Rising PSA

My husband is 56.  He had an RP in January of 2010 at NYU.  Pre-op PSA was 51.9.  Biopsy, 12 cores positive, gleason 8.  Three months after surgery, PSA 0.35.  Six weeks later PSA 33.5.  1st Lupron injection coupled with oral Casodex in May 2010.  Three month PSA immeasureable.  PSA results every three months as follows: Jan.2011 - 0.12, April 2011 - 0.30, July 2011 - 5.35, January 14, 2012 - 6.20.  He only had the one Lupron injection because the side effects were so bad.  He has been on no treatment since then.  He is going for a bone scan on Wednesday.  Looking for your advice.  Do you think a PSA of 6.20 is of concern at this point.  We know its distant, but will a bone scan show anything yet?  Thank you.  Kim

[S. Kaul, MD]

Hey Kim!

Though I would not usually consider a level of 6.2 ng/ml a matter of concern, it is the fluctuating levels and the velocity that gives me a bit of uneasiness. I would suggest getting this evaluated by a urologist to consider regrowth/ secondaries (A bone scan may show secondaries) and for appropriate management.
Hope this is helpful.

Take care!

[klrose]

Thank you for your time and your comment.  
He is going for a bone scan today.  
I understand the concern over fluctuating levels and doubling time, but what do you mean by velocity?
thanks again for your time.  This is such a mystery cancer.  No one seems to know what to do about it.  Every case is so individual and there just doesn't seem to be any answers out there.  Very frustrating.  
thanks again.
Kim

[curmudgen]

With PSA testing velocity refers to the rate that  the readings increase..  

especially from april '11 to july 11  from- .3 to  5.35  in less than 6 months.

[klrose]

Thanks for your reply.  I know, i'm concerned about the increase also.  My husband did have a bone scan yesterday and all is clear. So is a "wait and watch" approach ok at this point?   I'm inclined to go back to see an oncologist.  I know the only option out there for him right now is to go back on hormone therapy.  He wants to hold off on doing that because his thoughts are that the longer he holds off on going back on it, he won't become hormone resistant and will be able to use it down the road, should his PSA keep rising dramatically.  He knows once he becomes hormone resistant, there is nothing else for him. Any advice?

[curmudgen]

Good news on the bone scan -

My only advice, and I am practicing what I preach, is to get as much information as you can ... there is a good book - "The Invasion of the Prostate Snatchers and....."  written by an oncologist and a person with PC - discusses pros and cons from step one on....  one never knows what to do -

retest every 6 months and watch those numbers....  search " PSA velocity " to get more information....  good luck

[normanbk]

My query would be what about where the prostate used to be? That is also a popular place for where the cancer can recur. If that is the case I would ask why not zap it with radiation therapy?