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Prostate Cancer

Increasing PSA Levels for a Prostate Cancer Survivor

01/24/2008

Question:

My husband is a Prostate Cancer survisor, it has been 3 years now since he had a PSA of 64 and a Gleason score of 9. He underwent hormone therapy and radiation sucessfully. His PSA is now elevating slightly. The last one was .5, but the doctor said it was doubling each 3 months. He would start hormones again if it went to 2.0. I know we cannot "look into the future" but what are the survival rates for this type of diagnosis? He is otherwise healthy, exercises and eats healthy. Thanks for any insight you may have.

Answer:

Prostate cancer generally responds to hormone therapy and locally advanced prostate cancer treated with radiation therapy plus hormone therapy may offer an improved cure rate compared to radiation therapy alone. However, based upon your letter, it seems that your husband underwent radiation and then the hormone therapy was discontinued. Now the PSA is relatively low but increasing and there are many treatment schedules that might fit his situation.

Delaying hormone therapy reduces the complications from the hormone while not shortening the survival time. Intermittent hormone therapy may also be used. If the PSA continues to increase, then a ProstaScint scan my help identify the location of residual prostate cancer. If the recurrence is local (ie. in the prostate), cryotherapy may offer another treatment option to treat any prostate cancer in the prostate. Surgery on the prostate after radiation is complicated and generally not advised.

Survival times are somewhat unpredictable and would be assessed based upon your husband's response to hormone intervention. If hormone therapy does not reduce PSA, other treatment protocols are available in clinical research trials.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati