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PSA level has raised. What to do further?

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Practicing since : 2005
Answered : 614 Questions
I am aged 78, PSA gone up to 11 and XXXXXXX 4 + 5 = 9
clinical stage 2.
Its my decision. At my age, 1) should i bother, OR 2) have an EBRT, OR 3) an EBRT with a brachytherapy
OR 4) an EBRT with a Calypso
What are my estimated life years with each? What about the Partin tables?
Thank you, my email, YYYY@YYYY
Posted Mon, 14 Oct 2013 in Men's Health
Answered by Dr. Manuel C See IV 1 hour later
Brief Answer:
I would bother to get treatment.

Detailed Answer:
Good Day and I am very sorry to hear about your condition.

From your medical history I would think you are generally healthy and if that is the cause then you still have more than 10 years to live.

That being said I strongly believe that you will benefit from treatment with prostate cancer. First reason is that you are healthy and you have more than 10 years to live. Second is that you have a very high XXXXXXX score and it will be aggressive in the coming months to years.

Did you have a bone scan to check for bone metastasis?

Radiation therapy with hormonal treatment would be your only choice. I believe EBRT with calypso will have a better imaging/targeting capacity. Whether this would translate to lesser complications and better outcomes still remains to be seen. But i still will opt for the calypso system if it is available. EBRT alone or with brachytherapy would also be an acceptable option. I would think it would depend on the expertise of the Prostate cancer team that will be performing your treatment. It is very important for them to be accustomed to the treatment that you will be choosing.

For me Radiation therapy is all the same and the outcome is case to case basis.
There are reports that 5 year after radiation (EBRT) 90% still have undetectable PSA which would relate to cancer cure.

PArtins table is a tool that we urologist use to check the chance/probability that the cancer is organ confined or chance of lymph node metastasis. This is useful if surgery is being contemplated but with your clinical parameters, you will not fall into a surgery candidate.

So to summarize, If I was in your position and I am the patient. Knowing what I know I would get radiation treatment and I am leaning towards the EBRT with calypso since theoretically it has several advantages over conventional EBRT and EBRT + brachy.

Thank You and I hope I have answered your question clearly and sufficiently.

Above answer was peer-reviewed by
Follow-up: PSA level has raised. What to do further? 19 hours later
Thank you doctor. I have had a CT bone scan and it is clear. I have no symptoms,
I do not have to go to the toilet at night, no pains etc.
I live in Australia and I am told Calypso 4 D is not available here (I am surprised, we are supposed to be at the forefront of things here!)
At age 78 what are the estimated life prospects (assuming something else doesn't get me first)
1. Do nothing = estimated years left
2. EBRT = estimated years left
3. EBRT + Brachytherapy = estimated years left XXXXXXX Saunders
Answered by Dr. Manuel C See IV 5 hours later
Brief Answer:
Please see detailed answer below.

Detailed Answer:
Thank you for your follow-up question. It is really hard to say or predict the activity of your cancer more so to say how many more years will be given to you. Here is my best answer:

1. with your XXXXXXX score 4+5 = 9 - they did a study for those who didn't want any treatment and follow them up. In 5 years 7/10 died of prostate cancer meaning 30%survivial after 5 years. This study did not put age into factor but like I said before XXXXXXX 9 prostate cancer is agressive and will manifest if not treated.

2. EBRT alone - I'm sorry to hear that calypso 4d system is still not available in AUS but there are other system for EBRT, just make sure they will be using an image modulated radiation treatment (IMRT). This is important since with IMRT they can escalate the dose thereby killing more cancer cells and reducing the dose for the surrounding organs (bladder, rectum etc). Outcome are also superior with IMRT. Survival rate for IMRT 90% in 5 years and 75% in 10 years and this is for gleasons 8-10 patients already.

3. EBRT with brachytherapy - I would say the same survival with IMRT. in 5 years it is 75-90% that the serum PSA stayed very low (nadir).

I hope I was very clear in explaining and good luck XXXXXXX

yours truly,

Manuel See IV ,MD DPBU
Above answer was peer-reviewed by
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