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
Did you say the PSA was 100 ? That is very high and if that number is real (ie, from cancer, but not from prostatitis or other non-cancer reasons) then there are few surgeons in the United States who would pursue surgery alone as a curative options. If you plug those values into most nomograms the likelihood of metastatic disease is high -- likely well over 50%.
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
It sounds like you're doing your due diligence and taking all the correct steps to get the information you need. I always tell my low risk patients (based on Gleason score, PSA, and clinical staging) that there is no wrong answer. Weigh all the options, get all the opinions from various experts and then confidently make your decision. It will be the correct one.View Thread
With a Gleason 8 prostate cancer there is certainly a chance of PSA recurrence after surgery. Just because the prostate is removed, doesn't mean that it hadn't already spread (microscopically -- ie, no way to tell on CT/x-ray/etc.) to either the local area where the prostate was located or to the lymph nodes/bone.
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.
I would typically not expect the T alone to cause such a dramatic increase. More likely this is some type of prostatitis. That said, the fear in using T is that theoretically many believe it is "fuel" to a prostate cancer fire.
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.
You have many options. Are you currently on hormone therapy (Lupron) ? If not, than that is the first step -- androgen deprivation. This is usually achieved through an LHRG agonist (like Lupron) with or without an oral agent such as casodex.
After that fails, then you have a whole host of options. Given your metastatic disease you are an excellent candidate for Provenge. (roughly a 6 week treatment -- 3 treatments total -- one every 2 weeks).
After that you and your urologist/medical oncologist can consider chemotherapy (Taxol), Zytiga (oral drug) or Xtandi (new oral drug).