How can high PSA levels be controlled?

Q: My 61 years old father is suffering from prostate cancer for the last one year. Initially, his PSA level was 637 and his backbone was paining for the last six months but after radiation therapy and surgery the PSA level came to normal range. First he had taken Bypro and then he started taking Cytomid 250 mg. But now his PSA level is increasing. I want to know about the further treatment and the risk factors of this increasing level of PSA? Which type of screening test should be done now?

A:In patients with prostate cancer and very high PSA, any recent onset back pain or pain in any of the bones should be investigated to rule out spread of tumour to the bones (i.e. metastases). Bone scan is the right investigation to screen for bony metastases. It is very important to pre-emptively treat bony metastasis in order to avoid fractures and associated complications. In your father's case, he is already on hormonal treatment. In such cases regular monitoring would include 3 monthly PSA levels, 6 monthly or once a year (decided on case to case basis) bone scan and DEXA scan to monitor for bone weakness. Hormonal therapy itself can lead to osteopenia (i.e. bone weakness) due to lack of testosterone action.