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Urology/Hormone resistant Prostate CA

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Question
My father had a RPT 3 1/2 years ago. His PSA at the highest was 5.6 pre surgery but his prostate was full of cancer in almost all the quadrants. Gleason score 7. The cancer had extruded from the gland. 6 weeks post-op his PSA was 3.4. No nodal involvement. clean bone scan. Went on Lupron and Casodex. Has endured the symptoms of those drugs and lowered his quality of life.

Now his PSA went from 0.01 6 months ago to 1.2. Is this showing he has hormone resistant PCa? Is that a high jump? We see a urologist soon but would really like to hear your impression.

My father is almost 80 and on multiple meds for arrhythmias, Coumadin, Lipitor, Procardia.

Any comments would be greatly appreciated.

Answer
Linda:

While your father's PSA wasn't high, it sounds like he had substantial cancer.  Gleason 7 is relatively aggressive.  If your father is now 79 (almost 80) and had his surgery 3 1/2 years ago, that means he was probably 76 at the time of the surgery.  Further, he had detectable PSA after his surgery which means he had positive margins and all the cancer was not removed.  He might have gotten radiation therapy at that time to control the remaining cancer but it appears he was just given hormonal therapy.

The rapid rise in PSA at this point despite hormone therapy suggests biochemical recurrence.  This is a relatively small jump in absolute terms, but quite high in percentage.  A repeat PSA would be helpful to determine the rate of increase.

We have new drugs to use at this point and radiation therapy can theoretically be considered. I would urge your father to talk to an oncologist as well as a urologist to hear about all his available options.  I wish him the best.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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