Could my father’s rising PSA indicate cancer spread?

Question

Hello doctor,

My 68-year-old father has prostate cancer with a Gleason score of 7, and his prostate-specific antigen level has increased from 8.6 to 14.2 over the past six months.

He is currently receiving androgen deprivation therapy, but he continues to complain of persistent bone pain, especially in the hips.

So my concerns are:

Does this rise in prostate-specific antigen and ongoing bone pain suggest that the cancer may be spreading to the bones despite treatment?
Should we request advanced imaging, such as a positron emission tomography scan, now rather than waiting another six months?
If his disease progresses to castration-resistant prostate cancer, are oral treatments such as Abiraterone considered safe and effective at his age, or would chemotherapy be the only treatment option available later?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I completely understand and appreciate the fear and anxiety you may be experiencing, especially given that his cancer has shown signs of progression with a rising PSA ( prostate-specific antigen) level.

Once the PSA begins to rise and symptoms start to worsen, we generally recommend proceeding with further evaluation. At this stage, imaging studies and blood tests are essential to assess for disease progression.

A bone scan is required, and given that he is symptomatic with a rising PSA, we do not recommend waiting for six months before further assessment.

That said, there is no need to be overly worried, as effective treatment options are available. If the disease has become castration-resistant, we can modify his treatment by introducing newer hormonal agents such as Abiraterone or Enzalutamide.

These medications are specifically used once the disease shows resistance to conventional hormonal therapy and have proven benefits in controlling disease progression.

Another important aspect of management at this stage is bone health. We recommend starting Denosumab, administered as a monthly injection, along with calcium and vitamin D supplementation.

This treatment helps reduce bone pain, limits skeletal complications from bone metastases, and decreases the risk of osteoporosis, which commonly occurs with long-term hormonal therapy.

If there is any specific area of significant bone pain, localized palliative radiotherapy can be administered to that site. This usually provides excellent pain relief and helps improve quality of life. Following these interventions, the disease often stabilizes and becomes better controlled.

In addition, I would encourage close attention to his psychological well-being, nutritional status, and overall general health, as these play a crucial role in treatment tolerance and recovery.

The patient will be reviewed after seven days with the available blood reports and imaging results, following which further treatment refinement will be undertaken based on the clinical response and investigation findings.

I hope this answers your questions. Please follow up if you need further guidance.

Thank you.