What is the purpose of a PSA blood test if I am on hormone treatment?

Hi David

I'm not a HT expert and there are many people on here  that do know lots about the subject but in answer to your question as to why u still have to have a PSA test if HT is keeping it low, think it's because some HT can stop working as well as when u first start taking it so just to monitor in case the HT has to be changed at some point.

I see that u still have 2 years of HT, I presume that u had a high Gleeson or/and the cancer had escaped the gland ?

Best wishes

Steve

Hello David M  A warm welcome to the online Cancer Community.

I am so sorry to read of your issues - it's a sad state of affairs but the NHS is working - it's just overburdened, under staffed and under financed - so - you are on Hormone Therapy, you have had your Radiotherapy and Brachytherapy and are to continue on Hormone Therapy for another two years. You are also to continue PSA testing - now you have had your treatments this should be every 6 months.

Between them the Hormone Therapy, The Radiotherapy and the Brachytherapy will kill off the cancer cells.  You are being kept on Hormone Therapy to ensure the treatment has worked.

Your only treatment now is the Hormone Therapy and regular 6 monthly PSA tests.

Your PSA should drop to it's nadir (Lowest) reading 18 months after Radiotherapy ended. From this point your PSA should not rise by more than 2 whole points - if it does (and we all hope it doesn't ) then further intervention would be required. That is why you should now remain on lifelong testing.

I hope this explanation helps - anything else - just ask.

Best wishes - Brian.

Thanks for your reply. Sorry to be dense.

I was told that Zoladex stabilized the cancer (Stopped further growth). Can it also kill some of the cancer?

Would my reduced PSA be because some of the cancer was killed by the Zoladex or because the Zoladex reacts with the PSA.

In the worst case can my PSA levels rise while I still have an active Zoladex implant?

Thanks again

. 

Hello David - I wouldn't say you are dense - it's a treatment and you are given it with no explanation.

The Zoladex suppress your testosterone - which is the food for the Prostate Cancer so the cancer cells get killed off. The Radiotherapy and the Brachytherapy finally kill of any remaining cancer cells.

You stay on Hormone Therapy to wipe out anything that's been missed.

Your PSA is reduced because the combination of the three treatments has wiped out the cancer and it should now stay low., as per the last paragraph of my previous post.

I hope this help, if you need anything else, let me know.

Best wishes - Brian.

Hi David.

A very warm welcome. I have attached a link which explains that the Zoladex (also termed Androgen Deprivation Therapy) effectively puts the prostate cancer cells into hibernation and makes other treatments more effective by giving them time to work e.g. your Brachytherapy and radiotherapy will be working for up to 18 months. The length of time you stay on ADT is determined by the TNM and Gleason score/ grade of cancer. You need to have regular PSA tests to ensure that the cancer has been killed but it will also tell you if some cells have escaped your initial treatment, in which case further scans would be arranged to see where it has gone to so that additional targeted therapy could be given. MRI and CT scans would show how effective your treatment has been in the targeted area but if it is suspected that the cancer has metastasized then scans would be offered to the wider area along with a possible PSMA PET scan where a marker is injected which attaches specifically to prostate cancer cells to pinpoint exactly where the problem is. The criteria for further investigation would be either an increase of 2 above your nadir or if the rate of increase (doubling time) in a short period of time gives rise for concern. I doubt that the NHS would offer you regular scans to monitor how effective the radiotherapy/ Brachytherapy is working but if you are concerned then you may be able to get them done privately.

Please come back if you have any questions.

https://alliancecancercare.com/news/androgen-deprivation-therapy-what-is-it-and-when-is-it-used/#:~:text=It%20doesn't%20actually%20kill,ADT%20can%20have%20side%20effects.

David, I forgot to say that your PSA can increase even if you are still on Zoladex, hence the doubling time criteria. The cancer can become resistant to ADT treatment. If this happens then you will normally remain on the implant but the medical team would normally add in an antiandrogen which acts in a different way to reduce testosterone levels. The thing to stress is that there are now many ways of treating prostate cancer if the first line of treatment isn't completely effective.

Thank you all for your excellent and patient help. Much appreciated. I understand it much better now.

I think my care team may have actually given me the answers but for some reason I could not get it to fit together. Maybe my pre-conceived expectations expecting there to be further scans got in the way.