Health hotline: Prostate cancer Q&A

I quit taking Lupron shots and my PSA stayed at 0.0 for four years. Then it gradually started to rise again. Over a period of four years it rose to 11.6. It was very gradual at first, it started rising more rapidly near the end of the four years and would go up like 4.8 in 3 1/2 months. That is when I got a 3-month Lupron shot. My PSA went down to 1.4 and then after a second Lupron shot three months later to 0.013. I had a third Lupron shot and I assume that it will be down to 0.00 after my next PSA test.

If my PSA is 0.00 after my next test, should I keep taking Lupron shots to try and suppress the cancer and keep it from coming back, or should I stop taking Lupron shots and just wait until my PSA rises again like I did after my original treatment? If my PSA reappears at some time in the future and starts to rise, should I just ignore it because of my age or start treating it with Lupron or some other drug again? Or try something else?

Answer:

Regarding the PSA rising more rapidly as it gets higher: That is because as cancer grows it doubles in number of cells, volume and, of course, PSA so it takes as long for the PSA to go from 2 to 4 as from 8 to 16.

One way to give the hormonal-ablative treatment Lupron is to give it intermittently, usually giving two or three shots until the PSA is undetectable, then stopping and waiting for the PSA to rise again. This allows the patient to have a break from the side effects (hot flashes, fatigue, muscle mass loss, ....). Then when the PSA rises, another shot or series of shots can be given.

This is not a curative treatment so at some point the cancer may continue to grow despite the absence of testosterone. At that point, sometimes chemotherapy may help, but it is unlikely to be curative.

Among questions about incontinence and erectile dysfunction:

Can incontinence improve after 12 months?

Last year, I had radical retropubic prostatectomy. I am in my 50s. During surgery there was a complication of reconnecting the urethra to the bladder neck (mobilizing bladder to reach the urethra). Subsequently, vest sutures were placed!

Before surgery, I had total urinary control. Three weeks after surgery the catheter was removed, and I was totally incontinent. I have a constant drip 100 percent of the time (sleeping, sitting, standing, walking). When I am sleeping I can get up and urinate, but I am wet from the continuous drip. The Urodynamic test determined my bladder is normal and not hyperactive. I am scheduled to have a Cystoscopy Test. My doctor believes incontinence will only improve within 12 months, but not after 12 months! I am being told after 12 months I will need to have an Artificial Urinary Sphincter.

Note: I began doing Kegel exercises after the catheter was removed!