There are a number of studies looking at ASAP. The typical recommendation is to repeat a biopsy. There is some difference of opinion as to the timing of this biopsy, but most would agree that it should be done within a year. The likelihood of having cancer on a subsequent biopsy is approximately 40%.View Thread
typically the nurse at the hospital or doctor's office should give you detailed instructions. Two options:
1. take an empty syringe (ideally 20cc) and remove the fluid from the balloon port (the one not hooked up to a bag) until nothing else comes out. I recommend placing some KY jelly at the tip of the penis and then gently pull the catheter out.
2. second option is to but the catheter as the other gentleman advised.View Thread
Often after radiation therapy patients will experience some frequency and bladder urgency. These symptoms can often be managed with different medications. You may wish to speak to the urologist about some opitons.
Depending on your age and medical condition I think it is still reasonable to have a discussion with an experienced surgeon about prostatectomy. Classically a PSA of 50 (assuming its from the cancer and not from benign causes) suggests a high likelihood of metastatic disease. There have, however, been several published reports in the literature of the benefit of prostatectomy in high risk disease in combination with a good lymph node dissection for staging. In your case the benefit of "local control" is huge -- it would allow you to remove the catheter and have an improved quality of life. Following surgery you would still have the option of adjuvant radiation if margins were positive and the radiation oncologist believed there would be a benefit.
Lupron is not a cure. Its a temporizing measure. If there is no evidence of metastatic disease I would consider speaking with both urologists and radiation oncologists about the possibility of definitive treatment.
In the absence of any symptoms suggesting prostatitis, infection or other benign cause for PSA elevation that is a dramatic rise. I would re-check it now. Why wait 3 months? If there is evidence of any infection or symptoms of prostatitis I would treat with antibiotics and re-check within 3-4 weeks.
At the very least you should see a urologist to consider doing a biopsy if the PSA really is 5.
Unfortunately primary care doctors have been discouraged from PSA testing by the US Preventative Task Force that believes we over-treat prostate cancer. While this is true in many cases I believe that you should always acquire the information and if a patient has cancer that is the time to have an educated discussion about treatment options (which include active surveillance)
Bottom line: I would re-check the PSA now and if still elevated see a urologist about doing a biopsy. If there is an aggressive cancer you would rather know about it now rather than 3 months from now or a year from now.
So it would appear that the PSA never did nadir after surgery and there was a positive margin at the time of surgery. The rise has been relatively slow over the past 5 years which would suggest a local recurrence. Were you offered adjuvant radiation in 2008? I would recommend getting some staging studies and consider seeing a radiation oncologist to see if salvage radiation is still an option for you.
There are always steps you can take if ED is the only issue. It all depends on how important it is to you and how aggressive you want to be. If oral medications, penile vacuum device, or injections are not enough than you may want to speak w/ your urologist about an inflatable prosthesis. This typically has a very high patient satisfaction and for many men is a significant improvement in their quality of life and regaining control of their identity.View Thread
Typically the PSA after radical prostatectomy should be zero if there is no reminaing disease or no remaining prostate tissue. Depending on the pathology of the original tumor an early rise such as this may indicate a local recurrence which would be amenable to definitive treatment such as adjuvant/salvage radiation.
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.
Seems like there is a lot going on. I don't think the problems are related.
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
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