PSA levels after treatment

Hi Worrypants1 . The last time you posted you were waiting for the results of the final scans and a meeting with the medical team to see what treatment was going to be offered. Can you update your profile as it looks as if your husband has been offered hormone therapy but I am confused by your comment about 'second and final' injection especially if he is not having or had some form of radical treatment. The perineural, cribriform and Gleason 8 all put your husband at a higher risk which usually means a longer term of HT and as the PSA is still at 7.5, but reduced from 10 after a monthly injection, then I think he might be put onto Bicalutamide again for a couple of weeks to prevent the testosterone flare and then given the correct 3 monthly injection. From your last posts you thought that HT/RT was the preferred route so the consequences of the 'mistake' is that the radiotherapy part might be delayed as it is usual to shrink the cancer before being offered it and they usually want to see a PSA below 1. These mistakes do occasionally happen, as can a failure in the administration of the injection/implant. The positive to take from this is that your husbands form of prostate cancer does seem to be hormone sensitive. 

Let us know how you get on today and come back with any questions.

Hi Always hope,

My husband had radiotherapy which finished in August, which was combined with hormone treatment I e. Tablets before the radiotherapy, along with 2 hormone injections of 3 months doses, but, it came to light that his first dose given was only one months dose...which is why they did the blood test on Monday, found out Tuesday that the PSA isn't where it should be. The oncologist at the Christie had prescribed the dose, but, the nurse failed to follow the instructions, for reasons we don't know yet, there is an investigation currently to determine what went wrong. I am truly sorry for your husband's diagnosis and journey. Xx

Hello Worrypants1 

I am under The Christie and although I have completed my HT (I was on 6 monthly doses), the deal was I would request my GP to generate the prescription for HT, I would collect it from the chemist and take it with me to the GP's on injection day - I knew I was on the right dose as I could read the packet!! - It's called a "shared agreement". It worked well apart from me having to remind the GP to generate the prescription.

Best wishes - Brian.

Thank you Millibob,  we are just concerned about the potential impact on my husband's health, the specialist nurse at Christies was horrified, which is why she is speaking to the oncologist today ...cancer diagnosis is bad enough, without having to be subjected to avoidable stress. .. hope you're doing relatively well Brian.

Thank you again

Cx

*unavoidable stress  

That's good that he has had radiotherapy. Do you know if this was just to the prostate or was it to the whole pelvic area. The idea with the injections/implants is to give a more complete testosterone suppression whilst the radiotherapy is doing its job over the next 18+ months with the aim of having a better long term outcome. It is possible to have radiotherapy without hormone therapy and when the PSA is followed in this instance the drop in levels can be less dramatic. If your husband had his first injection in August or September and it was only for 1 month then it should be out of his system in about 2 months after having it so the drop in PSA you have seen is as a result of the radiotherapy.

Thank you again Always hope...yes, the radiotherapy without hormone treatment was discussed in a meeting with the oncologist before his treatment started, but, he said, it's not really an option in your case....just hope we hear something soon xx

I read your profile and this thread, and I can't work out what he had done, and when, and what his PSA profile has looked like during the process, which makes it difficult to comment. Was the second HT injection given? Did they check his PSA and Testosterone level before doing so? Did he have a second anti-flare course of Bicalutamide for the second HT injection? What's the timing of that 7.5 reading in relation to everything else.

Really need a timeline with treatments (including injections, PSA levels, Testosterone levels if they were measured, etc.

In the UK there is now a daily pill option: Orgovyx (Relugolix) but it only works well if your can be sure of taking it (the time for half of the drug to leave the body is 24 hrs).

It is new (to the UK) but does have a lot of favourable characteristics (better T suppression, reduced CVE risk, no T flare, faster T suppression (a few days) and recovery) if patient compliance is good. 

https://www.nice.org.uk/guidance/ta995/chapter/1-Recommendations 

I've been taking it for 7 months now and for me it is fantastic.

My urologist was against (too new), but both Oncologists I met were OK with it.  I was the first patient at my (quite large) hospital here in Belgium (approved Nov 2023) to take it.

I was a bit suspicious of the injections and how they last for so long and whether they were reliable (I didn't know how they worked at the time).
So I was happy to have the option of Orgovyx. 

From the NICE document:
"The list price for relugolix is £87.45 (excluding VAT; dictionary of medicines and devices, accessed August 2024) for a 30‑pack of 120‑mg tablets."

That's really cheap for one month (but I guess it is free on the NHS anyway), 170 Euro here (but free as well for everyone), $2300 in the US!