A Patient's Guide to Managing Hormone-Refractory Prostate Cancer  

Chapter 2. When You Need Immediate Attention


The good news about prostate cancer is that it is one of the slowest progressing cancers…in most cases. However, there are some situations that require urgent attention.

If you are in pain due to the cancer.

When you are experiencing severe pain due to the cancer, nothing else has a higher priority, even the cancer itself. Refer to Chapter 19. “Managing Pain” for approaches to dealing with the potentially severe pain of cancer.

Once you’ve gotten the pain under control, you can get back to controlling the cancer.

If your PSA is over 100 and doubling rapidly.

The strategy of this book is keeping the PSA—hence, the cancer--under control.

The problem with a high PSA—say, over100, an arbitrary point—is that it usually is a precursor to metastases. Although there is no particular time associated with the growth of bone or soft-tissue mets, the high value is usually followed by the appearance of mets unless the PSA is brought back down soon.

To take this one step further, the cancer damages the body through these metastases. Bone mets result in pain and possible fractures. Soft tissue mets can result in organ damage. Prostate cancer does not kill unless there are metastases.

PSA doubling time (PSADT) is simply the trend of the PSA. With HRPCa, a doubling time of less than one month is considered quite rapid and in need of reversal. It is important to reverse that trend or to stabilize the disease.

Stopping the rise of the PSA will require concerted actions by you and your oncologist. The remedial steps depend on previous treatments and present condition. Therefore, you should work with the oncologist to decide which treatments are appropriate. This book will provide you with recommendations that may be useful. Once you’ve been able to control the PSA, you will have time to review the full message of this book for longer term treatment.

If you have a GS of 9-10, but your PSA is normal.

This combination of a high Gleason Score and a normal PSA may (NOT NECESSARILY) indicate that the cancer is a form that produces a neuroendocrine product, rather than PSA. Sometimes called small-cell prostate cancer (SCPC), pure SCPC is a fairly unusual situation, happening in only a few percent of prostate cancer cases, according to the medical literature.

The problem with small-cell prostate cancer is its aggressive behavior, with early development of metastases. It is this aggressiveness that requires expeditious reaction.

First, it is necessary to determine if a diagnosis of small-cell prostate cancer is valid. Then, a particular regimen of chemotherapy is required. See Chapter 20, “Small-cell PCa.”

Continue to Chapter 3