Questions to Ask Your Doctor: If Your PSA is Rising After Initial Treatment

If a man experiences a rise in PSA levels after surgery or radiation, hormonal therapy is frequently utilized, and often for many years. Some men will not require additional treatment if their PSA remains fairly steady or rises very slowly.  However, many men’s prostate cancer will continue to progress during their life, despite hormone therapy, and will require more aggressive treatment.  This might include additional hormonal therapies, chemotherapy or treatment with new drugs now available for cancers not successfully treated by hormone therapy or chemotherapy.

If your PSA is rising after your initial treatment, here are a few questions to discuss with your doctor:

  • Why is my PSA rising again?
  • Are there any genetic tests I can do that might make me eligible for clinical trials or new, gene-targeted drugs?
  • Can we chart the changes in my PSA? What can this tell us about my prognosis?
  • Am I a candidate for local “salvage” prostatectomy or radiation? Why or why not?
  • Should I get a bone scan to see if cancer has spread to my bones?
  • If you recommend that I start androgen deprivation therapy (hormone therapy), how will this benefit me and slow down the growth of the cancer cells?
  • Is this the optimal time to begin this treatment?
  • What are the benefits and drawbacks of hormone therapy?
  • If I begin hormone therapy, will my PSA drop back to zero?
  • How long do the treatment effects of hormone therapy last?
  • If hormone therapy stops working, are there other treatment options besides chemotherapy?
  • Are there dietary changes that I could or should make to optimize treatment? What about exercise?
  • Should we add a medical oncologist to my treatment team to gain an additional perspective on treating my disease?
  • What about immunotherapy, checkpoint inhibitors, and new drugs targeted to specific genes?

Discussing these questions with your doctor will help you to be an informed part of the treatment team.

Terms to know from this article:

Hormonal therapy

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body's natural hormones. Sometimes surgery is needed to remove the gland that makes hormones. Also called hormone therapy, hormone treatment, or endocrine therapy.

Hormone

A chemical made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in a laboratory.

Prognosis

The likely outcome or course of a disease; the chance of recovery or recurrence.

Prostatectomy

An operation to remove part or all of the prostate. Radical (or total) prostatectomy is the removal of the entire prostate and some of the tissue around it.

Bone scan

A technique to create images of bones on a computer screen or on film. A small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it collects in the bones and is detected by a scanner.

androgen

A type of hormone that promotes the development and maintenance of male sex characteristics.

Oncologist

A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.

Immunotherapy

Immunotherapy is a type of treatment that boosts or restores the immune system to fight cancer, infections and other diseases. There a several different agents used for immunotherapy; Provenge is one example.

PSA

prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.

Gene

The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.

Learn More