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What causes persistent PSA increase despite medication?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I have been on hormone therapy for metastatic prostate cancer for two years. Initially, my PSA responded well, but it has increased from 0.4 to 2.1 ng/mL over the last three months despite continuing Lupron. I am experiencing significant hot flashes, fatigue, and worsening bone pain in my ribs. What are my next treatment options? Please help.

Thank you.

Answered by Dr. Mona Kamal

Education:

Master in Pathology

Professional Bio:

Dr. Mona Kamal is a highly experienced pathologist and general practitioner with over 41 years of clinical expertise. She earned her Bachelor of Medicine, Bachelor of Surgery (M.B.Ch.B.) degree in 1982 and a Master’s degree in Pathology in 1989, both from Alexandria University, Egypt. Throughout her extensive career, Dr. Kamal has consulted with over 200 patients, demonstrating a strong commitment to accurate diagnostics and comprehensive patient care. She currently practices at Shifa Lab in Alexandria, where she applies her deep knowledge of pathology alongside general medicine to provide precise and compassionate healthcare services.

This doctor is not available for online consultations on the platform anymore.

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Lupron (Leuprolide acetate) is a synthetic hormone used to treat conditions like prostate cancer (a type of cancer that develops in the prostate, a small gland in men that produces semen), endometriosis (a condition where tissue similar to the lining of the uterus grows outside the uterus, causing pain), and uterine fibroids (non-cancerous tumors that form in the uterus).

It is classified as a gonadotropin-releasing hormone (GnRH) agonist, which works by inhibiting the secretion of gonadotropins (luteinizing hormone and follicle-stimulating hormone). By suppressing the release of these hormones, Lupron reduces the production of sex hormones like testosterone in men and estrogen in women.

The active ingredient in Lupron is Leuprolide acetate, a long-acting synthetic analog of GnRH. This drug works by binding to GnRH receptors in the pituitary gland, leading to an initial surge in hormone release followed by desensitization, which ultimately reduces hormone production.

Other ingredients in the formulation include Mannitol (a sugar alcohol used as a stabilizer), Lactic acid (used to adjust the pH), and Sodium hydroxide (used to balance acidity). These excipients ensure the stability and proper delivery of the drug during administration.

In prostate cancer treatment, Lupron lowers testosterone levels, which can help shrink tumors or slow the growth of cancer cells that depend on testosterone. It is administered through injections, typically given monthly, every three months, or every six months, depending on the prescribed regimen.

Prostate cancer treatments vary by stage, including active surveillance, surgery (radical prostatectomy), radiation therapy (external beam or brachytherapy), hormone therapy (androgen deprivation therapy), chemotherapy, immunotherapy, and targeted drug therapies.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.

Answered by Dr. Mona Kamal
Medically reviewed by iCliniq medical review team
Published At February 5, 2025
Reviewed At June 23, 2026

Education:

Master in Pathology

Professional Bio:

Dr. Mona Kamal is a highly experienced pathologist and general practitioner with over 41 years of clinical expertise. She earned her Bachelor of Medicine, Bachelor of Surgery (M.B.Ch.B.) degree in 1982 and a Master’s degree in Pathology in 1989, both from Alexandria University, Egypt. Throughout her extensive career, Dr. Kamal has consulted with over 200 patients, demonstrating a strong commitment to accurate diagnostics and comprehensive patient care. She currently practices at Shifa Lab in Alexandria, where she applies her deep knowledge of pathology alongside general medicine to provide precise and compassionate healthcare services.

This doctor is not available for online consultations on the platform anymore.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Education:

Master in Pathology

Professional Bio:

Dr. Mona Kamal is a highly experienced pathologist and general practitioner with over 41 years of clinical expertise. She earned her Bachelor of Medicine, Bachelor of Surgery (M.B.Ch.B.) degree in 1982 and a Master’s degree in Pathology in 1989, both from Alexandria University, Egypt. Throughout her extensive career, Dr. Kamal has consulted with over 200 patients, demonstrating a strong commitment to accurate diagnostics and comprehensive patient care. She currently practices at Shifa Lab in Alexandria, where she applies her deep knowledge of pathology alongside general medicine to provide precise and compassionate healthcare services.

This doctor is not available for online consultations on the platform anymore.

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