My dad had prostate cancer 14 1/2 years ago, at which time his PSA was not indicative of any cancer at all. He was given radiation therapy (which later went on to cause leukemia, from which he has also recovered). He was give a prognosis of 8 years. There has been no sign of cancer since he completed treatment in 1995. But his PSA has continued to climb and has suddenly "shot up" to over 300. A bone scan was ordered and our doctor has told him there have been some "minor changes," which will be discussed later this week when he sees his specialist.
Is it really possible that after 14 1/2 years there could be a metastass? This seems so unlikely when he has even outlived the prognosis by nearly 6 years.
If there is metasteis -- is it treatable?
My father is 82 years old and in otherwise pretty decent health (except for all the damage caused by years and years of cancer drugs! which we do realize have saved his life.).
Thank you for your question. Two widely used definitions of biochemical failure following radiation therapy for prostate cancer are the ASTRO and Phoenix. The ASTRO states that biochemical failure occurs when 3 consecutive rises in the PSA after the post-treatment PSA nadir using the midpoint between the nadir and the first rise. The Phoenix definition of biochemical failure is the nadir PSA + 2.
Furthermore, a recent article in Nature Medicine (Nat Med 2009; 15: 559-65) suggests that metastatic disease can originate from a single precursor cell. Theoretically, if one precursor cell is left in the body after treatment, this could give way to metastatic disease several years down the road.
It is not clear whether or not your father is on hormonal therapy from your initial question. After biochemical failure following radiation, patients often times begin anti-androgen therapy. Anti-androgens block testosterone receptors in the prostate cells. Normally, testosterone would bind with these receptors and fuel the growth of prostate cancer cells. There are further treatment options available, such as combination hormonal therapy and chemotherapy agents.
These questions should be discussed with a medical oncologist with knowledge of your particular case.
Ashutosh (Ash) K. Tewari, MD
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