Need help for my dad - is this treatment plan reasonable?

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dmid
New Member


Date Joined Feb 2008
Total Posts : 4
   Posted 2/23/2008 7:33 AM (GMT -7)   
Hi everyone, we are very new to all this, and I am new to this forum. 
 
My dad, 65, was recently diagnosed with prostate cancer.  When he went for his medicare checkup his psa was elevated.  They tried an antibiotic, but it didn't work and his number increased (I don't know offhand what it was up to).  They did a biopsy and discovered the cancer.  He was just in to the urologist for the follow up appointment - he is staged at a T1-c, and his Gleason was a 7 (I don't remember if it was 4+3 or 3+4).  They did a CT and Bone scan and did not find that the cancer had spread.
 
Dad does NOT want to do surgery, due to the potential side effects.  The dr's seem to agree - there is a 43% chance that the cells have moved into the area outside of the prostate. 
 
The urologist feels he is not a good candidate for the seeds due to the size of his prostate and the chance that the cells have moved outside the prostate.
 
They recommend that he do the hormones for two months, then the radiation. 
 
Any thoughts?  Any questions we should be asking or things we should be concerned about?
 
Dad is very comfortable with the doctor and very comfortable with the plan.  He sees the radiation oncologist this week.
 
Thanks for any input that you may have!!

Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 2/23/2008 12:46 PM (GMT -7)   
Sounds like a reasonable plan. How nice it is to have such a caring and interested daughter !!!
 


FLHW(David E)
Regular Member


Date Joined Nov 2007
Total Posts : 201
   Posted 2/23/2008 6:08 PM (GMT -7)   
Have you looked into protons? Quite expensive as most insurance companies will not cover?
I have not experienced it, just heard a lot about it and thought I'd throw it out there as an option.

go to www.protonbob.com
Dx'd 2/18/05
PSA 219, bone mets, lymph node involvement
Gleason Score: 7
Current (1-28-08)
PSA: 36
Lupron, Nilandron

Personal Blog:
prostatecancerat42.blogspot.com


dmid
New Member


Date Joined Feb 2008
Total Posts : 4
   Posted 2/24/2008 5:33 PM (GMT -7)   
Thank you both for your responses.  I will definitely check out the protons...have not heard of that treatment at all!!
 
 

Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 2/25/2008 5:16 AM (GMT -7)   
DMID,

I'd be certain and get another opinion from the best treatment center you can access.
You can do this while you schedule and plan your treatment.
(If you let us know your general area, many here can likely give you some recommended-by-expereince facilities.)
While only the patient and his loved ones are familiar enough with all the issues to make an informed treatment choice, the emotional roller coaster of being informed you have cancer can sometimes lead to hasty interpretations of the "specialist's" advice - especially when trying to read best-guess percentages.  [For example, several "7's" here have been re-stated a "prostrate-contained 6" in post-surgery biopsy.]

One other point, I don't believe radiation (except maybe Proton) should be chosen to avoid side effects.  The side effects (incontinece and E.D. - both usually treatable) will likely only be delayed.
This would be a good topic to bring up in the second opinion consultation.
I would also use this consultation to question the 43% number and how it should be weighted in your decision tree.

Many patients have chosen radiation and this choice has served them well.
You have found (informed and caring) friends here as you investigate your options and move through your treatment of choice.

Your friend,

CCedar
ICTHUS!
2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
OPEN R P 16FEB07 at age 54. 1+" tumor - touching inside edge of gland.  + Confined:)
Pad Free @ 14 weeks.  Six Month PSA <.003  :)   Nine month PSA <.008
:)
At 9 months, ED treated with Pump Exercises & 100mg Viagra Daily

kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 2/25/2008 6:50 AM (GMT -7)   

    I'm sorry you have had to join us to help your father.  The decision you make has to be made for You and your Family.  All we can do is share our stories.  All I will say is that although the ED and in my case Incontinance side effects can be problematic.  Most of the time they can be dealt with.

    We are wishing you well in your decision and treatment.

    KW


    43
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second opinion Doctor at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 4th, 2008 - Appointment with Original Dr. to discuss options and recomendation for surgical fix for incontinance.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
 
     


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8122
   Posted 2/25/2008 8:49 AM (GMT -7)   

Hi ~  dmid & Loved Ones…

 

Welcome   to…   ~ HealingWell ~

 

and

 

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Click on the link just below for important information that will help you ~ help us!!

 

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The information (link) listed above is to help you get started on your journey.

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 2/25/2008 8:59 AM (GMT -7)   
Hi dmid,
As you can see there are amazing helpers here at HealingWell. I too, needed their assistance for my own disease, my cancer had indeed spread a bit but I am doing very well regardless. You mention the 43% number. I have seen many nomagrams that had told me about the 33% chance that my disease had spread but it was in my case 100% after surgery. Even still I still believe that I can win and there will not be another occurance. So if you can take the time to look at the 43%, reverse that thinking, that means 57% chance likely it has NOT spread. Those numbers have high error rates and are not always accurate predictors. It's best to be positive, believe positively, and stay positive.

PS. Do you know what his PSA is, yet? You'll notice many of us have a signature line below. If you will, you can have one also. Your personal profile in the control panel is where you can put it. It will help folks with similar numbers to respond.

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 2/25/2008 12:07:38 PM (GMT-7)


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 2/25/2008 9:51 AM (GMT -7)   
dmid,

The treatment plan appears to be right for your dad and having confidence in the treatment provider is very important. The statistics indicate that radiation and surgery have about the same effectiveness on cancer reoccurence out to 10 years after the treatment. After 10 years surgery has a better result. With your dad being 65 then radiation is certainly a valid treatment and it sounds as if the doctor believes that the cancer may have escaped the gland. I am sure that your dad will do well.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 2/25/2008 10:30 AM (GMT -7)   
I am sorry to hear you are in the same position that I was a few months back.  My father also was diagnosed with prostate cancer, Gleason 7.  He turned 63 a few days before his surgery. We opted for surgery, however, my father was very nervous about the side effects.  We went into the surgery hoping that the surgery would cure his cancer and get everything.  Unfortunately, it did not.  However, we would not have known for sure that the cancer had spread outside the capsule if he did not have the surgery.  I also feel that having surgery (and hope) that the surgery has removed 99% of the cancer.  My dad has been on Lupron since January and will start radiation in 9 days.  I am praying that the radiation will kill any remaining cancer for good.
His PSA was .05 following surgery.  It is such a difficult decision and while my dad was so concerned about the side effects of the treatment....and still is...the rest of the family is more concerned about the effects of the disease.  It is a lot to get your mind around and I wish you and your family the best.  Keep us posted.
 
Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07
Lupon beg. Dec 03, 2007 2 yr
Radiation soon to follow
 
 


dmid
New Member


Date Joined Feb 2008
Total Posts : 4
   Posted 2/25/2008 11:48 AM (GMT -7)   

Thanks everyone!  I did find out that his psa was 8.4.

I updated my profile to include a signature...I think tongue


Dad, 65, diagnosed 2/8/08
PSA 8.4
Gleason 4 + 3 = 7
Stage T1C
Plan to begin hormone therapy and radiation soon
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/25/2008 2:18 PM (GMT -7)   
Hi Dmid
 
Your Dad's projected stage of PCa appears similar to mine was when I was diagnosed.  He would be a prime candidate for some form of beam radiation treatment.  Please read my thread referenced in my footnote below and learn all you can about proton radiation therapy for your Dad as part of the educational process in making a treatment decision for him.  If your Dad is on Medicare, which I am assuming he is at age 65, Medicare pays the full cost of proton radiation treatment at one of the several proton treatment centers in the U.S.
 
Keep in mind that hormone therapy slows down the cancer, but does not eradicate it.  There can also be unpleasant side effects from hormone therapy.  I am just wondering why his doctor wants to start hormone therapy now and then get to some form of radiation treatment two months later.  He may have a good reason, but you should know what the reason is.  Perhaps the reason is to shrink his prostate before treatment.  I don't really know how important it is to reduce the size of the prostate if a patient is having radiation treatment.  I would ask his doctor this question.
 
There is always some degree of  probability that the cancer has spread beyond the prostate, depending of the Gleason score and other tests.  Tables have been constructed to give a projected probability percentage--I assume that is how the 43% probability was determined in your Dad's case.  I did not put a lot of emphasis on this statistic when making my treatment decision, especially if the post biopsy scans are negative (which they were in your Dad's case).  No matter what treatment one elects (including surgery),  there is always some probablity that the cancer may recur (hopefully it is a small probability if the cancer is treated early enough).  If the cancer is treated early enough, many studies today indicate that the chances of a cure are relatively close for all forms of treatment, especially in older patients.   
 
Did your Dad get a 2nd opinion on his prostate biopsy?  This is very important because determining the stage of cancer by reviewing the biopsy slides is more of an art than a science.  Many patients have their slides sent to Johns Hopkins for a 2nd opinion.  The potential concern in your Dad's case is to make sure that a 2nd opinion does not result in a Gleason 8, which would be cause for greater concern.
 
Best of luck to your Dad. 
 
Dave


-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 

Post Edited (pcdave) : 2/25/2008 2:21:47 PM (GMT-7)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 2/26/2008 7:43 PM (GMT -7)   
tongue Hey ~ dmid, Dad, & Loved Ones,

 

We’re glad you found all of us!!!

 

We know ~ we can “all” make “Your Journey” smoother just by being here for you! 

This is truly a great forum!!! ~ You have joined!  You are now part our forum family ~ a group of wonderful individuals who are so willing to share... 

So ~ Please stay with us and take our hand when you need it! 

Keep posting.... OKAY!!  

  

KNOWLEDGE    IS    POWER  ...  and  POWER conquers  fear

 

YOU MAKE THE DECISIONS… YOU HAVE OPTIONS…

~ and ~

Your decision will be the right decision for you!!!

 

Pull from “all of us”… things that will help to make your dad’s journey smoother.

 

Our thoughts and prayers will be with all of you as you continue your research.

Keeping you close in thoughts and prayers.

In Friendship,  Lee & Buddy

 

“God Bless You”

It's a little prayer  ~  "God Bless You" ...but it means so much each day,

It means may angels guard you and guide you on your  way. 


mama bluebird - Lee & Buddy… from North Carolina

 

v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

4th PSA 2-13-2008 (23 months) Less than 0.1 Non-Detectable :)


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 2/26/2008 8:00 PM (GMT -7)   

Quote taken from dmid’s 2nd thread titled:  pcdave

Thank you for your response to my post about my dad!!  I am so thankful that there are so many people willing to help us to help dad.

 

OK...couple questions:

 

1.  How does one go about getting their biopsy slides sent to John Hopkins, and how long does that take?

2.  Is proton radiation different from the radiation that you normally hear about

3.  Regarding the hormone treatment - the urologist recommended this, but dad will be seeing a radiology oncologist on Thursday, so I am so happy you brought this up so they can ask.  The urologist said that using the hormones would kind or "arrest or freeze" the cancer from continuing, and then at that point they would zap it with the radiation.  Do you think it could be a problem to wait for so long to start the radiation?

 

Thanks again for any help!


Dad, 65, diagnosed 2/8/08

PSA 8.4

Gleason 4 + 3 = 7

Stage T1C

Plan to begin hormone therapy and radiation soon


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 2/26/2008 8:57 PM (GMT -7)   
If there is concern about the Pca leaving the prostate, a color doppler would indicate the location and extent of the tumor.  Could be helpful in making a treatment decision.  I too had proton and recommend it highly.  Proton is different than radiation (photon) in that  it does not exit the body, but stops at the tumor site.  Best wishes to you both. 
Dutch
Diagnosed Feb 2001  (Age 65)  Currently 72
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - Aug 2001 - No side effects.
6yr PSA - 0.19
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/26/2008 9:55 PM (GMT -7)   

Hi Dmid

We are all here to help!  You are most welcome!  Here are the questions you asked me in a separate thread which Bluebird has posted above.

1.  How does one go about getting their biopsy slides sent to John Hopkins, and how long does that take?

 

Tim G did an excellent job in responding to this question which I am copying here:

 

"My biopsy slides were sent to Dr. Jonathan Epstein at Johns Hopkins for a second opinion.  My urologist initiated the request and the pathology lab here in Seattle sent them to JHU.  I had a confirmatory second opinion on the slides back in about 10 days. Dr Epstein confirmed the positive biopsy and the Gleason score of 3+3."

 

2.  Is proton radiation different from the radiation that you normally hear about

 

The experts claim that proton radiation is a safer form of radiation than photon or x-ray radition. "Protons deposit their radiation differently than x-rays do. Compared to an x-ray beam, a proton beam has a low “entrance dose” (the dose delivered from the surface of the skin to the front of the tumor), a high dose designed to cover the entire tumor and no “exit dose” beyond the tumor."  X-ray radiation enters and leaves the body at the full dose of radiation with the potential for more damage to good tissue surrounding the prostate than with proton radiation.  However, x-ray radiation has become more sophisticated in recent years (e.g., IMRT) in which the dose of radiation is more controlled to help reduce damage to good tissue surrounding the prostate. If you read my thread on my journey with prostate cancer, I have given more detailed information about proton radiation and why I chose it.  http://www.healingwell.com/community/default.aspx?f=35&m=1002871

 

3.  Regarding the hormone treatment - the urologist recommended this, but dad will be seeing a radiology oncologist on Thursday, so I am so happy you brought this up so they can ask.  The urologist said that using the hormones would kind or "arrest or freeze" the cancer from continuing, and then at that point they would zap it with the radiation.  Do you think it could be a problem to wait for so long to start the radiation?

 

As I said in my first posting, it appears that your Dad's stage of cancer before treatment is similar to mine.  From the time I was diagnosed with PCa, I did not start my treatment until  almost 5 months later.  The delay resulted because I needed time to research my treatment choices and make a treatment decision.  A good majority of my waiting time had to do with getting an appointment with my radiation oncologist of choice at a proton radiation threatment center and then getting an opening for treatment.  From my research, a waiting time of a few months before treatment is not usually considered a problem because prostate cancer is usually slow growing (but not necessarily for all men).  In your case, you should become as educated as possible in your Dad's treatment choices and not be swayed solely by either the urologist or radiation oncologist who are treating your Dad at the beginning of this process.  They, of course, will be part of your education process.

 

I know that this is a very stressful time for your family right now.  The key to stay as calm as possible and become as thoroughly educated as you can in your Dad's treatment choices.  It seems that you have already boiled his treatment down to some form of beam radiation treatment.  Therefore, you need to explore both x-ray radiation (IMRT) and proton radiation.  You need to be familiar with the pros and cons of each treatment and the potential side effects.  While many men (including many members here) who are your Dad's age or older have had their prostates removed surgically, I agree with your Dad that the potential side effects from surgery may well be more problematic than those with radiation treatment.  The medical oncologist that I consulted with told me that I had about an equal chance of a cure with any form of treatment I selected.  It was then a matter of deciding what treatment gave me the best chance for quality of life with the fewest potential side effects after treatment.  Some men feel the need to have their prostate removed surgically no matter what the potential side effects are after surgery.  I think it makes sense for younger men (in particular) who are unwilling to gamble that some other form of treatment will give them the remaining longer life spam that they expect.  Younger men often seem to overcome potential side effects better then older men (but not always). Because I was almost 69 years old when diagnosed, it made the decision to opt for radiation treatment very easy for me.

 

Keep us posted as to the progress you are making.  Don't hestiate to keep firing questions at us because members here are more than willing to help and share with you their experiences with prostate cancer. 

 

Best of luck and God Bless!

 

Dave



-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  
 
 

Post Edited (pcdave) : 2/26/2008 10:08:28 PM (GMT-7)

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