Despite treating advanced or recurrent prostate cancer with hormone therapy, it is common for a man’s PSA to eventually start rising again after many years, 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. It is important at this stage if you have not already had a consultation with a medical oncologist that you engage them as part of your treatment team.
If your PSA is rising after despite being on hormone therapy, 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 drugs?
- Can we chart the changes in my PSA? What can this tell us about my prognosis?
- Should I get a CT or Bone Scan to see if cancer has spread to my bones or lymph nodes?
- 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 my hormone therapy has stopped working, are there other treatment options?
- 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.