Dr. Saurabh Subhash Pandya
Urology
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Patient's Query
Hello doctor,
I was diagnosed with Gleason 6 before twelve years. Undergoing radiotherapy from then, intially, it was 0.40 nadir, which increased annually. The last four PSA readings were 1.12 ng/mL, 1.60 ng/mL, 1.46 ng/mL, and 2.35 ng/mL. This last value was my concern. My urologist has retired, and I await his successor to contact me. Symptoms of urinary frequency and nocturia have remained since before treatment. I am taking Flomax twice daily, along with Metoprolol, Losartan, Sucralfate, Aspirin, and Pepcid. Kindly help.
Hello,
Welcome to icliniq.com.
Your PSA (prostate-specific antigen) has been rising post-radiotherapy. Since it is above 2.0 ng/mL, I suggest you go for a PSMA PET (prostrate-specific membrane antigen positron emission tomography) scan. This will show any recurrence in the prostate or lymph nodes or elsewhere. Further treatment can be planned accordingly. We call this stage biochemical recurrence (blood reports show recurrence but not proven on imaging yet). If there is a recurrence, we can plan second-line treatment based on the location and number of lesions. It may include hormonal therapy. You can ask your specialist to prescribe Mirabegron (Solifenacin and Tolterodine) 50 mg once daily for frequency and nocturia. Flomax (methacrylic acid copolymer, microcrystalline cellulose, triacetin) once a day should be good enough. Avoid nighttime fluid intake. Make sure it is PSMA PET and not FDG PET (fluorodeoxyglucose positron emission tomography). I hope I have cleared your doubts.
Thank you.
Patient's Query
Hello doctor,
If the scan indicates recurrence, could salvage brachytherapy be a possible treatment? Would that be more likely to arrest progression?
Hello,
Welcome back to icliniq.com.
If recurrence is local, brachytherapy can be given. Hormonal therapy with or without second line antiandrogens should help if outside the prostate. There may also be a role of prostate biopsy to see if the grade of the tumor has changed. I hope I have cleared your doubts.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply,
I am awaiting a call back from the doctor's office. I will again request the scan you noted. Aside from the stated symptoms, there is a burning sensation in one thigh, and for about two weeks, there has been mild hip pain on either side. We thought this was a return of past arthritis, which had been eased with fish oil supplements. The thigh burning started three days ago occurs when in bed at night, and seems to be progressing. It is relieved considerably when standing up. There seems to be no swelling. Is this likely related to the spread of the malignancy?
Hi,
Welcome back to icliniq.com.
Burning pain in the thigh may be due to nerve irritation or vitamin B12 deficiency. Continue calcium and vitamin supplements if not taken currently. The joint or bone pain may or may not be related to the malignancy, this can be ruled out after the PSMA PET (prostate-specific membrane antigen positron emission tomography) scan or a bone scan.
Take care.
Patient's Query
Hi doctor,
Thank you for the reply,
I will speak with the oncologist to discuss the hike in PSA and will request the scan you mentioned. Meanwhile, the moderate hip pain persists, but not the other leg pain. It is most troubling and having constant dizziness and very low blood pressure. My morning BP stays between 90/57 mmHg and 102/60 mmHg. On occasion, it was above 80. During the day, it goes up and down but remains mostly around 100. The dizziness is fairly constant when standing. This dizziness and low BP have been with me for almost two weeks. Could this be caused by a return of the malignancy?
Hi,
Welcome back to icliniq.com.
Dizziness may be due to a double dose of Flomax (Tamsulosin Hydrochloride). You can stop it for four to five days and see. Start taking calcium, vitamin D, and vitamin B12 supplements. If the dizziness persists, you may have to reduce the dose of antihypertensives.
Take care.
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