Whats the next step for my Dad?

Bonnie12 · Regular Joined: 13 May 2008 Posts: 10

Hi Everyone,

My Dad was diagnosed with PC back in 2007. He has since then had the operation to remove the prostate and since the PSA did not drop, he then had to have radiotherapy, which he had finished almost a year ago. Since then he has been having the 3 monthly PSA tests and the last one we found out today is it is at 0.75. Last test if was 0.25? Dr says to go back in another 3 months for another test - but he said Dad will have to have some more treatment. Obviously the cancer has spread outside of the prostate bed, but I guess they are not sure where?

What would be the next treatment plan for him?

Why do we have to wait another 3 months when we know the PSA is going to go up?

Can someone please shed some light on this for me...I'm worried again. Ever since he was diagnosed in 2007, it just doesnt seem to be going away.

Will this next lot of treatment get rid of it????

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

Bonnie,

The surgery was a primary treatment and is always done with the goal of a cure. The follow-up radiation was because the surgery failed to get all of the cancer. They call this salvage radiation and it radiates the bed of tissue that surrounded the prostate site. That was a second shot at a cure.

It appears this second shot failed to get all the cancer (if I understand your post his PSA has climbed since radiation). The course of action now consists of treatments to slow the progression. The standard approach is hormone deprivation therapy. Testosterone and other androgens are reduced chemically because they fuel prostate cancer. At this point I recommend that your father seek a medical oncologist that specializes in prostate cancer. Hormone therapy can get more complicated than most general oncologists or urologists are prepared to address. There is also chemo that has more side effects and less impact on the cancer than hormone therapy. A good medical oncologist would also likely consider and help you find clinical trials.
_________________
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

interval · Regular Joined: 11 Apr 2008 Posts: 43

Hi Bonnie,

Hawk is right recommending to seek a medical oncologist that specializes in prostate cancer. On the other hand, every individual patient has to make his own decision about his therapy in close collaboration with his physicians. To reach this decision, the patient need more info about treatment and its effects on disease and the rest of his body. Regarding hormone deprivation therapy, you should know that many urologists think that it has been and still is being significantly overused. Please read more here:
http://www.prostate-report.org/__new_approach_regarding_androgen_deprivation_therapy.php
_________________
men health questions
http://www.askmenhealth.org

Bonnie12 · Regular Joined: 13 May 2008 Posts: 10

Thank you for the replys.

I just want to ask a couple of more questions:

1) Why are the Doctors waiting another 3 months before they decide what to do? Why can't they start treatment on my Dad now? He is only 56. I can only assume that the PSA will continue to rise?

2) Will he then have scans etc to find out where the cancer has gone? Can they do more radiation on it when they know where it is to kill it?

3) What else can they do other then hormone therapy?

I need my Dad around for a alot more years yet!!!

Thanks for all your help!!!

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

Bonnie,

I will recap my last post and try to do a better job explaining. Radiation to cure PCa after surgery is called Salvage radiation Therapy (SRT). It is done ONLY if there is NO evidence the cancer has spread beyond the prostate bed. Once cancer spreads beyond the prostate bed it cannot currently be cured but it can be treated and slowed down (not by radiation). Men have lived well over a decade of active life in these situations.

Once surgery fails and cancer is large enough to see on a scan, it is too late to target for a cure. The only radiation given in such patients is to alleviate pain in late stage disease. It does not cure the cancer and does not extend life. It treats pain.. You father appears to have failed the last chance for a total cure.

His options now are treatment to slow down the cancer (hormone, chemo, clinical trials) as I posted above. if he develops far enough along that he has pain the radiation may be used to treat the pain.
_________________
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

interval · Regular Joined: 11 Apr 2008 Posts: 43

Just to help Hawk to better summarize:

First of all you need a good oncologist to see what is the situation of your father, because if prostate surgery fails, there are two possibilities:
1. Cancer has spread beyond the prostate bed
In this situation cancer cannot be cured or stopped. The only action of treatment is to slow its progression.
2. Cancer hasn't spread beyond the prostate bed
In this situation there are some hopes to fight cancer
_________________
men health questions
http://www.askmenhealth.org

Bonnie12 · Regular Joined: 13 May 2008 Posts: 10

Thank you for your responses.

I am just finding it really hard to get my head around all this?

Does anyone know if going from a PSA score of 0.25 to 0.75 in 3months is a fast increase? Could it slow down? Or is it likely to keep going fast?

Why are the Dr's waiting another 3 months to test it again?????

I dont understand Sad

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

The PSA rise would be considered a very fast rise IF the values were higher. For instance a jump from 2.5 to 7.5 in 3 months would be very significant. The good news however is that a solid medical oncologist specializing in prostate cancer told me that PSA velocity cannot even be calculated on values at the level of your fathers PSA. and the rate of rise at these levels are meaningless.

He is getting close to the level where they will start to have more meaning so hopefully the PSA will slow down.
_________________
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

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