Helping my dad - advice needed

skimo · New User Joined: 21 Aug 2009 Posts: 2

Hello,

This is my first post. I must first say this forum has been a great resource for me during the past 2 weeks since I found out about my
dad's PSA scores. I really appreciate this forum and its members.

I was hoping to get some advice as what to do for my dad. I live alone in the USA for school but my dad works abroad and I would like to bring him the best treatment in the US. Unfortunately, where he is, there is no access to good medical centers. He plans on coming to the USA in in september.

situation:

He is 57 years old. PSA results I have. (each score was done at a different lab)

2009 august: PSA 15.1 FPSA 0.99

2007 october: PSA 7.6 FPSA 1.31
2006 october: PSA 10.6 FPSA 1.23

no family history.

Sonar showed 2 nodules. one small and one big at 1.3Cm .(sorry the data is not conclusive as these are bits and pieces I have been able to extract from mom)

No DRE done. No Biopsy done. My dad is hesitant to do the biopsy where he is and would like to come to the USA to do it.

I am extremely worried/overwhelmed at the moment. My questions concerns are:

1) How bad is it? Benign? Cancerous? Advanced? I have read tons about PSA numbers, but the thing I can't wrap my head arround the fact that PSA numbers are not normalized to prostate size? I read about PSA velocity, but that too is not expressed as a % but more of an absolute. Also my dads numbers are going up and down, not sure if this is due to different labs or PSA can actually go down.

2) Are there more things to be done before doing the biopsy? I read about PCA3 test and also about DRE.

Anti-biotics? The local physician he spoke too recommended biopsy. But I do not feel like he exhausted all other methods. Biopsy where my Dad is, is very primitive and I am afraid of poor quality and spreading anything if found.

3) What is the best place to take him? I am really looking for a good doctor. I live in Austin, and my dad wants to go

here: {link deleted by admin. http://cancerforums.net/viewtopic.php?t=12696 as amended http://cancerforums.net/viewtopic.php?t=7121 } . Just because he feels like its a specialized place.

But i have no idea how to value the prostate center of austin. All I know is that half their links are broken and a google of the physician names doesnt turn out anything useful except for Dr. Fargin. I am willing to travel anywhere in the USA. I heard the big names like J Hopkins, Mayo and Texas MD Anderson. But these are general hospitals and could not get a name of a Urologist.

I (we) will be paying for everything in cash as insurance doesn't cover US treatment. But thats fine, luckily we have been saving for this rainy day. Yet, I am not putting price into consideration,I dont want to trade a buck for health.

4) How long does the "process" take? I will probably understand this more once I am able to communicate directly with a hospital. However, from doing blood work, to doing biopsy to treatment. How much time are we looking at? (he needs to get time off from work).

5) can most of the initial "consultation" with the doctor happen remotely? As in, could I send in the sonar scans, psa tests, and get an opnion without my dad having to travel here? (I am a bit new to the US medical system and not sure how relations work here)

Thanks so much for you support. Unfortunately all the friends I made here are college buddies and I dont have anyone with experience to consult with . Any guidance would be appreciated.

Thanks again and sorry for the long post.
kareem

**on a mission for dad**

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

With these PSA values, it seems likely that a urologist would recommend biopsy. There are two excellent centers in Houston, at Baylor University, and at MD Anderson, not very far to drive from Austin. Perhaps other readers have personal experience with urologists in this area.
_________________
John

johnT · Senior User Joined: 27 Apr 2009 Posts: 177

Any psa over 10 would be a major concern and your dad needs to get a biopsy. There is no way other than a biopsy to detect PC and no doctor will perform any procedure without a biopsy.
The two best Drs in the US who can identify prostate Cancer is Dr Fred Lee in Rochester MI and Dr Duke Bahn in Ventura Ca. They are both interventional radiologists who specialize in identifying PC using color doppler ultra sound and targeted biopsy. Both have performed over 15,000 biopsies and it's well worth the travel to see the best.
Dr Bahn's web site is www.pioa.org; I don't know Dr Lee's but you can google him. They will also give you an unbiased treatment recommendatio; most prostate cancer centers specialize in one treatment and will steer you towards that treatment.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Hawk · Senior User Joined: 22 Nov 2006 Posts: 406

Any guess on cancer Vs. benign or guess on stage of cancer are of little value because they would be guesses. MD Anderson is THE top rated cancer center in North America.

That is where I would go but Baylor would likely do just as well. First comes diagnosis them some unhurried, thoughtful, decision making.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

skimo · New User Joined: 21 Aug 2009 Posts: 2

Thanks for your feedback. I have contacted MD Anderson and will see what they say.

I will try to find people with personal experience in Texas area.

Thanks again
Kareem

Reinardo

Hello kareem:-
To be concerned, yes. To be overly concerned, no. PSA sequence from 2006 thru 2009 with drop in 2007 is somewhat strange, not typical of normal cancer growth. Even if so, would suggest slow cancer growth.
PSA is not a direct and reliable marker. Drinking excessively on a hot day made my PSA go up by 4 points.
Only measuring PSA at short intervals (2-3 months), under equal conditions, at the same lab, will lead to conclusive results. Unless this is done before I wouldn't agree to a biopsie, the procedure being unpleasant and not without any risk.
My feeling is you overreact. The house is not on fire. There is good treatment available for prostate cancer. Properly treated your dad can reach old age, quite unlike other types of cancer. I had my cancer diagnosed in 2001 and I`m still feeling fine.
Have my best wishes, both of you, , Reinardo
_________________
Diagnosed in 2001 at PSA 8.9
Triple Hormone Therapy (Leibowitz) in 2002
Active Surveillance thereafter

johnT · Senior User Joined: 27 Apr 2009 Posts: 177

Reinadro,

I see you were treated with ADT3; can you tell us your original stats, Gleason ect. was it localized? what is your psa now?

I've read a lot of Dr Liebowitsz's papers, but have never run into anyone that was treated with ADT3 for localized PC. Please share your story. How long were you on it, 13 months? what were the side affects? How long did they last after you went off it? 50 or 150mg of Casodex? are you currently on Proscar?
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Reinardo

Hello JohnT:-
Yes, I will gladly do so but it will take me some time to put it in proper writing. However, this being Kareem's thread I'd better open a new topic.
Reinardo
_________________
Diagnosed in 2001 at PSA 8.9
Triple Hormone Therapy (Leibowitz) in 2002
Active Surveillance thereafter

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