psa raising after surgery

[cherylyb]

My husband had a radical robotic prostectomy in July 2009.December 2 he had his first PSA and it was 0.2. January 13 he had another PSA and it is now 0.3.He has no side affects from the surgery.The lymph nodes were clear and the prostate margins were clean. Where would this travel to now. What would be the best test to determine where the PSA levels are growing. His Gleason score was 6 which after the surgery was changed to 7. His PSA was 4.6. What is hormone therapy verses radiation?

[Ash Tewari, MD, M.Ch.]

Thank you for your question. PSA is not specific when the prostate is in the body but when taken out PSA values are largely reliable. This is due to the sensitivity of serum
PSA as a marker for prostate cancer, serial PSA measurements are routinely obtained to detect early disease recurrence in men who have had aggressive primary therapy for localized disease. Usually after prostatectomy we expect the PSA value to decrease to levels below 0.2 ng/mL. In the case of your husband, 0.2 was followed by a 0.3 which makes the possibility of residual disease high. In cases as such adjuvant therapy is recommended and consists classically of Radiation therapy (RT) to the prostate bed where the cancer is expected to be most often, and Androgen deprivation therapy (ADT). Classically PCa starts spreading locally (surrounding tissue: prostate bed and bone ) and through the blood to the lungs and liver.

Ash Tewari, MD

http://www.cornellroboticprostate.org

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[chris_w408]

Hi cherylb,

I am in a very similar situation as your husband. Diagnosed w PC in early "09 with a Gleason 9 and T3 (stage diagnosis following surgery). Radical prostatectomy done June '09 and biochemical failure w 0.7 PSA 90 days after surgery (sound familiar?).

I am in the process of having BOTH hormone therapy (6 mos of Lupron & Casodex) AND radiation therapy. Radiation began 30 days following start of hormone therapy at 180 units/day for 8 weeks by IMRT. This will be followed up 3 weeks after end of radiation with 6 mos of chemotherapy (part of a clinical trial).

Why have I opted for this protocol?

I have gotten opinions from several leading urologists and oncologists in my area and they all recommend the same thing: Don't wait, get after the cancer as aggressively as possible, as soon as possible.  

The fact that bone & body scans don’t show metastatic progression isn’t an “all clear” sign. The rapid biochemical failure with repeated PSA test confirmations means the PC remains.  

From everything I have found so far this puts us in the category of Advanced Prostate Cancer, Stage 3 which will progress to Stage 4.  All we can do is slow the progression (which is not yet a clear path for significant success) and we should use every tool we can.  

How long can we expect to live?   The data is highly variable and subject to much discussion depending on many factors including Gleason score, pre-surgical PSA, time to biochemical failure following surgery, surgical results (margins), presence of NPI, presence of seminal vessel invasion, PSA at time of detected biochemical failure, T2 vs T3, PSA doubling time after surgery, general health of the patient and likely other factors I don’t known about.

I am not a Doctor, however I have reviewed as much of the research literature as I can find.

In general it seems to me that the data suggests that hormone therapy (by itself) adds 3 months to longevity;

Radiation therapy (by itself) adds 3 mos of longevity.  

Hormone therapy plus Radiation therapy together adds 12+ months to average longevity.  

I suspect that many of these studies involved fairly advanced condition patients and that treatment of earlier stage patients (like your husband and me) may well produce improved outcomes over the studies averages.

I hope someone reading this post can add more information to the question of prognosis and outcomes for high grade Gleason patients presenting with rapid biochemical failure following RP.

In any event these protocols (hormone and radiation therapies) seem to now be the standard of care for AdvPC.  

In short:I’d see about getting both hormone and radiation therapies and consider entering a clinical trial if you are comfortable with the relative risks and potential rewards.

Best of luck.