Advance Prostate Cancer

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ray123
New Member


Date Joined Apr 2010
Total Posts : 7
   Posted 4/26/2010 11:03 PM (GMT -6)   
Hi guys!
 
So this is my first post. My father was just diagnosed with prostate cancer about a month ago and he told me two weeks ago (i am his son). I cannot find many people on here with advanced prostate cancer advice so I decided to ask. From what i can tell he is at a severe risk. His PSA was like 44 with a gleason of 7 (4+3). He just finished with all of the tests and his lymph nodes are completely fine. However, a very small spot was found on the spine and they speculate it to be a metastatic prostate cancer. Im not totally sure though. However, he is very young as well, only 43, so he has very high strength and mental resolve. He has yet to see even the first sign of symptons and has changed his diet to completly help (vitamin D3, broccoli, vegetables, fish, no sugars, various supplements and 5 glasses of green tea a day). Sadly I'm not quite sure what to expect or what the best thing for him to do is. I know radiation has been suggested because of how young he is in combination with HT. Have any of you been in the same situation, and what do you all think is the best route to take. I read you can actually scoop out the tumor in the spine if it is one especially since its small then fill it with liquid nitrogen and burn away the cancerous cells while getting the prostate removed but im not totally sure. What do you guys think. And why is surgery usually out of the question following mestastasis? I do not understand why it wouldnt be smart to remove the prostate anyway since its the point of origin and the only metastasis is a small one on the spine. He is very young so I think he could take the rigourous treatment. What do you all think?

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 4/26/2010 11:39 PM (GMT -6)   
Ray,
Sorry to hear about your dad. If the PC has escaped the prostate, whch is very likely with a psa of 44 then surgery only won't work. If it is in his spine then it is most likely in other places, but is too small to detect. Radiation combined with Hormone treatment can still work. The best advice is to see a good oncologist that specializes in prostate cancer because it now has to be treated as a systemic disease and just a local treatment like surgery or radiation won't work. A good oncologist can also run more tests to determine where the cancer is.
There are many patients that have been on hormone therapy for years and many cases of HT causing the PC to go into remission. Keep up hope. the diet will slow the progression of the PC so have your dad keep it up.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


ray123
New Member


Date Joined Apr 2010
Total Posts : 7
   Posted 4/26/2010 11:45 PM (GMT -6)   
He is seing the 7th best doctor in the nation at the Duke hospital clinic, so that is very good. I know that they have done like 3 bone tests and only the spine showed up (and I think pelvis bone a small one but that was it) and the major organs were working fine. Bit i dont see why removal of the prostate, a hip replacement and the liquid nitrogen wouldnt work. Its not like hes 77 but I think they are discussing it tomorrow. I can only hope for the best when he sees the doctor and oncologist tomorrow.

aspen4
Regular Member


Date Joined Dec 2008
Total Posts : 59
   Posted 4/27/2010 5:09 AM (GMT -6)   
Sorry to hear about your dad. You will gain a lot of information from all the good members here. I was diagnosed 2 years ago at age 50 with a PSA of 342. HT has worked very well for me. Get your dad a top notch urologist and try not to overthink this. Hard not to do. There are some very knowledgable people here who are glad to help.

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/27/2010 6:04 AM (GMT -6)   
Ray, I have no advice for you but wanted to simply extend a "hello" to you. I hope that your dad's visit with the oncologist gives him (and you) some positive news and hope.

Do you happen to know if there is any family history of prostate or breast cancer (there seems to be a link between the two) since 43 is way too young to be dealing with such a serious situation.

Please come back and let us know how things are going for you and your dad. You will both be in the prayers and thoughts of all of us here.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/27/2010 6:15 AM (GMT -6)   
Ray, I think John and the others are right on th mark. Getting a very good medical oncologist is the most important think to do at his point, and it looks like your Dad has one. A lot can still be done. I have a high risk PCa, gleason #8, and have just had a recurrence. Doctors at Dana Farber recommended radiation and HT for me. From the research I have done it seems like the way to go. BB. Hang in there.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/27/2010 9:01 AM (GMT -6)   
Hello Ray,
 
I wanted to help out with one of your questions.  You have been told that surgery is (usually) not prescribed for men with metastatic prostate cancer, but were not yet told why...
 
Surgery for prostate removal, called a radical prostatectomy (or RP for short), is performed when there is a high likelihood that all of the cancer is confined inside the prostate, which is the case with the majority of men at the time of their diagnosis.  If the cancer is confined, then removal of the prostate can result in a complete cure for the patient, and he may never have to deal with the problem again.  This is the best possible outcome.
 
If the doctors believe (based on tests or on a comparison to other cases with similar characteristics) that the prostate cancer (PC for short) has escaped to lymph nodes, or bones, or elsewhere, then surgery is no longer curative by itself.  If the doctors believe that the escaped PC has remained local in the prostate bed area, then radiation is often the best solution for treatment, because it is directed to an "area" around the prostate.  It, too, can be curative, if the spread is only in that area. 
 
If the PC has spread outside the prostate bed area, what they call "distant" (to bones or other organs), then the doctors usually focus on a containment strategy using hormone treatment (HT) to effectively manage the PC.  Removal of the prostate is usually not performed in this case, again, because it is major surgery and it does not "cure" the situation.  The HT is used to treat the cancer in both the prostate and distant PC.
 
Hope that this helps answer that question...

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 4/27/2010 9:29 AM (GMT -6)   
Ray,

If the spot on the hip is not cancer, then Radiation treatment may kill all the cancer in the local area and cure your Dad. If the spot is cancer, the Radiation will do what you are talking about - reduce the cancer load. They can also zap the "hot spot" with Radiation to prevent any side effects. Hormones are given in a high risk cases because they were shown to improve results of Radiation treatments. Also, if the spot they found is metastatic, the Hormonal treatment is a standard of care. So, on the surface, the doc's recommendation is appropriate. HOWEVER, I would join others in saying: get more opinions from good oncologists.

I was is a "high risk localized" group, my PSA was around 30 and G8. I was 47 at the time of diagnosis. I was offered a couple of clinical trials and took one. It is something your Dad may want to consider. I also went to Duke. My oncologist was Dr. Febbo and surgeon was Dr. Moul. Who is treating your Dad?

Most of all, keep your (and your Dad's) spirits up.

All the best,

Greg
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 4/27/2010 9:30 AM (GMT -6)   
ray, I have nothing to add to your information so far, but want to welcome you to the Forum. Also, see if your Dad would be interested in joining us- for support- friendship and just general sharing.... He and you will always be welcome here.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 10 gms., margins clear
32 Months: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/27/2010 10:17 AM (GMT -6)   
Ray --
 
Sorry to hear about your dad's illness.  My dad had prostate cancer, so I understand very well the anxiety and the desire to be helpful.  By doing some research and asking intelligent questions on this Board, you are doing your dad a great favor. 
 
One question you asked is why not do the surgery even if the cancer appears to have spread.  There is some support for that -- typically referred to as "debulking the tumor."  What they mean by that is getting rid of the place where most of the cancer is located (the prostate).  Your dad might ask his oncologist about that.  The reason it is often not done is it won't cure the cancer if it has spread, and the surgery often has some unpleasant side effects. 
 
Last thing I would add is this:   In prior posts, there has been some reference to a urologist and other references to an oncologist.  They play different roles.  In your father's situation, I would rely primarily on the advice of a medical oncologist, rather than a urologist.  Of course, he could consult with both, but with advanced prostate cancer, better advice tends to come from a medical oncologist IF he has substantial experience with prostate cancer.   One of the mistakes my father made was staying for too long with a urologist.  
 
Best wishes,
Medved
 
 
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Kmac
Regular Member


Date Joined Mar 2010
Total Posts : 58
   Posted 4/27/2010 10:33 AM (GMT -6)   
 
Hi Ray,
 
Like everyone else has said on here - sorry you have to be here, however you have come to the right place for invaluable words of wisdom, advice and support. The men (and women) on this forum are lovely people who really do care.
 
I understand how you are feeling right now -my dad was also diagnosed a bit over a month ago and it is still all very overwhelming and scary. I cannot provide you with any medical advice as I am still researching.
 
If you need to vent though and just want support I can provide that. I feel really helpless as the child, but still want to be able to help my dad and all the info that Ican to pass on to him.
 
All I can say is -go one step at a time with this disease and visit here for support.
 
Kylie

ray123
New Member


Date Joined Apr 2010
Total Posts : 7
   Posted 4/27/2010 10:58 AM (GMT -6)   
Quick update, he went back to his doctor for the "final report" from all of the bone and CT scans. It is confirmed there is two spots, one on the hip and one of the spine (they wouldnt tell us size). I did want to mention that you guys are awesome for responding so fast and being so caring. Secondly, there IS a family history of the disease, but I don't think it has ever been this serious. The doctor he saw earlier today said he would not want to do surgery unless the prostate swelled. My dad goes to see the oncologist at 1 and plan on asking him about surgery to (my dad is willing to take on the potential side effects for the potential lifespan increase). I will keep you guys updated about the oncologist and the suggested treatments and what not.

P.S Has anyone tried the Cryoablation procedure. Looked rather effective for curing cancer in the spine or hip and killing the cells. Atleast putting it in remission.
 
Ray

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/27/2010 11:22 AM (GMT -6)   
Ray,

I want to welcome you and your father too, to HW Prostate Cancer. I can't add much, was reading all the posts above, and you have been getting a good welcome and a slew of good advice already.

From reading your update, surgery doesn't sound like it would be a productive treatment for your dad. As far as Cryo procedure, of all the potential primary treatments when I was first diagnosed, that was the only one that my urologist was strongly against. He thought that as a rule, it was very ineffective, and can cause probllems otherwise.

Hopefully the right combinations of radiation, combined with Hormone Treatment, would be the path to helping your father getting this PC under control.

I wish the best to both of you, and hope you stick around and keep us posted closely of his events.

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, 4/8 .04, next one:  July
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- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/27/2010 12:52 PM (GMT -6)   
Best thing for you is to go see top notch onco-docs like Scholz, Strum, Volgezang, Myers. Top uro doc does not even compare to these guys. Radiation can be palliative and relieve possible pain at bone sites, Dr. Jeff Forman is reknown in doing many patients for such and is in Michigan he is mentioned in some PCa books for a good reason. There is no point in doing surgery or cryo or hifu. If you did radiations to the gland and pelvic areas it could 'maybe' cut down on tumor burden and not a cure because mets have been found already, but once outside the gland even micro mets can occur. Hormone and drug therapies can do wonders for perhaps years and years and without the other treatments.

I am a 8 yr. survivor and psa of 46.6 and plenty of PCa found all 12 biopies 75-95% and Gleasons 7,8,9's, total urinary blockage too and scans appeared clear (worthless data anyway-not definitive for micro mets), did radiations and ADT3 hormone therapy as primary treatment, switched drugs back in 2005 and done well intermittently on old school drug, so 8 yrs. plus since emergency room and first psa test ever. Get the book - A Primer on Prostate Cancer (you need it asap).


Youth is wasted on the Young-(W.C. Fields)


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 4/27/2010 1:03 PM (GMT -6)   
Hi Ray,
 
I am sorry to hear that your Dad's cancer has metasized. Seems that many young men who have PCa have the most aggressive forms.
 
The information that I've read on this thread is right on the money. With that, there are a few doc's who do recommend "de-bulking." If I'm not mistaken Dr Snuffy Myers is one of them. However, in Dr Myers' case he went for the lymph nodes, too, eliminating several. Since your Dad's cancer has gone beyond the lymph nodes, that would likely not be prudent. Further, I would wonder whether de-bulking would even be covered by insurance. Therefore, unless your Dad is wealthy AND insistant upon getting a debulking procedure, the two least costliest methods are HIFU and cryosurgery, either of which would do a good de-bulking job, with minimal quality of life issues. The question really is, does de-bulking potentially increase lifespan? And the answer is, no one really knows and most believe it doesn't.
 
As to freezing the bone spots, I believe radiation is the preferred method. Your Dad's oncologist may recommend radiating the spots and that is something that usually provides pain relief and, if the spine is affected, minimizing the possibility of serious spinal issues.
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


ray123
New Member


Date Joined Apr 2010
Total Posts : 7
   Posted 4/27/2010 4:44 PM (GMT -6)   
Thanks so much everyone for the advice. My father went to the oncologist and was prescribed casodex (I think thats the spelling) and will be given HT starting next tuesday. Hopefully his body will not resist the HT for quite some time. He also was allowed into a study in which he wil be monitored much more closely than if he were not during his HT treatments (every 3 weeks he does a PSA rather than months). So now we are very hopeful and glad that we got no more bad news today. Thanks again everyone you all have been awesome. Now i need to get him to join the site to discuss his trials because we cant quite understand what hes going through like all of you.

Ray

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/27/2010 6:35 PM (GMT -6)   
The frequent monitoring sounds like a good idea. Starting the Casodex before the LHRH agonist (Lupron, etc.) is also a good idea, since it helps prevent psa "flare." So sounds like your dad is on the right track. He might ask the doctors whether, as part of the regular monitoring, they will check both Testosternone (T) levels and Dihydrotestosterone (DHT) levels. You want to check T levels to make sure the HT is doing its job (keeping T at an acceptable level). You would check DHT levels because T is converted in the body to DHT and DHT is thought to promote growth of CaP cells -- so you want to keep DHT levels low. Some oncologists will add dutasteride or finasteride to the other "hormone" treatments, because they help control the conversion of T to DHT.

But more important than any of this science -- which after all the doctors will have a good handle on -- is for your dad to know that you are in his corner -- which you obviously are.

Best wishes,
Medved
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

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