Does PSA test really work, long term Zoladex harmful?

[Tommyt262]

My father has Prostate Cancer with gleason 9. PSA test show no sign of cancer, but after a biopsy, revealed gleason 9. Cancer spread to lymph nodes but not yet to bones. Traveled to Dr. Tewari but said it was beyond surgery. Did Radiation Theraphy two years ago and has been on Zoladex since. Follow up PSA test comes up no cancer. Father is feeling healthy.
Question 1: Because of previously tested for PSA test that did not revealed cancer, but only to find in Biopsy to reveal a gleason 9, would the PSA test now after radiation therapy really show that Prostate Cancer has gone or dormant ? What other test can be done to confirm the result of Radiation Thereapy?
Question 2: Father has been taking Zoladex injection for two years. Oncology doctor recommends, "he get off of Zoladex becuase the body might get use to the medication because it won't be as effective in the future. Also, getting off Zoladex can tell if Prostate Cancer is dormant and see if PSA level increases". Urologist believes, "in taking this injection indefinitely, as it is dangerous to get off due to cancer's likelyhood of returning". Which doctor is more correct? What is your oppinion?

Father is having ED as well as no sexual activities from Zoladex, but that's a small price to pay. Please advise. Thank you in advance.

[HeinrikMD]

Hi,

For question 1:
The PSA is used to detect relapsed disease. If it is rising, then it would mean the disease is returning. Of course other tests such as imaging tools like a bone scan would also tell if the disease has progressed. However, the PSA tends to catch the disease earlier before it even spreads to the bones. Hence, the doctor generally looks at the PSA and any symptoms which may be worth investigating.

For question 2:  
Unfortunately there is no clear answer for this. What is clear is that patients with lymph node involvement like your father do benefit from the Zoladex after the radiation. There is no clear benefit as to continuous treatment, nor consensus as to how long constitutes adequate therapy.
If you discontinue now, we already know that the benefit has been achieved (some patients only take the medications for 6 months after the radiation). If you choose to continue, the benefit is not very clear and the safety issue is  likewise unknown. For breast cancer patients, there are hormone therapies that last for 5 years, safety issues involve bone loss/fractures and lipids/heart disease. Of course it would be difficult to estimate how it will go for men - but the heart disease may be worse.

At this point you may have to make a value judgment. If you are the type to take on risks and unknowns, and he is doing well, you may consider continuing but with monitoring for adverse effects. If you are more conservative, you could consider discontinuation.

[Tommyt262]

Sincerely thank you very much for your time and information.
Definitely, it would be great to know that his cancer is dormant and stop the medication. But why would his Urologist tell him to continue indefinitely. Is it because he thinks cancer has spread into bones or it was a gleason 9?
Is there any other type of treatment if cancer comes back even with continued use of Zoladex?
Would it prolong life to stop hormone usage now, and start back up if any trace of PSA ever comes back?
Thank you again for your time and effort in answering our questions.

[HeinrikMD]

Hi,

Perhaps the urologist feels that the treatment is going really well, and withdrawal of the drugs must be responsible for it. However, it is really not possible to say whether it was the response to the radiation that is still working, or it is the hormones. As I mentioned before, this is a value judgement as there is no clear superior course of action.

There are secondary hormones and chemotherapy that can be used if Zoladex is no longer working.

Holding the hormones now or continuing it would not translate in a survival gain. Put another way, the survival at this point would not change whether you continue the hormones or not. Hence, the benefits are not clear. The risks/harm, of course may be hard to measure but they are believed to be increasing as there are cumulative effects of hormones particularly on bone and the cardiovascular system. Hence, in this situation, the risk-taker would continue treatment, the risk-adverse, would choose to discontinue treatment.

[tinter]

I was diagnosed with an advanced mestatic prostate cancer that had advanced into my hip bone, lympth nodes and top part of my femur 18 months ago.
I've had no operations (other than a Turp) as the cancer was considered to far advanced.
Originally the the Gleeson score was 7 and my PSA was 193.

After having had Zoladex implanted on a regular 3 month basis, my PSA count has been 0.1 for the last 9 months but the hot flushes have been killing me.

My urologist has referred me to an oncologist who claims like the previous forum poster to go off the Zoladex and have a break and monitor the PSA which not only gives the body a spell but doesn't let the cancer get use to the medication.
If it increases, then back on the implant.

Question....the urologist says it's like "letting the genie out of the bottle" and suggests to stay on the Zoladex 9tough out the flushes) seeing I've had such fantastic results but this thinking is totally adverse to what the cancer specialist has suggested.

Just who is right and understandably I don't know which way to jump.

Rob.

[Nateski]

I sometimes do not think these people (doctors) know what are talking about. I had T3 Prostate cancer. The doctor told me only two injections at first, then on my 2nd injection he wanted to give me two more which I told him no. He asked me why and I told him that the "hot sweats" bother me, I in-turn get angry! Especially when people ask me stupid questions about why I perspire, after telling them repeatedly why. All I want to know is when the effects will leave my body? I started my first injection in June, and my second  w/ "Radiation Therapy" in September 2007 after having a Radical Prostatemomy in January 2007. All I want to know is "WHEN" at least the sweating will cease. I was told if I am sweating this means the Zoladex is working.

[tinter]

G'day,
It certainly means that the Zoladex is active in your body and the hot sweats will not go away whilst ever you are on the 3 monthly implant like I am for the rest of my life.

It's one of those problems associated with medical science that keeps us alive by keeping the PSA level in check.

I had another PSA done only yesterday and again for the 4th lot of 3 months in succession, I'm at 0.1.
I'm off on Monday to get a further oncologist opinion from a different specialist to see what he reckons.

12 months ago I was put on a course of tablets called "Androcur" to minimise the effect of hot flushes but the side effects knocked me around big time.
I became unnaturally lethargic, developed slurred speech, had problem with typing skills and all in all felt **** whilst on it.

In the end I put up with it for awhile (the flushes did subside) but the cost to my general well being was too geat and I went off it.

My urologist has also told me that Androcur in its own right has been known to cause tumors on very rare occasions by itself so if I can suffer the hots, better to stay on it.

It's a perplexing predicament to be in we prostate cancer