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Dad Diagnosed With Gleason (5+4)

emeraldglen
Posts: 2
Joined: Nov 2012

My dad was diagnosed In China with Gleason (3+5) 11/08/2012.

He is 66 years old with good health.

His tPSA is over 100. His fPSA is 16.86.

His bone scan came back negative.

I sent the biopsy slides to Dr. Epstein at JHU for second opinions.

Opinion from Dr. Epstein is worse. 100% of the 12 slides are positive. Gleason score is now 5+4 (presented in 2 of the 12 slides).

He suggests HT and RT. Said surgery will probably make no sense at this point.

Bone Scan negative (11/05/2012).

I think that CT scan is also negative.

Current Treatment:
Patient is on Hormone Therapy, beginning from 11/08/2012.
Bicalutamide tablet 50mg (AstraZeneca): 1 tablet daily, beginning from 11/08
Leuprolide injection: Once every Month, beginning from 11/08
Other Medication:
Tamsulosin Hydrochloride Sustained Release Capsules: 1 capsule daily, beginning from 11/08
Liptor tablet: 1 tablet daily, beginning from 08/28/2009

Dr. Epstein's suggestion echoes with the opinions we got from some experts in China.

What should we proceed from this point? What is the expected life span for this stage of prostate cancer?

I read Dr. Walsh's book and Dr. Meyer's Book at HT and diet.

I bought the following supplement for my dad.

Source Naturals Vitamin D-3 -- 2000 IU - 200 Softgels

Schiff Natural Vitamin E Complex -- 200 IU - 100 Softgels

Nature's Bounty Lycopene 10mg, 60 Softgels

Nordic Naturals Ultimate Omega, 1,000 mg Fish Oil, 180 Soft Gels

POMx Pills

Nature's Way Soy Isoflavones Standardized -- 60 Capsules

Source Naturals Selenium, 200mcg, 60 Tablets

These are mostly suggested by Dr. Snuffy Myers.

Is there anyone experienced with taking diet supplement in Dr. Meyer's Book?

Your helps are greatly appreciated.

Thanks,

Tim

Samsungtech1
Posts: 350
Joined: Jan 2011

I am teuly sorry for your dad's sickness. It would seem with all positive cores that it is more than the prostate. Have they tested the lymph nodes? It does not get this bad without spreading. My tests came back negative, but it was in my bladder and lungs. No one saw it. Had to demand an x-ray just to prove my point. No fun winning that argument.

The problem now becomes who you trust. HT and casodex would be a start. Might help isolate where it is. But I am sure you have heard DaVinci, cyberknife, and a whole host of similar treatments. The second opinion would seem to be the hard point. 12 of 12 positive cores is bad. I believe the above treatment is a good treatment. Unfortunately it really is hard to say, but all those positives are a worry.

Mike

VascodaGama's picture
VascodaGama
Posts: 1599
Joined: Nov 2010

Tim

I am sorry to read about your dad’s diagnosis. I wonder who has recommended the medication he is taking and protocol. In any case, he should consider a consultation with a medical oncologist to access other options of treatment.

Gleason 9 is of high risk for spread and that may be difficult to be caught totally in surgery or radiotherapy. Traditionally Gleason 9 guys are recommended radicals with intent in debulking but the risks and side effects from such treatments may cause nasty outcomes, such as incontinence, erection dysfunction, prostatitis and colitis. Worse cases of fistulas are also reported.

When cancer metastasizes and it is made of small colonies, image studies are negative because they are not very reliable in locating the cancer, but your dad’s PSA was high so that the image studies should at least indicate abnormalities in the prostate.
In such a case “attacking” the gland with a radical could improve the prognosis.
I would suggest you to discuss about the above with a specialist medical oncologist.

Your question regarding “time” is pointless. No one knows about live spans or can predict the status of a patient by his Gleason type. Continuing treatment and leading a healthy life style will surely take your dad for long periods of longevity.
Hormonal treatments are known to provide long periods of control on the cancer. Newer drugs used as second line HT once the first ones have failed, are known to extend still years of the treatment. In fact it all depends how the cancer of your father responds to the medication and how your father will accept the side effects. Diet and physical fitness are important aspects to consider to counter the effects from the medicines and symptoms.

Regarding supplements, you should read other sources of information other than Myers’ book. However, not all supplements work in the same way to all patients. Your dad need to check the lipids and change accordingly.
The National Cancer Institute got an article titled “An Overview of Nutrition in Cancer Care”, which may be of interest to you. Here is the site;
http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/Patient/page1#Keypoint5

Several tests will become important when on HT medication. Bone loss is typical and PCa likes weak bone. Maybe your father needs to take a bisphosphonate. Take him for a DEXA scan and ask for a testosterone test along the PSA. Check for liver and heart health with lipids (Amenia) and ECG.

Hope for the best.

Welcome to the board
VGama

hopeful and opt...
Posts: 1364
Joined: Apr 2009

There was a major study "the Select Study" among approximately 35,000 men that was designed to measure the benefits of selium and vitamin E over a seven year period. The study was stopped early since negative benefits were observed.

Afterward, there was also another study at the Cleaveland Clinic that looked at Vitamin E. This study also showed negative benefit for Vitamin E.

caseyh
Posts: 63
Joined: May 2002

Vitamin E and Selenium are no longer recommended by Dr. Myers.

mrspjd
Posts: 693
Joined: Apr 2010

Tim,

Here's a link to some basic but comprehensive guidelines on nutrition & PCa that might be helpful:
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf
Your own independent research will dictate which diet & supplement choices are appropriate pertaining to a heart/prostate-healthy diet for both you and your dad under a doctor's supervision.

caseyh
Posts: 63
Joined: May 2002

Tim,

Excluding the vitamin E & Selenium, your list of supplements is pretty basic and recommended by Dr. Myers for most of his patients. Vitamin D should be monitored and optimized using blood tests. Dr. Myer's list of supplements and dosages have changed over the years as the literature has evolved. He recommends additional supplements, changes in diet, weight control, and exercise on a patient by patient basis.

Most of us take our supplements on a daily basis not knowing if they are doing any good, but fearing the possible consequences if we stop. I am in my 13th year of survival, and I felt that way for many years. About a year ago I met a patient who was diagnosed with disease so lethal that doctors basically told him to get his affairs in order. He used diet and supplements (no medical treatment) to reverse his disease to a point that a tumor on his liver disappeared and his PSA dropped dramatically to a manageable level. He is now receiving more conventional medical treatment and is doing very well. I am absolutely convinced that diet and supplements can have a tremendous impact on PCa. I have also met patients who have gotten themselves into deep trouble trying to self-medicate their disease with herbs and supplements. I see nutrition & supplements, for the most part, as being a COMPLIMENTARY approach that should be done under the supervision of a PCa oncologist. It is not clear if your dad remains in China, but if he returns home, he should be under the care of an oncologist who specializes in PCa. I personally would be extremely reluctant to use an oncologist who rejected a complimentary approach.

Dr. Myer's nutritional program along with a large collection of prostate cancer friendly recipes are explained in plain language in his new book, THE PROSTATE CANCER NUTRITION BOOK, Rivanna Health Publications, 2012. The chapter on “Evidenced-Based Nutrition” discusses the conflicting and confusing nature of studies often reported on the Internet by gurus who seem to lack the basic understanding of biology necessary to properly interpret the study. The goal of his book is “to reduce all of this information into an easily adoptable diet and exercise program proven to a have dramatic impact on your health.”

I admire the fact that you are doing the research necessary to take charge of your dad's cancer. You probably feel somewhat overwhelmed by the gigantic amount of material that you need to digest. Feel free to email me via CSN Mail for additional information.

Wishing you and your dad success,
CaseyH

mrspjd
Posts: 693
Joined: Apr 2010

Re the statement in the previous post about "patients who have gotten themselves into deep trouble trying to self medicate their disease with herbs and supplements." SO TRUE and unfortunately, when cancer patients self medicate, especially with questionable cancer therapies such as those that promote a cancer cure with megadose supplements like Vitamin C, "deep trouble" and harmful adverse effects can be the result.  

Whether considering conventional or alternative PCa therapies, be they complementary and/or holistic, nutritional or other, a patient educated about PCa is an empowered patient who makes informed prevention and tx decisions TOGETHER with their expert medical team. For some patients, this may require switching to a new/different medical team.

Swingshiftworker
Posts: 658
Joined: Mar 2010

If you're going to give your father all of the listed supplements, you might as well try to give him megadoses of Vitamin C too. Can't hurt (except your pocketbook) and might help.

Who knows?

Read the 1st post in the thread that I started on the subject. See: http://csn.cancer.org/node/250517. View the video and read the link and other posts. Do your own research on the Net about it and decide for yourself if it's something else you want to try.

Good luck!!!

mrspjd
Posts: 693
Joined: Apr 2010

Tim,

Sorry to read of your dad's high risk PCa dx. Kudos to you as it's obvious you've done some good preliminary research to educate yourself & dad about Gleason 9 PCa. Together with your dad, your research skills & education about PCa will be an asset to the quality of his PCa tx & care.

One book I would recommend that was very helpful to us is "A Primer on Prostate Cancer: The Empowered Patient's Guide" by Stephen B. Strum, MD. Re your question "How to proceed." Some areas of research that were important in our experience with a high risk PCa dx and that may be worth researching for your dad's case include:
>ADT3 (aka triple androgen deprivation therapy--adds a 5-ARInhibitor to the ADT protocol) vs ADT2; 
>Add'l advanced diagnostic imaging tests pre tx, if available, such as F 18 PET/CT and MRI or Endorectal MRI (may contribute to a more accurate clinical staging); 
>Scope of tx field using IG/IMRT (inclusive of pelvic lymph nodes); 
>Total amount of Gy dosing may be a factor in successful RT outcome. See http://www.ncbi.nlm.nih.gov/m/pubmed/22330997/
>High Dose Rate Brachy (HDRB) combined with IG/IMRT may be another RT option to consider, especially if dad's high risk G9 clinical staging is determined to be localized-locally advanced, such as T3.

Your dad is fortunate to have your support and medical advocacy during this challenging time. Best of luck to you both. 

emeraldglen
Posts: 2
Joined: Nov 2012

Thanks for the information.

some updates:

After 1st month HT, tPSA dropped to 28.10, FPSA dropped to 4.37

After 2nd month HT, tPSA dropped to 11.53, FPSA dropped to 2.77

I am a bit worried about the 2nd month result. The PSA drop is only around 60%.

Should we add Radio Therapy or other hormone drug into the mix now?

One thing that hinders the possible addition of RT treatment is the weather there.

Currently it is very cold in my hometown (lowest temp is around minus 10-15 celsius).

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