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Thread: Prostate Cancer in pelvic bone

  1. #1
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    Question Prostate Cancer in pelvic bone

    Short story long: my father (76 yr old in otherwise excellent health other than a childhood murmur which resulted in related a fib) PSA readings between 10-13, GP put him on several rounds of antibiotics. He found a urologist and insisted on a biopsy that came back as a Gleason 8. Prostatectomy saved both nerves, biopsy found cancer had advanced to a Gleason score of 9. Post surgery found “microscopic” amounts of cancer in the mouth of his bladder and seminal vesicles. 6 weeks post surgery his PSAs were at 2.8 they started Ht. Pre-radiation PET scan found cancer had spread aggressively post surgery and is now in his pelvic bone as well as spread through his bladder and seminal vesicles. He is meeting a General Oncologist Wednesday to discuss & outline a plan including radiation (cast has been made - expecting 5 days a week for 6-8 weeks) immunotherapy, nutritionist and pain management with a meeting with a second GO next week. There is a center 2 hours away performing proton therapy and we’re getting more information there too. I’m seeking info on what we should know, questions we should be asking, also trying to prepare for the challenges to come: cooking for someone with nutritional needs and sever diarrhea (none of us are great or imaginative cooks). The pain and concern of bone deterioration and fracture concerns. How to support him and my mother (his primary caregiver) emotionally and mentally.

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Hi Tracy,

    Sorry to read about the battle your dad is having. It is great that you are taking an active role in helping him deal with this.

    I'm not well versed in suggesting the questions you will want to ask -- but others here will be able to give you some excellent suggestions in the next few days.

    In the meantime, just wanted to wish him -- and yourself -- well.

    Good luck!
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  3. #3
    Hi Tracy. I had a look at your first thread, and IMO your dad's PCa was metastatic well before his diagnosis and surgery. (I don't know why a bone scan was ommitted from his initial workup for what was then a G8 ). There are many treatment modalities as you know. I would suggest that care at a Center of Excellence for prostate cancer would be ideal for determining the best combinations and order, whether it's radiation, immumotherapy, chemotherapy, HT, etc. (even for chemo, for example, the best combinations and order are the subject of current research). Choosing an immunotherapy may require some genomic and genetic studies. Topic (P) in the Subforum here (near the top of the main Forum page) has studies on mPCa. Some metastases, especially in bones and lymph nodes, can be directly irradiated, depending on their location.

    Keep us posted and best of luck,

    Djin
    Last edited by DjinTonic; 08-20-2019 at 11:01 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    7-05-13 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  4. #4
    Quote Originally Posted by TracyD View Post
    Update: scan results came back today; showed my dad’s prostate cancer is in his pelvic bone as well as his bladder and seminal vesicles (stage IVb). They started his HT weeks ago, will be fitted for his forms tomorrow (will apparently be in the form for radiation to best aim) and is contacting an immunologist. What should we prepare for? What questions should we be asking?
    Quote Originally Posted by DjinTonic View Post
    Hi Tracy. I had a look at your first thread, and IMO your dad's PCa was metastatic well before his diagnosis and surgery. (I don't know why a bone scan was ommitted from his initial workup for what was then a G8 ). There are many treatment modalities as you know. I would suggest that care at a Center of Excellence for prostate cancer would be ideal for determining the best combinations and order, whether it's radiation, immumotherapy, chemotherapy, HT, etc. (even for chemo, for example, the best combinations and order are the subject of current research). Choosing an immunotherapy may require some genomic and genetic studies. Topic (P) in the Subforum here (near the top of the main Forum page) has studies on mPCa. Some metastases, especially in bones and lymph nodes, can be directly irradiated, depending on their location.

    Keep us posted and best of luck,

    Djin
    I have never heard of a prostatectomy where they left the SV either.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    ADT - 6/3/19
    ART - 8/5/19

  5. #5
    Quote Originally Posted by TracyD View Post
    Short story long: my father (76 yr old in otherwise excellent health other than a childhood murmur which resulted in related a fib) PSA readings between 10-13, GP put him on several rounds of antibiotics. He found a urologist and insisted on a biopsy that came back as a Gleason 8. Prostatectomy saved both nerves, biopsy found cancer had advanced to a Gleason score of 9. Post surgery found “microscopic” amounts of cancer in the mouth of his bladder and seminal vesicles. 6 weeks post surgery his PSAs were at 2.8 they started Ht. Pre-radiation PET scan found cancer had spread aggressively post surgery and is now in his pelvic bone as well as spread through his bladder and seminal vesicles. He is meeting a General Oncologist Wednesday to discuss & outline a plan including radiation (cast has been made - expecting 5 days a week for 6-8 weeks) immunotherapy, nutritionist and pain management with a meeting with a second GO next week. There is a center 2 hours away performing proton therapy and we’re getting more information there too. I’m seeking info on what we should know, questions we should be asking, also trying to prepare for the challenges to come: cooking for someone with nutritional needs and sever diarrhea (none of us are great or imaginative cooks). The pain and concern of bone deterioration and fracture concerns. How to support him and my mother (his primary caregiver) emotionally and mentally.
    I know you want the best for your father, but if you have a RT available close to home, I would forget the proton center 2 hours away. Driving 4 hours a day / 5 days a week needlessly or not being comfortable in his home is not what your father and mother need going forward.
    Last edited by Duck2; 08-20-2019 at 01:25 PM.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    ADT - 6/3/19
    ART - 8/5/19

  6. #6
    Quote Originally Posted by TracyD View Post
    ... also trying to prepare for the challenges to come: cooking for someone with nutritional needs and severe diarrhea (none of us are great or imaginative cooks). The pain and concern of bone deterioration and fracture concerns. How to support him and my mother (his primary caregiver) emotionally and mentally.
    Hopefully his RO will provide a list of do's and don't regarding foods. Look into the low residue diet. Basically it's low fiber/low gas, and generally is just the opposite of what most people believe to be a healthy diet... limited fruits and veggies, high in starches. I got hit with bowel problems right away the second week of RT, and have had to deal with it ever since. Limited coffee in the AM, nothing carbonated, no beans or watery veggies, limited salad, lots of rice and grilled chicken breast. I've also had to limit dairy, so what little I use is full fat.

    Also look into liquid nutrition from Vitality Medical (vitalitymedical.com)... I lived on Ensure Clear and IV nutrition for a full week about a year ago. And I bought an inexpensive toilet seat bidet for $50 because there are times when it's just too raw down there to use paper products.

    Regarding emotional health for the three of you (yourself as caregiver, your mom and dad) this will be difficult, no doubt about it. Depending on the frailty of your father as the disease progresses, cachexia and sarcopenia may become a problem. Hoping these things do NOT come to pass, but are known to occur with metastatic cancer. Hopefully the HT & RT will be able to control your dad's cancer and you will have another decade or so together. I am close with several men who are stage 4 on lifelong HT and to look at them you would never know it. Good luck to you and your family!
    Late 2012: PSA 4, age 62 all DRE's 'normal'
    Early 2014: PSA 9.5, TRUS biopsy (false) negative
    2015: PSA's 12 & 20, LOTS of Cipro ... Mar'16: PSA 25, changed Urologist
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2ea 15-40-100% G8(4+4)
    Aug'16: DVRP,
    "broad cut" 11 LN-,-SM, 53g 25% involved, multifocal EPE, PNI, B/L SVI, pT3b

    Jan'17:
    began Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Jan'18-July 2019: PSA's <0.008, T~12
    Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
    "Everyone you meet is fighting a battle you cannot see"

    Mrs: Dec 2016: Dx stage 4 NHL/DLBCL,
    Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+6X IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog

  7. #7
    When PCa spreads all the way to one or both ends of a seminal vesicle, especially the tip, it can be very difficult to remove it completely; and, even if you can, it may have already grown into, and fused with, adjacent tissue.

    Djin
    Last edited by DjinTonic; 08-20-2019 at 01:55 PM.

  8. #8
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    Thank you! At this point we know the cancer will not be removed completely. We’re just looking to stall it.

  9. #9
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    The thought was that they rent an apartment for the 2 months and come home weekends if he is up for it.

  10. #10
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    I learned last night that they completed an MRI and bone scan prior to his RP but not a PET scan. The standard bone scan is apparently only 80% accurate though.

 

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