Another worried daughter needs help. Dad has Stage 4 PC

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chadhas
Regular Member


Date Joined May 2010
Total Posts : 25
   Posted 5/14/2010 2:55 PM (GMT -6)   
Hello,

My Dad was diagnosed with stage 4 PC in March 2010. Initially the doctors suggested a biopsy but after getting bone scan and MRI results, it was discovered that the cancer was already spread to his bones (pelvic, spine and almost all major skeletal bones). So his urologist said that biopsy is no longer required and we should start the treatment asap. PSA at the time of diagnosis was > 500.
He had his Orchiectomy done in end of March 2010. He is now getting Zometa infusions once every 3 weeks and also taking Bicalutamide 50mg.
I have a few questions and would appreiate any help:

1) Is this the correct line of treatment for him?
2) Is PSA related to the level of metastasis? Does extensively spread metastasis imply a high PSA?
4) His spine is effected by the PC cells and his hemoglobin before the treatment was 9 which went further down to 6.7 within 14 days of Orchiectomy. Is this normal?
His first PSA test is scheduled in July 2010, that is, after 3 months of surgery. How low shall we expect it to go? Also, he will complete 6 Zometa infusions by then.

Thanks
Chadhas

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/14/2010 3:01 PM (GMT -6)   
Chadhas,

Welcome here. I can't answer any of your questions, but I feel for both you and your dad, he is definitely in a s erious situation. Some of the men here with advanced cases can better answer your questions. There are several women here too ,that might be able to share support with you.

Please keep us posted, we care!

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


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 5/14/2010 3:15 PM (GMT -6)   
Hi Chardas, I echo David's comments. My father didn't have quite that level of metastasis, but he had the orchiectomy and then HT and lived for many years --- and as his PCa doctor predicted kept the PCa in check long enough that he died of something else. (Heart) I think it was about 30 years ago he was diagnosed and so I assume treatments are even better today.

I do hope you'll keep posting and let us know how he's doing. As David said, we care!

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"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
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
PSA on April 9 less than 0.02 
 
  


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 5/14/2010 9:41 PM (GMT -6)   
Few, if any of us can second guess your doctor. I assume that you went with someone you trust. Many on here would recommend a second opinion before you started, but the game is on. Unless you see something that is contary to

Yes, the high PSA is directly related to the amount of PSA producing PC cells in your fathers body. We have men on here who have had PSA over 3000, so his is not the highest we have seen.

The member with a 3000 went down to zero, but there is no rule. It will depend on how the PC responds to the HT. By eliminating testosterone, and doing the Zometa for the mets, and the Casodex for the PC, it would appear that he is being given excellent treatment. Only time will tell how his PC responds to the treatment. Most PC's will become resistand to the Casodex eventually, but wonderful results have been obtained with it for long periods.

Sorry you have to be here, but please feel comfortable in asking any questions you feel like. Most of us are not doctors or professionals, and can only give our experience or opinion. Your doctors are the ones you have to establish clear lines of communication with. Don't be shy with them. Make them talk to you.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


chadhas
Regular Member


Date Joined May 2010
Total Posts : 25
   Posted 5/15/2010 1:44 AM (GMT -6)   
Hello,

Thanks Purgatory and sleepless09 for your reply and support. It really helped!

Thanks Goodlife for your reply,
My dad completed 6 weeks of his orchiectomy today and we still have 6 weeks to go before his first PSA will be tested. He is feeling better as far as bone pain is concerned and is having no difficulty in passing urine, which he used to have earlier.
His HB level was quite low (9) at the time of diagnosis and went further down to 7 after the surgery. Is that normal?
Also, he gets flu like symptoms for 1-2 days after Zometa infusion. Will it continue with every infusion?

I really feel great to have joined this forum and to know that people care!

Thanks & Regards
Chadha family

Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 5/15/2010 2:35 AM (GMT -6)   
Chadhas-
I also cannot add much but understand your concern. My father had PC 10 years ago and now my boyfriend was diagnosed at 44 (5 mos ago) with Stage 4. Fortunatley, my father was diagnosed early on with seed implants, his PSA is undetectable now. My boyfriend did the prostectomy, on casedox and lupron and now halfway done with radiation. His PSA is now <.05 but started at 56. His first PSA reading was 37 about 1 mo after surgery. 16 a month after that and now <.05 since 3/18. We are lucky that the surgeon is a friend and does a PSA test every month. I remember being told that it should half with each test. I hope that your dad's PSA is lower than that given his type of surgery and HT. I pray for the best!!

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/15/2010 6:50 AM (GMT -6)   
Chadhas, sadly there are no words of advice that I can offer you but I can offer my support to you and your dad. I'm glad to hear that his symptoms are lessening as quality of life is very important with any disease.

While we may not be able to answer all your questions, we are all here to help you through this challenge. Please stay with us and let us know how you and dad are doing.
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!


Kmac
Regular Member


Date Joined Mar 2010
Total Posts : 58
   Posted 5/16/2010 7:42 AM (GMT -6)   
Likewise, I have no medical advice as I'm new to this and am also asking lots of questions. As a daughter though also please know that everyone on here genuinely cares and will provide you with comfort that only people who can relate can. Thinking of you and your dad.

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 5/16/2010 9:45 AM (GMT -6)   
Chadhas:  In my opinion the best info. out there on HT is Dr. Snuffy Meyer's book, there are a few other things that possibly could be done it appears according to Dr. Meyers.  The main one being adding Avodart to your Dad's medicine list.  It inhibits dihydrotesosterone which is significatly more powerful than tesosterone itself.  At a minimum your Dad shoul be tested for dihy levels.  Pick up his book it will help.
 
Good luck
David
 
P.S.  I can't remember the exact title of the book but if you google Dr. Meyers it'll pop up.
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


chadhas
Regular Member


Date Joined May 2010
Total Posts : 25
   Posted 5/16/2010 11:34 PM (GMT -6)   
Thanks all for your wonderful responses and support.

dkob131,

I will take the book and read it. We did ask the doctor if any medication should be added and I meant dutastaride (Avodart) but he said no and asked us to wait till my dad's first PSA reading. Also, my dad is on Bicalutamide(Casodex) 50mg and not the highest dose 150mg. Any ideas why the doctor would have done that?

Thanks & Regards
Chadha family

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 5/17/2010 11:36 AM (GMT -6)   
Chadhas: I could be wrong here and someone may come along to correct me but I believe in most instances if you are on Lupron or such that the usual dosage of Casodex is 50mg and if it is Casodex alone then the dosage is bumped up to 150mg or such.  It appears your Dr. has a good understanding of things from what you have said so far.  It would make perfect sense to see how your dad reacts to the medications he is already on before adding or subtracting more.
 
The Zometa infusions have a tendency to get easier the more they are adminstered but if they don't, ask the Dr. to slow down the IV drip this sometimes makes a big difference in how patients respond to it.
 
Good luck
David
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 

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