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PSA rising despite hormone therapy? AUA guidelines summarise many of your doctor's options.


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Jim Marshall (not a doctor) said ...

Your PSA is still rising, even though hormone therapy is keeping your testosterone at castrate levels? Your doctor tells you "There are lots of things to try yet". You can get some ideas yourself what your doctor is thinking of from the AUA guidelines.


The American Urological Association (AUA) has issued guidelines for USA doctors for treatment.


Your specialist will have personal guidelines much the same as these. But the treatment your doctor chooses may well be different from the AUA guidelines for many reasons, among them:

  • newer evidence;
  • more detailed knowledge of drugs, how well they might work, and the likely side effects;
  • more detailed knowledge of your health; 
  • different drugs available in Australia;
  • knowledge of your disease path to this date; and
  • (most importantly because this disease plays itself out differently in every man) - your doctor's experience with many patients.


Some terms used in the guidelines:



Castrate Resistant Prostate Cancer

  • Your PSA is rising while on hormone therapy; and
  • a test shows that your testosterone is at castrate levels (otherwise is might just be that you need stronger hormone therapy).

(In CRPC your doctor may suspect that tiny bits of prostate cancer (micro-metastases) are hidden in your body, but they have not been found yet.)



Metastatic Castrate Resistant Prostate Cancer

  • You have castrate resistant prostate cancer; and
  • your doctor finds your prostate cancer that has left your prostate and travelled to other organs (most often bones).



Your doctor finds symptoms caused by metastases of prostate cancer - changes to scans, pain, other organs like kidneys, bladder, not working properly ...



No symptoms.



A chemotherapy also called Taxotere, given by infusion at a hospital, usually 3-weekly.


Performance status

How well you are:

Poor performance status: Capable of only limited self-care, confined to bed or chair more than 50% of waking hours. (If your doctor believes this is caused mostly by your prostate cancer, and that treatment will greatly improve this, they may regard you as 'good performance status' for these guidelines.)


Evidence level

How confident researchers are of the evidence. 

This does NOT show how well the treatment works.

There may be level A evidence (the highest) that a treatment works, but that it only works in 30% of patients.


Index patients

The guidelines are written for 6 different levels of seriousness of the disease:

Index Patient 1. Asymptomatic non-metastatic CRPC

Index Patient 2. Asymptomatic or minimally-symptomatic, mCRPC without prior docetaxel chemotherapy

Index Patient 3. Symptomatic, mCRPC with good performance status and no prior docetaxel chemotherapy

Index Patient 4. Symptomatic, mCRPC with poor performance status and no prior docetaxel chemotherapy

Index Patient 5. Symptomatic, mCRPC with good performance status and prior docetaxel chemotherapy

Index Patient 6. Symptomatic, mCRPC with poor performance status and prior docetaxel chemotherapy


To see the guidelines, click one of these two links:





The link above is to a PDF file on another site.

PDF files are often large.

If you have not used a PDF before, your browser may ask you to get Adobe Acrobat.

Adobe Acrobat reader is available for free.

... end Jim

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