Rising PSA after prostatectomy and late radiation cystis
Hello,
I am writing for my father (64), he has prostate cancer for more than 10 years now. His prostate was totally removed 15 years ago. After a couple of years later the cancer came back and he underwent radiation (cyberknife). 10 years later his PSA rose above 30, he had metastases in the lymph nodes and he got a light chemotherapy with Taxotere. He also had a high Gleason Score. For years he has been on hormone injections, currently he is on Leuprolin again. My suggestion is, that he became hormone resistant. Shortly after the chemo his PSA was at 0.03, four months later his PSA is again at 4.0 On the scan you can see only a small spot of the metastases in the lymph by the lungs left. Shortly after chemo he got a chronic cough for 3 months, since the cough started he can't hold his urine. Since then he has a urgeny and he has to go to the toilet every 10 minutes, although there is nothing in the bladder and emptying the bladder is difficult. His discomfort has been getting worse and worse. Yesterday in the ambulance it was determined that he has a bladder infection. this infection was not detected by the doctors for months!
My questions are
1) can a PSA rise due to the cystitis even if he no longer has a prostate?
2.) can late radiation cystis occur after 10 years of radiation? (maybe the taxotere treatment triggert the bladder?) or is it more likely that the symptoms are coming from the long undiagnosed cystitis? And if you have radiation cystis, what helped you?
3.) What experiences have you had with hormone resistance? What has helped you?
Thank you from the bottom of my heart!
Nicole
Nicole: I don't have any real answers to your questions since I am 13-years post prostatechtomy and my PSA numbers are starting to rise sharply and starting on female hormone therapy (monthly injections and daily tablets). Your issues do help me in what to look out for. I am about 20 years older than your father and functional.
Hi Nicole (
). I can't personally speak to your father's situation, but I can tell you that, while there can be some residual PSA following prostatectomy, a rising PSA after removal is overwhelmingly due to recurrent cancer. This article from the American Cancer Society goes into more detail and notes the need to speak to the doctor about the specific case: https://www.cancer.org/cancer/prostate-cancer/treating/psa-levels-after-treatment.html#:~:text=After%20surgery&text=Modern%20PSA%20blood%20tests%20can,aren't%20necessarily%20cancer%20cells. I can also tell you that radiation cystitis can occur up to 20 years after radiation (see: https://pubmed.ncbi.nlm.nih.gov/20212517/#:~:text=Acute%20radiation%20cystitis%20occurs%20during,20%20years%20after%20radiation%20therapy.) Again, only a doctor can determine if this may be your father's situation.
Finally, castration resistance is a real thing and potential issue. I also want to note that there are treatments for castration resistant prostate cancer. I want to share with you a search of our archive on the topic of castration resistance for you to peruse, if you like, at you convenience: https://prostatecancer.net/search?s=castration%20resistant. Some of this information may help inform further conversations with his doctors.
Your father is very fortunate to have you advocating on his behalf. Wishing both of you the best and please feel free to keep us posted and to ask additional questions. Richard (ProstateCancer.net Team)Hi Nicole, I have been through all the procedures possible with the exception of hormone therapy. As you know the study is very personal and emotional. One of my biggest issues was anxiety. I don't believe hormone therapy deals with the anxiety, as you are still living with the decease and continuing diagnosis. I chose an Orchietomy! Yes casteration! Read on don't leave now! There is a taboo there without question! I did a study on line and read some studies from Canada, UK and Australia. There is a movement that thinks Orchietomy is a better way! I agree with that! The procedue is outpatient and recovery is nothing compared to what I had already been through! My PSA went to .09 The doctor told me: "I think we are in a good place. I don't need to see you again unless you PSA increased drastically or you have blood in you urine! Done! Anxiety gone! My biggest culprit! Hope this is helpful!
Best wishes! Age 78Hi. I’m dealing with this as well. Had a prostectomy in 2020, was told two weeks later I had a positive margin ( from my prospective I think they named this wrong) and had a PSA done every three months. Was told back then that if the PSA went to 0.2 I was going to have to do Radiation and hormone treatment. After three non detectable PSAs, it went to .13. The Oncologist and Urologist both agreed the PSA was rising aggressively and I should start radiation. Following PSAs have been undetectable until this January when it was .6. Sent me for a PSMA Pet scan which didn’t find anything. 6 weeks after the January PSA, it’s at .9. Now I’m being told it’s not the PSA number that’s concerning but how long it takes to double, and will be back to having a PSA every three months and possibly a PSMA every year. Was told by the urologist that I may live with Prostrate cancer the way people live with high blood pressure or high cholesterol. I’m confused. It was always about the PSA number and now it’s not. Time for a second opinion. Sorry for the long reply but it’s the backstory and what I’m being told now that has me shaking my head.
Hi
. Your confusion and frustration are certainly understandable. I suspect that, being that the PSMA PET came back negative, your doctor is focusing on the doubling of the PSA as it is a pretty strong indicator of aggressiveness of any prostate cancer. The PSMA is generally effective at PSA levels above a 0.2 ng/ml, however, as noted in this article "There is a small chance of a missed diagnosis because a small percentage of prostate cancers do not express PSMA and cannot be detected by a PSMA PET scan:" https://jamanetwork.com/journals/jamaoncology/fullarticle/2797264#:~:text=PSMA%20PET%20scans%20are%20not,by%20a%20PSMA%20PET%20scan. Your doctor should be able to provide additional information. Of course, in a confusing situation like this, where even the doctors are not sure what is happening, a second opinion is certainly an option. I also want to note that there is research into finding prostate cancer that doesn't show up on the PSMA (see: https://www.hopkinsmedicine.org/news/articles/finding-metastatic-prostate-cancer-that-doesnt-make-psma). Hoping you can get some answers and peace of mind soon. Please feel free to keep us posted on how things are going. Best, Richard (ProstateCancer.net Team)
