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best of luck,
Dr TareenView Thread


I would definitely agree with a close PSA followup and possibly a re-check now to make sure the PSA rise is real.View Thread

It sounds as though your father is not what we call "CRPC" or "castrate resistant prostate cancer." You are correct in saying that a rising PSA after definitive treatment usually implies some type of disease recurrence, but this can be anywhere. Most commonly if its not in the area of the prostate then the most likely spots are lymph nodes or bones.
Fortunately, this is an exciting time in prostate cancer treatment with many new therapies available for this type of disease. Once the staging (CT scan, bone scan, etc.) studies are back you can discuss with your doctor possible therapies such as Provenge, Zytiga, Enzalutamide, and chemotherapy.
If your urologists is not experienced in managing advanced prostate cancer you may wish to get an opinion at a high volume center or from a medical oncologist who routinely treats advanced prostate cancer.
best of luck.
Dr TareenView Thread

With all that is going on, your prostate issues can certainly wait. I would consider starting a 5 ARI medication such as Avodart and Proscar and re-checking the PSA in 3-4 months. I suspect the PSA increase was from prostatitis and not cancer. Likely on the medication your PSA will be less than 1. (normally we see at least a 50% decrease, but I would expect a larger decrease in your case if this is truly from prostatitis)
Many experts believe that HGPIN is a pre-cursor to prostate cancer. I would follow the PSA and down the road consider doing a definitive biopsy at some point based on the clinical picture.View Thread

In addition to getting a second opinion on the biopsy I would strongly consider doing a prostate/pelvis MRI at a high volume center. You may very well find suspicous lymph nodes, extracapsular extension beyond the prostate, or other findings which may help guide your treatment decision.View Thread



The fact that the PSA never went to 0 after surgery suggests that it was always present even after surgery.
At this point you need to get some imaging studies -- bone scan and CT or MRI. If there is obvious metastatic disease than likely homone therapy is the next step. If there is no evidence of visible disease on imaging studies than you need to consult with your urologist and possibly a radiation oncologist as to whether radiation therapy may be worth considering.
best of luck,
Dr. TareenView Thread

Bottom line is I would re-check the PS and make sure it returns to normal (some would treat w/ antibiotics as well in case there is prostatitis present). If the PSA remains elevated above baseline, I would strongly consider doing a biopsy.
best of luck,
Dr. TareenView Thread
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