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Prostate Cancer

Explanations and Treatment for PSA Fluctuations

07/21/2005

Question:

Hello, I have a long lasting prostate cancer story (11 years):- radical prostatectomy in Feb 1995 (T2a N0M0R0) - PSA < 0.05 for 4 years (end 1998) - slow PSA rise in 1999 and 2000 to 0.15 - steeper increase to 0.7 in 2001 - RT of the prostatebed end 2001 (64 Gy) - small decrease to 0.5 until mid 2002 than increase again (steepness of increase smaller) - end 2004 PSA is 1.15 - Cholin + F18 PET/CT in Nov 2004 showed one single small bone metastase with "low activity" in the pelvis - nothing else detected; - Dec 2004 radiation of the suspected metastase - 40 Gy (no biopsy taken before); - between Feb and April 2005 PSA dropped in 3 consecutive measurements from 1.15 to 0.6; in May it jumped to 1.18, in June it dropped to 0.66 and now this months another incease to 0.8; this seems to proof that there was really a metastase detected. I would like to emphasize that I never had any antihormon treatment! Since Dez I get a monthly Zometa infusion. I am sorry about the length of my contribution - but my story is very long as you can see. My question is: are the presently ongoing strong PSA fluctuations explainable? Is this a good indication?? Any recommendations?? Thank you!

Answer:

We not infrequently will see fluctuations and generally three successive increases are accepted as failure and you have not fallen into this category.  My sense would be to continue to observe but if your PSA begins to rise consistently I would begin hormone therapy.

I hope these thoughts are helpful to you.

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Response by:

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University