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    Rising PSA levels during chemo
    4MyDad1970 posted:
    Hi all,
    First, my thoughts and prayers are with everyone here. Cancer is a horrible disease.

    Now, my Dad, age 59, was dx'd with PC nearly a year ago. He went on hormone therapy and had 9 weeks of radiation. After that, his PSA level dropped down very low. He had a couple of months feeling good, then started noticing pain in his hip. Had a bone scan and we found out that it had spread to his hips, sternum, ribs and 2 small spots on his spine. The only place he has pain is in his hip. His PSA doubled from 16-37 between August and October, which is when he started Taxotere. His PSA has crept up each 3 week visit, 4 or 5 or so. On Nov. 17th, he switched to Jevtana to see if that would be more effective. The last PSA jump was Oct. 26-Nov. 17, and it went from 37 to 47. Is this indicative of very aggressive cancer? On his last bone scan there was a slightly large new area on his already bad hip, plus activity in the existing spots. My concern is that this could spread to his lymph nodes or organs, particularly the liver. How do you know if this happens, and can it? I know Jevtana is one of the newer chemo's out there, but what next if that isn't effective?

    Thanks for "listening".
    az4peaks2 responded:
    Hi Christine, - Sorry about your Dad's medical situation and at such a relatively young age.

    From what you have Posted, your Dad has systemic, metastatic Prostate Cancer (PCa) upon which, Hormone Therapy has worked briefly but is now advancing, in spite of efforts to contain its spread. The bones are a favorite target of metastatic PCa but it can eventually spread to any of the bodies organs, including the lungs, liver, brain, etc..

    In fact, it is the interference in the functioning of such vital organs that usually is the direct cause of a PCa patients eventual demise, as you are evidently aware from your stated concerns. The reversal or pause (remission) in disease advance is what is trying to be accomplished in what is now a chronic, incurable disease.

    The changes that have been made in his treatment, so far, are attempts to find more effective methods to deal with the disease, but it appears that they have been unsuccessful to date. The obvious question is what specialty is providing the care? A Medical Oncologist, is , usually, the best equipped to deal with the drug manipulations necessary in advanced PCa, preferably with special expertise in PCa, if possible.

    Regular monitoring with appropriate imaging and laboratory follow-up are the most effective ways of tracking the disease and treatment effects. The reaction to the monitoring results are, of course, the most important aspects of his treatment and having the most capable expert that is, practically, available is the best approach you can make.

    Don't hesitate to discuss with his attending Physician, whether a consultation with one of the recognized "centers of excellence" in the field would be of value. Also, ask if there are any appropriate clinical trials that might be available for participation. He seems to be exhausting the present advanced disease approaches. Localized treatments, like radiation are only applied palliatively (treating side effects), like pain and associated factors.

    If the disease continues to advance, in spite of all heroic efforts to contain it, there will eventually come a time when Hospice care will likely become appropriate. If this does occur, it should be realistically considered but it does not appear that it needs consideration at the present time.

    Make this a special Holiday season and let your Dad know how much you love him and appreciate how much he has done for you, to make you the caring person you are. Good luck to your Dad and to all of his loved ones. I hope this has helped your understanding of advanced PCa. - (aka) az4peaks
    4MyDad1970 replied to az4peaks2's response:
    John, thank you for your reply and your very kind words. We just got news this morning that his PSA is now up to 57 after 1 treatment on the Jevtana, so another rise of 10 in 3 weeks. It is rather discouraging. He is seeing an PC Oncologist, as well as his Urologist and Primary Care Physician. His Onc did say it may take a couple of treatments for his body to respond, as everyone responds differently. We were hoping for better results, at least a glimmer of hope, however he seems to sleep better at night after his first round of the Jevtana. I am such at a loss though all this, providing support for family members, facing losing my father, etc. but am doing as you say and am thankful of the time we do have. God bless you.

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