My dad’s PSA rose after treatment. Should we try oral drugs?

Question

Hello doctor,

My 72-year-old father was diagnosed with prostate cancer last year, with a Gleason score of 7 and an initial PSA of 12. After six months of androgen deprivation therapy, his PSA decreased to 5, but has now risen to 9.2.

He has also been experiencing recent back pain, raising concerns about possible disease progression. So my questions are -

Should we consider a PSMA PET scan immediately to evaluate for bone metastases, or would it be reasonable to wait until his next follow-up?
Are oral medications like Abiraterone preferable to chemotherapy, given his age?
Is stereotactic radiation a viable option for limited metastases, or is it typically reserved for younger patients?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Given your father’s rising Prostate-specific antigen after an initial response to androgen deprivation therapy, this suggests possible progression toward castration-resistant prostate cancer, and his new back pain is concerning for potential bone involvement.

A prostate-specific membrane antigen positron emission tomography (PSMA PET) scan would be appropriate sooner rather than later, as it is the most sensitive way to detect bone and soft tissue spread. This imaging will guide the next steps in treatment and help determine the most effective management plan.

If the disease is confirmed to be resistant to hormone therapy, oral agents such as Abiraterone or Enzalutamide are often preferred before chemotherapy in older patients, as they are generally better tolerated while still controlling the disease.

Chemotherapy, such as Docetaxel, can be considered depending on his fitness and extent of disease, but it is usually reserved for patients who do not respond to newer hormonal agents.

Stereotactic body radiotherapy can be an option for patients with limited metastatic sites, also called oligometastatic disease, regardless of age, as it can provide local control, pain relief, and sometimes prolong survival when combined with systemic therapy.

I hope this information helps you.

Thank you.