Recurrent prostate cancer - spread?

[auntiejessi]

Hi there -

My father (72 years old) was just told yesterday that his cancer is back.

He was originally diagnosed with prostate cancer in July 04, underwent seed radiation starting in Sept 04.  Checked every 3 months for a year, then went to yearly.  Last Sept., his PSA was a negative (don't know the number), and now it is a 1.2.  (When he was diagnosed, it was never above a 3.2.)

His original biopsy showed 12 out of 15 samples were malignant, and his gleason was 9.  I don't remember the staging, but if it matters, I can easily find out.

His doctor is now saying there is a good chance it has spread.  They are doing a bone scan next week, and a CT scan the week after.  His prostate exam is normal, which is why they are thinking its spread, given the 1.2 on the PSA.

I'm not sure I understand all this - would the PSA be elevated if it has spread to nodes or bone?  

He says he hasn't had any signs or symptoms, but he's been experiencing more incontinence, and has "accidents" - he refuses to wear depends or similar things out of pride.  He wouldn't dream of telling me about impotence, so I don't know about that.

He also has Parkinson's, so its hard to know if aches and pains are from that, or if they might be related to cancer.  He started Sinemet for that maybe a month ago.

Any advice or ideas?

Thanks!!

[auntiejessi]

Thanks.

He has his CT scan on Thursday, and will have his bone scan this coming Thursday, and we'll get the results at an appt on Oct 3.  The waiting is terrible.

His doctor has mentioned the hormone treatments (lupron maybe?) and said that its a must, and probably chemo, depending on metastases.  

His Parkinson's was just evaluated a month or so ago, when he started the Sinemet.  It had been getting worse, but the sinemet seems to be helping.

Thanks again for your answers.

Jess

[HeinrikMD]

Hi,

The PSA would rise if there is recurrent disease in the prostate site or in the metastatatic site. The search for the metastasis is a reasonable thing to do, because if the recurrence is only in the prostate itself, it could be possible to perform another procedure such as a salvage surgery, which may confer better outcomes than medications alone.

If the other symptoms of Parkinson’s do not seem to be worsening, then the re-evaluation of the prostate becomes more important. Perhaps you could consult his neurologist about this question as well.

Stay positive.