Puzzling PSA increase

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My husband (Gleason 9, aggressive PC) was started on Abiraterone in Dec 22 after the Bicalutamide had stopped working.  His PSA immediately reduced and stayed around 0.9 until Jan this year, when it started to rise again.  Due to his review being cancelled in April he wasn’t changed to another HT and didn’t have another review until July, by which time his PSA had increased to 40.  His consultant changed the Prednisone to Dexamethasone and spoke about possibly changing the Prostap to Zoladex.  He also arranged for bone and CT scans, both of which were reported as clear with no spread. 

He had another review in August, by which time the PSA had risen to 61.  His consultant was mystified as, although the PSA has risen steeply, his testosterone level had reduced from 0.9 to 0.4.  He decided to leave him on Prostap and Dexamethasone for now but ordered a full MRI and another bone scan, as he’d since seen something on the previous one which could after all indicate a slight spread. 

Well, it’s rather worrying when a consultant doesn’t even know what’s going on!  We’re now awaiting his MRI result with some trepidation, while he’s awaiting his bone scan appointment in October.

  • Hi  , a worrying time waiting for results, hope all goes well.  Best wishes, David

  • Hello  

    I am so sorry to read of your husband's rising PSA. I would have said the cancer is resistant to the original hormone therapy but the PSA is still rising after a change - so like your Consultant I am at a loss to know what is going on.

    I wish you both well with the MRI and bone scan - can you please let us know how he gets on and what the answer is.

    Best wishes - Brian.

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  • Hi  - I’m sorry to hear this news, and I re-read your bio. Your husband’s battle is ongoing since 2008 and I note that, even when he was Gleason 6, his PSA was high at 12.  This makes these latest PSA readings less frightening, as he is obviously a high PSA patient whose cancer doesn’t easily show up on scans. Hopefully, they will find where the PSA is being generated and deal with it, and then PSA should reduce sharply again.  I wish you both the very best of luck with the ongoing prognosis.   AW

  • Thanks Brian.  It’s good to be able to come on here where people know what you’re talking about and share the same anxieties. 

    He has another oncology review next month so we’ll find out the result of the MRI scan then, and the next step.  Will post an update as and when.

  • Thanks Alpine Wanderer.  His last PSMA PET scan in Dec 22 showed a slight spread through the prostate and into a lymph node (as well as an unrelated lung cancer).  We understand that PET scans are more thorough than CT scans so have been feeling a bit less confident about the results of the latter, which didn’t show any further spread.  Apparently PET scans are very expensive so I suppose they have to keep them to a minimum.  Still, presumably the MRI should show up anything it missed. 

    Will post an update in due course.

  • I don’t understand why they haven’t gone for full pelvic radiotherapy. I had brachytherapy boost (Brachy plus radiotherapy to the whole pelvis), so surely they can now add the radiotherapy to his treatment pathway? When deciding whether to go for boost, I was told that the radiotherapy to the pelvis could be added at a later date - they just needed extra work to calculate the dose in the margins, so they didn’t exceed permitted exposure to too much radiation.   Maybe one question for your oncologist?    AW

  • There hasn’t been any mention of radiotherapy so far and my hubby assumed that he couldn’t have it, having already had the brachytherapy.  Must admit we’re rather in the dark with a lot of this so he just tends to go along with whatever the consultant says.  I suppose he’s waiting to see what the MRI shows to decide the next step.

  • Hi Chocaholic28, I'm so sorry to hear what a worrying time you and your husband are experiencing, I wish I was able to offer some advice as to the reason your husbands PSA is rising, I'm sure the MRI will give you the answer, 

    Eddie