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first PSA 3 month after surgery 0.51 repeated a month later 1.59, what now?????

bn20
Posts: 7
Joined: Sep 2011

hi everyone,
i have posted before my dad case, he had surgery for prostate cancer G8, 3month later PSA came at 0.51. his doctor suggested to repeated in 1 month time, so we had the result yesterday his PSA jumped at 1.59

his doctor sent him to a radiologist to decide if radiation is a possibility or just start hormone therapy,

i am getting really lost, any advice here please?????

tarhoosier
Posts: 181
Joined: Aug 2006

bn:

Your previous post brought numerous cogent replies. Good advice in each of them, in my humble opinion. Your father may not have read them.
If you are asking for advice about how to respond as a daughter and family support, then perhaps we misunderstand the direction of your questions. If you are asking about how he should proceed as a patient, our previous advice stands. He must see another doctor, one who understands his situation clearly. A radiologist would be reasonable in his case, though the factors you present make it unlikely that radiation, even if advised, would complete his treatment.
He should also, and perhaps first, see a medical oncologist, preferably one who deals with prostate cancer regularly. Continuing care will be necessary and the sooner he departs from his surgeon/urologist then the better he will be.
The psa dynamics you quote indicate that hormone deprivation treatment is in the near future for him. This can be successful for many years, leaving time for newer and more effective treatments to be discovered.
As a family member I think you and he would benefit from attending a local PCa support group to deal with the emotional issues such diagnoses bring. The members there, and their spouse or family member can share their stories.

VascodaGama's picture
VascodaGama
Posts: 1519
Joined: Nov 2010

BN20

Your dad is doing it right. The radiologist will answer to your doubts. If not satisfied he can get a second opinion from an oncologist too.
His cancer is aggressive as the PSADT demonstrates at less than two weeks. As commented by Tarhoosier you got many advices in your previous thread (http://csn.cancer.org/node/225734). Use them as reference and help your dad in a decision. Your dad should start a treatment the soonest.

I do not know what your doctor may recommend, but the famous oncologist Dr. Myers in similar cases recommends a protocol of hormonal plus radiation (IMRT), starting ADT and following with IMRT, two to four months later. The ADT recommended is for an LHRH agonist (Eligard or Lupron, etc.) plus an anti-agonist (Casodex or Cyproterone, etc.) which is taken continuous in a period of two to three years. The IMRT is done while on ADT, and should include the lymph nodes at the iliac.
You can listen to his videos here; Just navigate down to get the videos of your interest.
http://prostateexperts.com/category/provenge/

Your dad can discuss the above with his doctor and inquire about the full protocol ADT dosages and radiation grays and number of sections. Surely he should follow the doctor’s recommendation if he is satisfied with his qualifications in the practice. The machine/equipment delivering the radiation should be of resent modern models too. You can also inquire on the facilities.
He should get an MRI and a bone scan to verify for distant metastasis before starting the treatment.

Do your researches and let us know of your progress. We will try to help you to understand the details.

Wishing your family peace of mind.

VGama

bn20
Posts: 7
Joined: Sep 2011

yes tarhoosier i got many advice in my previous threat, and one of the advice was by Vasco is torepeat the PSA test in 1 month time and not wait 3 month, and this is what my dad did,

the big jump in his PSA was a dispoinment for us and made feel bad for not pushing him for futher treatement traight after the first psa result, but i couldn`t imagine that his psa will iump like that.

his oncologist sent him to radiologist who asked for test and surgery reports and said that he will discuss my dad s case with his doctor to make a decision, start just radiation or hormone therapy or both.

so i wanted just to know what is the best option, i read that radiation+hormone therapy give a good result and like you said Vasco Dr Mayers use that protocol for his patients.

My question is, whitch come first radiation or hormone therapy? i know Vasco you did explain that but please can you clarify it for me,

should my dad start with hormone therapy firt than radiation?

Vasco thank you so much

VascodaGama's picture
VascodaGama
Posts: 1519
Joined: Nov 2010

BN20

Your dad should follow his doctor’s recommendations. All the opinions you get at this forum are from survivors like me and Tarhoosier without any medical enrolment. We base our responses on our own experiences, researches and studies (eleven years in my case).
Surely many of us are quite acknowledgeable about the matters related to prostate cancer, but one should never decide on a treatment solo based on what is posted here. You must do your own judgements and researches, reading books and getting consultations with specialists.

Regarding your question; the protocol for a combi treatment with RT + HT takes into consideration previous treatments (Patients with the prostate gland or Patients without prostate). The ones with prostate usually start hormonal therapy first (neoadjuvant) and while on HT they receive the radiation. The ones without prostate (your dad’s case) have no definite standard. HT could be administered as neoadjuvant or adjuvant (after radiation). However, doctors have identified that in high risk cases similar to your dad’s condition, neoadjuvant HT started the soonest have better results. Radiation follows timely with a preference of starting RT three to six months later.

In this study you can read about Neoadjuvant and Adjuvant HT. They write like this;
“The results of this review indicate that neo-adjuvant hormone therapy administered three to six months before the primary curative therapy (radical prostatectomy radical radiotherapy) did not, as yet, result in a detectable improvement in overall survival or disease-specific survival. There was, however, a significant improvement in disease-free survival (approximately 90%) when given before radiotherapy”.

Here is the link; http://www2.cochrane.org/reviews/en/ab006019.html

Other aspects in the diagnosis of your dad are also used in the decision and that may be the reason why the radiologist is requesting more info on his previous status.
Some doctors, as you commented before, do not recommend RT to patients with higher Gleason score. You should consider that RT got its own risks and side effects and therefore RT should be done only when it is judged that the patient will get benefits from the treatment.

Again, I think that you should obtain details from the doctor and I recommend you to prepare a list of questions in advance. Your dad’s oncologist is the best to clarify your doubts. Nevertheless, If you are not confident with him, then you should consult with another oncologist specialist in PCa.

Wishing you peace of mind.
VGama

bn20
Posts: 7
Joined: Sep 2011

Vasco
My dad had a meeting with the radiologist this afternoon, so he saw all the reprts from my dads doctor(biopsie,scans,pathologist report)
he checked him and said that he should have radiation because there cancerous cells left behind. so my dad asked for HT but the doctor said that he prefer do the RT first,

Because he has to pay for it my dad will be ready to start radiation on 21/11 whitch means 1month from now

is that not a problem?or he should start RT as soon as possible, the radiologist didn`t seem to be worried about the time.

my dad asking my opinion and i am coming to you Vasco and all the guys here to tel me what do you think.

thank you

VascodaGama's picture
VascodaGama
Posts: 1519
Joined: Nov 2010

BN20

I got a second look at the info you provided in your threads and have not seen any comment regarding the results of image studies (bone scan, CT, MRI). You posted that you gave those details to the radiologist. Which scans are you talking about and what were the results?

Firstly, I would like to point out that your dad status does not alter in a matter of few weeks. Starting the treatment on 21/11 is reasonable to me. You should take this time to reach to a proper and final decision, probably by consulting the soonest with an oncologist too, while obtaining the “full protocol” recommended by the radiologist, and researching on the side effects of the treatments (this is a must do thing before committing).

The opinion of the radiologist you describe seems to be that for a salvage type of radiotherapy. In a SRT protocol, radiologists prefer to have the patient done with RT alone to certify success with an unmasked PSA (no influence of HT). Then, if required (unsuccessful RT verified) they will pass the patient to an oncologist for a following treatment of HT (aka ADT-hormonal therapy).

This is common practice, but in high risk cases (and in 57yo with no other health problems), a more complete protocol have demonstrated superior results.
I would rely very much on the opinion of the oncologist with regards to any advantage of ADT in a Gleason score 8 diagnosed with voluminous cancer (probably due to the presence of micrometastases).

Time is not a luxury to your father. Do your consultations and get all coordinated, but do not let anxiety take over the case.

I wish you and your family the best.

VGama

bn20
Posts: 7
Joined: Sep 2011

Hi Vasco,
he took the scans whitch he had before suregery whitch are negative(PSA 13,G8)
the radiologist did ask to do others scans before starting radiation. my dad did ask about combinations of HT and RT but the radiologist said that HT will not kill cancer cells, it will just stop them for some time but radiation do get rid of cancers cells left behind after surgery.

I do agree with you Vasco, we need a second opinion, i did read too many successful cases,when combinating HT and RT.

the radiologist gave us an appointment for the 21/11, i will try to go with dad and seek another oncologist opinion.

thank you Vasco

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