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Me again!

I've been trying to come up to speed on some of the things you wrote about in your question, and I am also coming up with a few questions of my own.

When you were originally diagnosed with prostate cancer, what were your PSA numbers?

And then you had radiation and the Eligard shot, which reduced the PSA to .6, but since changing drug therapy the PSA is rising again, correct?

How long has it been since your radiation treatment?

And when did the kidneys become involved, and why? Do you know?

Are you on antibiotics? How about other medications?

How long ago was the first percutaneous nephrostomy, with its stent?

And I'm not sure I understand why the second percutaneous nephrostomy would be basically "permanent" ?

OK. Those are my beginning questions, and while I know some of them are very basic, the answers may also prove helpful to the doctor to whom we forward your question.

In the meantime, I'll try to give you some good information you can read on the web. I'm just going to break your question into pieces and see where it gets us.

In case anyone else reading this needs an explanation of the PSA test, here's a good primer:

http://www.cancer.gov/cancertopics/factsheet/detection/PSA

A rising PSA after cancer treatment can, of course, signal more cancer activity, but it is also possible that there are more explanations: "According to Dr. Susan Slovin of Memorial Sloan Kettering Cancer Center, a rising PSA does not always indicate cancer or a recurrence. Moreover, even a steady rise and a very high PSA do not necessarily mean that a man will die of prostate cancer. A recent study suggests that a rising PSA "may indicate that the body is attempting to fight cancer by producing its own antiangiogenic proteins." Journal of the National Cancer Institute 1999;91:1635-1640

Here's that reference:
http://www.hypertext.org/ENGLISH/PSA.html

that's from the Hypertext Guide to Prostate Cancer:
http://www.hypertext.org/ENGLISH/OVER.html#toc

IF that study seems relevant, here is the text:
http://jnci.oxfordjournals.org/cgi/content/full/91/19/1635

And here's one more article on Rising PSA that you might be interested in:
http://www.cancernews.com/data/Article/233.asp

This article suggests that the faster the rise in the PSA, the more aggressive the cancer treatment should be:

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Rise_in_PSA_May_Predict_Aggressive_Prostate_Cancer.asp

Are the kidney problems in part (or whole) being attributed to the chemotherapy? Is there a hope that function can return, or is there permanent damage?

I see that on this page regarding Eligard, some side effects can be urinary blockages and problems with normal kidney function. Is this in part what happened?

http://www.eligard.com/resources/isi.aspx

here's an overview of percutaneous nephrostomy, which notes that the most common reason for it is in cases of urinary obstruction. The "discussion" at the end includes more info:

http://emedicine.medscape.com/article/421260-overview

Part of the reason to insert the tubes is to allow the kidneys to heal. And the stents prevent scar tissue from forming where it would be troublesome. While reading various articles on the web, I found several blogs by patients who had percutaneous nephrostomies and stents placed in both kidneys/ureters.

From what you wrote, it sounds like your doctors' intentions and hopes are to fix the problem with the kidneys so they can return to addressing the prostate cancer, am I right?

This page does refer (a bit) to recovery after percutaneous nephrostomies:
http://www.medsolution.com/surgery_urogen-nephrostomy.asp

So your reference to possible transplant or dialysis makes me think that for some reason the kidney damage may be irreversible. Is this what you've been told?

Was your PA all right with your waiting for the second procedure until Tuesday?

Let's say that the kidney problem is resolved to the best degree that it can be. What did your doctor say would be the next step in your prostate cancer treatment?

And just because I thought you'd be interested, here are a couple of prostate cancer forums that seem very current:

http://www.malecare.com/
http://prostate-cancer-log.blogspot.com/
http://advancedprostatecancer.net/

I hope I haven't thrown too much information at you at once. Like I said, I'm learning along with you. If you can get back to us with the answers to the questions above that seem relevant, we'll work to get an expert opinion as soon as we can.

Until then, take care. You are your own best advocate. Make sure they manage your pain, and use your PA to get you all the information you need until you can talk to your urologist or a nephrologist. And use us when you have more questions. That's what we're here for.