Prostate Cancer & Psa Levels

[Barquentine]

Father-in-law has prostate cancer.
23 Jan: PSA was 312
10 Mar: PSA fell to 128
24 Mar: started Enzalutamide tablets
12 May: PSA had remained low (130) for 2 months from 10 March.
3 June: FIL had a bad fall walking along pavement outside with my wife.
3 July: One month later his PSA had risen to 210.
9 July: PSA 244.
Can a shock to the body such as a fall trigger a rise in PSA? Either the Enzalutamide is not working and the 12/5(130); 3/7(210); 9/7(244) represents a trend - OR - this is a temporary rise in PSA caused by the fall and 2 readings close together in July should not be interpreted as a trend?
Consultant oncologist's opinion is that this is a trend and the Enzalutamide is not working and wants to try chemotherapy on FIL. We did not get a chance to put above theory to her.
Grateful for anyone's experience/knowledge about the effect of a shock to the system on cancer cells generally or PSA levels n particular. Many thanks.

[Sqad]

Let me try and make this simple.
A rising PSA is bad news and would suggest that the cancer is not responding to treatment.
I understand that you may well be .looking for more simplistic and less sinister causes, but you have my opinion above.
I agree with your Oncologist.

[Buenchico]

I'm certainly no expert but I've got prostate cancer so, understandably I think, I've been genning up on PSA levels quite a lot recently and, as I see it, the bad fall and the rise in PSA levels are entirely coincidental. I've also just done quite a bit of googling to see if there are any websites that suggest that a physical injury (other than to the prostate itself) can cause such a rise and I can't find anything relevant.

My own PSA level started high (although I was never given a precise figure) and the consultant seemed pleased when, after just two sessions of chemotherapy (together with ongoing hormone therapy) it had got down to 35. The last blood test result I had was from just before my sixth chemo session, when my PSA level was 12. I'm assuming that the blood test I had yesterday (before my seventh session of chemo tomorrow) will have shown a lower level still, so the combination of chemotherapy and hormone therapy definitely seems to be working for me. (A man's PSA level should ideally be under 2 in his younger years and not much over it it in later life).

In your FIL's position, I'd trust the consultant and go ahead with the chemotherapy. The actual sessions are a complete doddle, where you simply enjoy the free coffee and read a magazine (or whatever else you like to do for around three hours). The side effects aren't too bad either and most people quickly learn how to cope with them. I was given the chance to pull out of the programme after six sessions but I've decided to follow the consultant's advice and push on up to a maximum of ten as, up until now at least, I've coped well with the side effects. (I'll probably have some radiotherapy after that too though).

[Mamyalynne]

Searching for theories is human, it's what we all do.

Buenchico's reply is perfect - now you and he have to be practical,take the treatment offered.

[Barquentine]

Thanks very much Buenchico - and am very glad chemo is working for you and thanks for the reassurance about chemo. We will definitely go for that if they assess FIL as fit enough, He is 84 so not sure yet he will get it but they are doing the tests. I'm afraid I do always question everything even when the experts are giving their expert opinion. Hope your next session tomorrow goes well for you. Good news that all the side effects I've been reading about don't necessarily affect everyone.

[Barquentine]

Buenchico, I hope your latest chemo session went well yesterday. Do you mind if I ask what is the hormone therapy you are on at the same time as the chemo? The consultant only referred to two types of steroids when we had a telephone consultation with her - one the day before, during and after a chemo session and another that we think she said he has on an ongoing basis but the line was bad so we're not sure. She didn't mention any hormone therapy. Maybe since FIL is 84 he doesn't qualify for that.

[Peter Pedant]

// I agree with your Oncologist.//

I will make it even simpler - I think you should ask the oncologist what he wants to do as he has seen many more cases than we have ( together )

over the last 5 y - a big change in how 'we' view PSA and its ups and downs = this really is a case of "Doctor knows best" - and secondly - ask the FIL - if he wants a go then let him have it

[Peter Pedant]

Look - having had quintuple therapy for lymphoma ( unrelated to prostate) RG=CVP ( that is 5 isnt it) I wdnt have dreamt of saying
" I reckon double the steroids and no vinc is much better"

actually they halved the G ( gemcytabine) as it abolished my bone marrow - I just said yes

[Buenchico]

Hormone therapy seeks to reduce the amount of testosterone in a man's body because prostate cancer usually needs testosterone to 'feed' it.

Conventionally it's given by regular injections (at three-weekly intervals in many cases) or sometimes by oral drugs. Occasonally the surgical removal of a man's testicles is used to ensure that no testosterone is produced.

However there was clinical trial running for about a decade where those who agreed to participate were randomly selected to either have three-weekly injections as normal or to have oestrogen patches stuck on their limbs instead. (The idea is that using oestrogen patches doesn't increase the risk of osteopirosis, as long term use of the injections can do).

I applied to go on the trial and, as I'd hoped, got selected to try the patches. (They're exactly the same patches that women use for HRT treatment). I started off with having two on each of my limbs but then, based upon satisfactory blood tests, I was told that I only needed to use three patches instead of four. I simply change them twice a week, on Tuesdays and Fridays. I've experienced no major side effects from them (although it would be hard to separate out any of their side effects from those produced by the chemotherapy) other than I appear to be growing breasts! My testosterone level though is a big, fat zero.

The last date for signing up for the trial (which only gave you a 50/50 chance of getting the patches anyway) was the 30th of April this year so, unless (based upon the trial results from people who started using them a decade ago) they've already been accepted into mainstream prescribing, your FIL probably wouldn't be offered them.

However there might still be some benefit from him being given the injections or tablets though.

https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/hormone-therapy

[tinkerbell23]

Hi. This is my speciality and sadly I think an upward trend is a sign that Enz is no longer working xx

[tinkerbell23]

Ps: may I add that where I come from (Scotland) we do not take age into account when giving hormone therapy... in fact he would be more likely to be declined chemo at 84 than hormone therapy!

Its just a “given” where we are that patients with prostate cancer are commenced on hormones unless they wish surgical intervention.

(And due to covid waiting times some now are actually getting hormones whilst awaiting surgery!)

Hormones in combination with radiotherapy if curative intent

Hormones only if metastatic cancer with a view to enz or chemo alongside this if fit!

Take care xx

[Sqad]

Tinkerbell has summed up the situation perfectly.

[Peter Pedant]

since we are a weeny thread
is tinkerbelle's clinic name - - - tinker-swell ?
hur hur hur that will bring a smile to the old men's faces

[Barquentine]

Many thanks, Buenchico and everyone. FIL is starting chemo next Tuesday. We think that's the last treatment they can try for him. He has some steroids to take day before, same day and day after chemo. Consultant mentioned chemo can reduce immune system, but he can't get out anywhere anyway. She didn't say how many sessions he will have. I guess they play it by ear. Thanks again for all the helpful replies.

[Barquentine]

I may come back to this thread after he finishes his first session to ask about any side effects but hopefully they will be minimal since consultant said it will be a very low dose.

[tinkerbell23]

Haha PP..... Urology is certainly an interesting speciality!!!

Thanks Sqad!

Barq I am not on here as much as I used to be, but I will pop in & out.... and if i can help there are plenty of kind souls on here who might give me a nudge elsewhere to come & chat!

Good luck to your FIL- may i suggest prostate cancer UK website if you havent already acessed!

Take care! X