concerned about my dad

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rigagirl
New Member


Date Joined Apr 2010
Total Posts : 6
   Posted 4/7/2010 4:53 PM (GMT -6)   
Hi, I have been browsing these boards for a while. I am worried about my farther and any input would be much appreciated. He had PC surgery in March of 2008. The pathology showed the following: “Gleason grade 4+5, with established extraprostatic extension and perineural invasion. No definitive involvement of margins or seminal vesicles “. He did not start his radiation until a year later (March of 2009) and had 6 weeks of radiation. After the treatment his PSA was <.01, then went to .03 (3 months later) and .04 in November and he just had it checked again and it jumped to .266
I am wondering if the radiation therapy failed and the hormone therapy is his only option now… Or could it still be the post radiation “bounce”. His doctor does not seem to think so. He wants to start him on the hormones therapy.
What are your thoughts?

Thank you.
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Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 4/7/2010 6:21 PM (GMT -6)   
rigagirl,
I'm just a patient, but I have read everything about salvage RT I can over the past 3 years. To the best of my knowledge, "bounce" is a phenomenon that happens after radiation as a primary treatment, and not salvage (although PSA scores can fluctuate a little, especially when measured to two decimal places and beyond).

It does look like, from the numbers you provided, that salvage radiation has failed. It's very likely the cancer was already systemic on a microscopic level, before salvage even began.

Hormone therapy would indeed be the usual next step. The focus of the fight would shift from a curative effort to beating the cancer back by starving it of testosterone. For the best outcome, your father should be in the care of a medical oncologist, preferably one who specializes in prostate cancer.
Hormone therapy, often called androgen deprivation therapy or ADT, can sometimes buy the patient a lot of time, decades in some cases, but the actual time it will be effective varies from case to case.

Best wishes.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/7/2010 6:54 PM (GMT -6)   
rigagirl,

according to my own radiation oncologist, there isn't really any bounce after salvage radiation, that is usally associated with the different radiation formats used as a primary treatment. not a doctor, but based on the numbers your posted, it would appear that it failed. this means your husband has used up his curative shots at curing his PC. At this point, turning to HT would be a normal step, in order to slow down the growth of any remaining cancer.

perhaps some of the more "advanced" case brothers here could chime in on their first hand experiences with this next step.

welcome here, btw, sorry you needed to find us but you are most welcome to be here, and ask as many questions as you wish.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


rigagirl
New Member


Date Joined Apr 2010
Total Posts : 6
   Posted 4/7/2010 7:59 PM (GMT -6)   
Thank you so much for your replies. It's a real bummer. My farther did not jump at it soon enough, I believe, partially because he has been living overseas for the last few years. I still have a question though. If some of the cancer cells have escaped the prostate bed, why did his PSA go down to <.01 for a while? Would he still be showing some PSA numbers if he has cancer cells elsewhere?
Sorry, its just so confusing! My farther is only 61 and should still have many years ahead of him..........

Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 4/7/2010 8:15 PM (GMT -6)   
rigagirl,

I sympathize. I wish this hadn't happened to your father.

Your question is a good one. I guess the answer is that although PSA is an excellent early warning in the post-treatment setting, it still has its limits. The population of cancer cells could be so low as to not raise PSA above .01 initially. That's why men have to keep getting tested, even if they have undetectable PSA scores after treatment. All it takes is a few cells that have learned to live someplace besides the prostate. Over time, those cells proliferate, and when they do, they eventually, usually, throw off enough PSA to give themselves away. This usually happens far, far, before anything would show up on a bone scan or CT. With a lot of cancers, there's nothing like PSA to ring the alarm bell after treatment. In those cases patients can go along thinking they're cancer free, until bam! one day they have symptoms, and a scan shows tumors all over the place. With prostate cancer, and PSA in the post-treatment setting, it's different. We usually find out early, which is a blessing, albeit a harsh one.

In my own case, I'm not being tested on a sensitive level as your father. My PSA results simply say "less than 0.1". I could stay at that level for years and still have a recurrence down the road, so I will probably be tested for the rest of my life. It's possible I have a few prostate cancer cells setting up camp somewhere right now.

It's good that your father continued to be tested regularly. This gives him, and his doctors, time to evaluate his situation and come up with an appropriate strategy.

I wish you both well. What a lucky man your father is to have a caring daughter like yourself.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


rigagirl
New Member


Date Joined Apr 2010
Total Posts : 6
   Posted 4/7/2010 10:06 PM (GMT -6)   
Galileo,
thank you for your kind words!!

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 4/7/2010 10:23 PM (GMT -6)   
Good to chat with you tonight - we are here - if we can be of any help.

Kmac
Regular Member


Date Joined Mar 2010
Total Posts : 58
   Posted 4/8/2010 1:33 AM (GMT -6)   
 
Rigagirl - I'm really sorry, like everyone, that you have to be here. I understand how you are feeling as my dad also has PC, however we are at the beginning of the scary journey as he was only diagnosed a month ago and is yet to have surgery. If you ever need to chat or just vent about how you are feeling drop me a line.

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/8/2010 6:18 AM (GMT -6)   
rigagurl,
 
I'm sorry to hear that your Dad has likely failed salvage.
 
Both your Dad and I are in the same boat. I failed primary cryo and have a dilemma as to when to start hormone treatment (I do not qualify for any salvage as what is left of my prostate gland and the seminal vesicles are clean of any PCa). My Uro wants to wait until the psa passes 5.0 (presently 1.5) as there are quality of life concerns in such treatment. The reason why I am bringing this up is because I am searching for an oncologist for a second opinion (as to when to start hormones) and frankly, to guide me along subsequently. I suggest that at this point, your Dad should do the same thing. Even the best urologists are not always up to snuff on all available treatments and are usually more focused on just a few. With prostate cancer, it sometimes takes trials with many types of agents to find the one that will work the best; oncologists usually do a good job in this effort.
 
Best of luck to your Dad. 
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 4/8/2010 8:37 AM (GMT -6)   
sorry about your dad rigagurl
welcome to the forum too.

The fact that your dad's PSA was so low after radiation shows that almost everything had been destroyed, a very tiny amount of PSA can only get produced by a very tiny number of cells.

The rise now means that at the microscopic level some cells were not in the area treated with RT and they have been able to carry on growing, or rather increasing in numbers. Cancer cells don't really grow they divide and make more cells.
To put it simply normal cells have a mechanism that regularly makes a replacement and then the original cell dies (like with your skin: new cells grow on the inner layer of your skin and the old ones die and flake off on the outer layer ). In cancer cells this system goes wrong so as well as the new cell the old one stays around too so over time the number of cells increases. (Radiation sort of works by damaging the DNA in the cancer cells so that not only do they go wrong but they also can't divide properly to make new ones)

A rising PSA level is not wonderful news, but all the evidence would suggest that Hormone therapy is the right road to go down at this stage. The prostate cancer cells will also have trouble growing and replicating themselves if the production and distribution of testosterone is disrupted. And Hormone therapy treats the whole body, which helps deal with the cancer no matter where it may be.

(the husband of a friend of mine has had surgery then RT and HT and his PSA has been low and stable for a while now.)

All the best
Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist


BoisePSABantam
Regular Member


Date Joined Apr 2009
Total Posts : 20
   Posted 4/8/2010 9:05 AM (GMT -6)   
Rigagirl,

I'm a prostate cancer patient as was my father. One possible reason your father's PSA dropped to zero was his very high Gleason score. Many of those high scores, and some lower scores, my not express PSA, but the cancer is growing elsewhere. A lot has been written here lately on the value of bone scans and CT scans for teeny-tiny amounts of recurrent PSA. Most prostate cancers do express a predicted amount of PSA, but some odd variants do not. The only way to tell is with a bone scan and CT scans. Have your father get the scans so you have that information and your providers can make better decisions.

HT is about the only option at this point. Mitigate the effects with diet and exercise and he'll be around for a long time.
Pre-Surgery PSA: 4.92
age: 45 at DX.
DaVinci 5/07
1st PSA 0.07 8/07
2nd PSA 0.04 11/07
3rd PSA 0.04 02/08
4TH PSA 0.04 7/08
5th PSA 0.08 2/09
6th PSA 0.08 5/09
7th PSA 0.07 9/09
8th PSA 0.13 3/10


rigagirl
New Member


Date Joined Apr 2010
Total Posts : 6
   Posted 4/8/2010 10:19 AM (GMT -6)   
Thank you so much for all the input. I can’t believe how wonderful and responsive people on these boards are.
142 – it was nice talking to you last night.
Kmac- it is good to see another daughter on this board, thank you for extending your friendship. 
JoeyG, Alfred and BoisePSABantam – thank you for the information. My dad has had CT scans and bones scans and they did not find anything. His PSA was quite high before his surgery and then increased after the surgery well above .2 – that’s why they suggested salvage radiation…
HT sounds promising. Are there different types of HT? Do you guys have any opinion on which ones are “better” then others?

I think psychological effect of PC is almost harder then phycial. I think it is hard for my dad to come to terms that he will have to be treated for cancer for the rest of his life….

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 4/8/2010 11:04 AM (GMT -6)   
Hello rigagirl --- good on you for looking out for your dad. What a lucky guy!

Not so lucky is the treament failure. However, I write to tell you that my father went on HT when he was in his early 60s and was still on it many years later when his heart did him in. When he had a pacemaker installed, about 10 years before he died, the heart guy asked his cancer doctor, if his cancer was going to kill him. The heart guy said to me, "No sense putting your dad through this if his time is limited." So, off the heart guy goes to phone the cancer doctor and ask, "Tell me, is his cancer going to kill him?" A few minutes later the heart guy comes back down the hospital hall grinning from ear to ear. The cancer doctor's response was, "Absolutely .... it will kill him .... but, he'd have to make it to around 150 before it started to cause him issues." The heart guy said to me, "Looks like we'd best do the pacemaker to help him reach the 150."

May your dad do so well too.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02  
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
Feel free to email me at:  sheldonprostate@yahoo.com    


rigagirl
New Member


Date Joined Apr 2010
Total Posts : 6
   Posted 4/8/2010 11:13 AM (GMT -6)   
Sheldon - what an encouraging story!! I just need to gather all this information and pass it on to my dad, because like I said... the hardest thing for him right now is to accept that he might have cancer that is no longer curable. The effec that it might be slow progressing should be of much comfort for all of us invovled!

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 4/8/2010 11:51 AM (GMT -6)   
Hello again, rigagirl,

I'm 67 now --- check back in a couple of weeks and I'll be 68 --- and have been living with the knowledge I have cancer for a year now. It may be gone, it may not be. I can understand your dad having trouble thinking the doctors are stopping talking cure, and instead talking of beating it back.

I've no idea of what the long term success rate is with HT, but the few people I've known on it have pretty much all died in their beds of something else --- what used to be called 'old age' on the death certificates. As we get older, your dad and I, we come face to face with our mortality and it's difficult to accept that these bodies we've lovingly nurtured with extract of hops, ryr, wheat and sugar cane --- all the great food groups in liquid form --- are giving up on us. One of the problems us PCa guys have is that we know about the PCa and so we're focused on that when, fact is, it's likely the cancer we don't know about, or our plugged arteries, or the weak vein in our brain waiting to pop that's the real threat.

I don't want to make light of your dad's situation, or the possibility that it might be quite serious (I just don't have a clue) but I do think that if he's able to put this risk into perspective with other risks he may start to walk down the street as I do, looking at other men my age, and realizing that a lot of them are carrying around and growing prostate cancers, and they don't even know it. I suspect I'm in way better shape than they are, and your dad too. We've both got doctors watching over us and treatments and drugs to take to beat back the beast. Those other guys don't have this going for them.

I hope you'll keep writing and letting us know how your dad --- and yourself --- are doing.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02  
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
Feel free to email me at:  sheldonprostate@yahoo.com    

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