PSA rise

Posted by doverest @doverest, Jul 16, 2023

I'm 84 years old and had prostate surgery 17 years ago. No radiation or hormone treatment. Frequent PSA tests within normal range until last year when it bounced to 4 and three months ago when it reached 7. I took a PSMA scan and found no "mets" in bones or major organs--however, small traces in lymph nodes in neck. Other than this, I am in good physical condition and work out and travel frequently to Australia to visit family. My question is: do the side effects of hormone treatment (hot flashes, muscle loss, weight gain) out weigh the benefits. I ask this question because my father in law developed Prostate Cancer at 61yrs and did nothing and died at 95 with prostate cancer not from it! I need to make a decision soon, please help.

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hbp | @hbp | Jul 16, 2023

I had very little problem with ADT, mostly low energy. You are a little older than me but not by much. If I was in your situation I would give ADT and Androgen inhibitor ( ie Erleada ) a try and see what side effects you have. If you find that it is not worth it, then act accordingly. Good Luck young man!!

edmond1971 | @edmond1971 | Jul 16, 2023

Congratulations on 17 year survivor! While the information and experience of you father-in-law is interesting and could be taken into consideration, just know that his genetics isn't yours, so I would discount that scenario. My grandfather caught his prostate cancer late when he was 69 and died 7 months later.

Early detection equates to options, that is good rule of thumb. I would be curious to learn the Gleeson Score of the post surgery pathology, but in either case your PSA increases are a sign that the small traces in the neck are likely growing and will continue to grow, and the fear is that it spreads into your bones and/or organs. When/if that happens, you are dealing with a different scenario.

Side effects of ADT are something that I only know from experience and also online interactions, and I don't think anyone gets a free-pass to no-side-effects, but it does come in ranges. Your age is awesome (I had surgery at 41 and now in ADT for the past 9 months and I'm 52) so it is hard to relate to your scenario.

What if you went on ADT for a few months, the PSA dropped to undetectable levels, and you had average side effects, then you would know what is possible for you, as you can always stop it.

Definitely seek out more input, you will make the right decision and truly awesome that you are 84 and kicking it!

kujhawk1978 | @kujhawk1978 | Jul 17, 2023

hmm... When you have prostate surgery, PSa should be undetectable, amy increase after that above .2 is considered BCR and depending upon clinical data, GS, time to BCR, PSADT and PSAV, imaging results, co-morbidities and personal preferences - quality versus quantity of life, come into play,

Somewhat surprised when you say bounced from 4 to 7.1 that no imaging was done prior to that.

i expect you are consulting with a radiologist and oncologist.

I have no idea about whether radiation to the neck is a possibility, your radiologist should discuss that with you.

As to the ADT, if you and your oncologist determine it is something to do do, perhaps Orgovyx is an option, treat for six months, then see what the clinical data is, PSA, data if you decide to image again and decide whether to stop and monitor, or continue for another six months and assess...

I say Orgovyx because it has significant advantages over other ADT...

Faster castration
Higher sustained castration while on treatment
Lower CV side effect profile
Faster recovery of testosterone once stopped.

While the data of your father in law is interesting (my ex father in law lived to be a few days short of 100 after being diagnosed with PCa around age 90 but his PCa is not my PCa)

Kevin

cesar52 | @cesar52 | Jul 22, 2023

I had spread of my PC to lymph nodes twice. First time I had three lymph nodes in pelvic region. Got 39 sessions of Radiation and did pretty well. After 4 years with an undetectable PSA, cancer is back . A PSMA PET SCAN showed a small nodule in paraortic region. Got radiation again. But only 5 sessions now. Getting repeat PSA in August. Bottom line: you need treatment. For sure. Wish you the best.