psa question.

Lee, sorry to hear about your rising PSA. Others much more knowledgeable about HT, etc. will chime in soon, but I wanted to comment on your question about whether the surgery would drop your PSA "like a brick."

Not knowing much about your history, I would imagine that with a PSA of 700 the cancer is likely outside the area that surgery could reach. I assume you've had additional tests (bone scan, MRI, PET scan) to determine the extent of the disease?

Prostate tissue generates PSA. When that tissue becomes cancerous, it generates PSA much faster. Normally, with a healthy prostate, the PSA dies a "natural death" then more is generated, which usually keeps the levels in line. Prostate cancer cells anywhere in the body will generate PSA. So, in theory, if your prostate, lymph nodes, testicles, seminal vesicles were removed and the cancer had spread to your bones, you would still have higher-than-normal levels of PSA. That's what the HT is for...to "starve" the cells so that they stop generating PSA.

At least, this is my understanding of how it all works. As I said earlier, those much more knowledgeable than I should stop by soon to help answer your questions.

I wish you luck

Lee,
Usually when the PSA is so high the disease has spread to the bones in the pelvic region but can likely end up anywhere: spine, pelvis, long bones, even shoulders (my scan erroneously found a large hot spot there) .

If the disease is likely confined, and the patient is healthy otherwise, there is a "good reason" to remove the prostate. But removal is not without side effects and quality of life issues. Half of the guys have ED and 1/10 of them have some form of incontinence.

When it has already spread, the conventional thinking is to hit it systemically (drugs) and hope the cells are killed by starving them of testosterone. Of course there are other approaches: different injections, treatments, etc. You can read about them in other threads.

I am not a doc; I have not examined you; I have not had my hand up your butt; I am not a licensed professional; Your mileage may vary.... (Did I get all the disclaimers?) But,... It would seem that removal of the prostate would cause you to suffer a lot of unnecessary pain and side effects and do nothing to solve the issue. In addition to your worry about PSA and mets (terrible things to have on your mind) you would be worrying about: pee pads, pills, catheters, pumps, injections, and the location of the nearest bathroom. For at least 6 months your quality of life would go down significantly and if you were lucky it would be almost as good as it is right now - if you were lucky.

More disclaimers: I am not a medical professional. Taking this medicine may cause blue vision, stuffy nose, back pain, palpitations, and nausea.....

I wish you well.
Jeff in NY

Thanks for your replys once again,my desease is in my bones fairly widely spread and also in many of my lymph nodes as high up as para aortic region.Bone mets are throughout my spine,in two ribs pelvis and one showing in my right knee joint.The reason i requested surgery is because i had 9 months off of ADT (zoladex) due to an intolerance to the side effects (depression and dizziness) being of the most unbearable.The oncologist decided to try me on a new drug called firmagon (degarelix) but this was horrible and my psa went from 71 to over 700 in 2 months.Does anyone know why this increase could have happened ??.Can anyone advise me how to control the depression and dizziness brought on by adt ?