metastasis? That's important for a man with reduced testosterone, and many doctors still don't understand the risk. (That's one of the reasons I got a referral from my fine urologist team to a medical oncologist back in 2000.) In my layman's opinion, your father-in-law should have his bone mineral density tested, probably by a qCT (quantitative CT) scan instead of a DEXA, for reasons described in "A Primer on Prostate Cancer" - especially at his age), and he should probably also have his 25-hydroxy vitamin D level tested. (The Primer also is outstanding on other aspects of hormonal therapy.) If it turns out there are bone metastases, a more powerful bisphosphonate, Zometa, is often effective.

Keep your spirits up, and good luck to you and your family,

Jim

[mrpkpatel]

dexa scan is very imp -- jim i had that done after your post in feb08-- i am on fosamax with triple hormonal blockade-- psa staying .05