Husband's PSA doubling quickly -HIFU question

Wife Amy · New User Joined: 27 Jun 2009 Posts: 6 Location: Atlanta

My husband had a da vinci radical prostatectomy in Oct 2007, then subsequent radiation. Post surgical gleason was 4+5=9.
His PSA was <.1 until Dec when it went to .2, then .4 in March and .7 in June. He is 50 years old this month. We're thinking he should start hormone therapy immediately but as of yet unable to get appt with doctor until late August. We're wondering if HIFU can be performed after RP. Have any of you heard anything about this? We are sending an e-mail via Dr. Scionti's site to get more info.
We're a little scared but trying to stay optimistic.
Thank you!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 720

Hi Amy.

Unfortunately, when someone who has surgery and adjuvant radiation, and then has a PSA rise, the cancer is almost certainly systemic. With Gleason 9, it's possible that it was already systemic when your husband had surgery and radiation. It doesn't mean that it's metastatic necessarily, but it's most likely beyond the reach of local treatment, which includes HIFU. My guess is that Dr. Scionti will tell you much the same.

It is extremely important that your husband see a top-notch medical oncologist--don't put this off. Preferably the oncologist will be one that specializes in prostate cancer.

I'm not a doctor, but my layperson's view is that the strategy will turn from fighting a cancer on a localized basis (with an intent to cure) to treating the cancer systemically, starting with hormone therapy (as you noted in your email, this does seem the logical next step.) The objective changes from curing to stalling. In some cases, the cancer can be stopped in its track by hormone therapy for a decade or more. The best chances of making this happen lie with finding a good medical oncologist, in my view.

The question of when to start hormone therapy has been tossed back and forth, but the latest report I've seen indicates that when PSA doubling time is short, and Gleason is high, as with your husband's, early HT beats delayed. The oncologist is the one to ask.

I wish you well.

(BTW, HIFU *can* be performed after RP. But it would not help if the disease is systemic)
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

johnT · Senior User Joined: 27 Apr 2009 Posts: 162

I totally agree with Replicant. The Prostate Cancer Research Institute website has a list of Prostate Oncologists and their location.
Johnt
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Wife Amy · New User Joined: 27 Jun 2009 Posts: 6 Location: Atlanta

Thank you both for your reply, although it felt like a kick in the stomach when I read them. I do appreciate it.

johnT - Thank you for your suggestion on how to find an oncologist. Through the Prostate Cancer Research Institute's website, I have found a list of Genitourinary oncologists who practice in Atlanta. Do either of you, or anyone else, have any suggestions on how to determine level of competency of a doctor? Obviously I want the best for my husband.

My husbands doctor, who performed his RP, is the Director of the minimaly invasive and robotic urology program at St. Joseph's hospital, but he is not an oncologist. We sent him an e-mail over the weekend to try to get an appt as soon as possible. I don't know if he will refer us to an oncologist or handle the treatment himself. I'm guessing he'll refer us.

Any other suggestions would be most welcome. Thank you!

notme · Guest

I had HIFU done with Dr. Scionti, he is the most experienced outside Europe, so you will be getting the best answer. I'd sure be interested in his answer. I suspect the same the guys above said, but I hold out hope for your hubby.

I remember that Dr. Scionti told me that if cancer is outside the gland then he can cook it as well, as he can see it through the ultrasound picture, so maybe that could be the case??? If it's inside the bones then of course surgery nor radiation will work. fingers crossed...

Also, what about the "radiation bump"??? I hear the PSA goes up for a while after radiation, so maybe waiting until August is good, as it could just be that "radiation bump" and his PSA will come back down.

Awful they won't give you an appointment earlier, but hopefully it will work in your favor.
good luck!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 720

notme,

The radiation bump to which you refer is more commonly called "bounce".

It is a phenomenon associated with radiation as a primary treatment, not when radiation is done after prostatectomy.

I wish this were not so, but there it is.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

johnT · Senior User Joined: 27 Apr 2009 Posts: 162

Amy,
An oncologist that specializes in PC is rare, there are about 30 in the US and well worth the travel and money to see one as they have a knowlege and skill level far above urologists and medical oncologists when it comes to treating prostate cancer. The good thing is that you can travel to see the best prostate oncologists for testing a 2nd opinion and recommended treatments and the actual treatment can be done by a local doctor. The oncologist can become a specialized consultant working for you through a local doctor. The most important thing is to know what type of PC you are dealing with before deciding on any treatments and prostate oncologists are the best at doing this.
Dr Charles Meyers in VA is one of the best around and has advanced PC himself. You may even get a phone consult with a couple of doctors who are tops like Stephen Strum in Ashland Ore or Mark Sholtz in Marina Del Rey Ca. or Dr Barken, I think he is in either LA or San Diego.
Good luck.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

notme · Guest

I learn a lot here, but maybe "there's always a first"?

there's no harm in holding out hope

Wife Amy · New User Joined: 27 Jun 2009 Posts: 6 Location: Atlanta

[quote="johnT"]Amy,
An oncologist that specializes in PC is rare, there are about 30 in the US and well worth the travel and money to see one as they have a knowlege and skill level far above urologists and medical oncologists when it comes to treating prostate cancer. The good thing is that you can travel to see the best prostate oncologists for testing a 2nd opinion and recommended treatments and the actual treatment can be done by a local doctor. The oncologist can become a specialized consultant working for you through a local doctor. The most important thing is to know what type of PC you are dealing with before deciding on any treatments and prostate oncologists are the best at doing this.
Dr Charles Meyers in VA is one of the best around and has advanced PC himself. You may even get a phone consult with a couple of doctors who are tops like Stephen Strum in Ashland Ore or Mark Sholtz in Marina Del Rey Ca. or Dr Barken, I think he is in either LA or San Diego.
Good luck.
JohnT[/quote]

Thank you for your response. These are great recommendations and we will definitely pursue getting a consultation either by phone or in person with one or more of these doctors. It makes perfect sense to talk to an oncologist who specializes in PC. In my anxiety-ridden state I think I was thinking that his surgeon was an oncologist, but he is not. Thanks for the clarity!! I'll repost on our progress as we move forward.

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