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Metastatic Prostate cancer (Gleason 7, PSA 72)

supreet2000
Posts: 2
Joined: Jan 2013

Hello,

I am writing onbehalf of a family member, who has been recently diagnosed with Metastatic Prostate Cancer.

He has undergone Bilateral Subcapsular Orchidectomy surgery on recently by a Doctor who is (CMS, FRCS (Edinburgh), D. Urol (London)) in Ahmedabad, India.

Post the surgery family doctor who is (M.S., M.CH, Onco - Surgeon) suggested them to consult another doctor who is (M.D., D.M., Onco-Physician) for further treatment.

After a brief examination,  M.D., D.M., Onco-Physician doctor suggested following course of action

To continue Calutide tablets (50 MG)
To take Zoledronic Acid Injection to strengthen bones
Do PSA test two weeks after the surgery
Bone scan after four weeks of the surgery
Go for Radio therapy later if the pain in the left side of the pelvic area till the knee doesn’t subsides
Meet him on 31th January for a detailed examination and to decide further course of treatment
 

On the other hand, (CMS, FRCS (Edinburgh), D. Urol (London)) doctor suggests the following course of action:

To discontinue Calutide tablets (50 MG)
Prescribed medicines (Prescription Enclosed)
To wait and watch the response of the Bilateral Subcapsular Orchidectomy surgery
Do PSA test two weeks after the surgery
Bone scan after four weeks of the surgery
 

May I request for your assistance in reconfirming the diagnosis and the best line of treatment.

We have already done the following tests and the reports are available on request:

X-ray report - 5th January 2013
PSA Report - 5th January 2013
BIOPSY - HISTOLOGY REPORT (Page 1 & 2); Dated – 12th January 2013
99m Tc-MDP BONE SCAN; Dated – 16th January 2013
MDCT SCAN OF ABDOMEN-PELVIS; Dated – 16th January 2013
Testis - Histology Report - 23rd January 2013

Request you to kindly help.

tarhoosier
Posts: 187
Joined: Aug 2006

I think that the process you outline is the best available, considering the differences in practice there and elsewhere. The scans are equivalent to those available here.

Honvan, an estrogen derivative, is sometimes used in such cases in India, but may best be saved for now.

The difference in doctor recommendations is similar to what one would find here, as well. With no more of the information available and based only on my amateur and incompetent experience I think either doctor could be right. The first one is more aggressive and focused on immediaate treatment and the second is more deliberate, waiting to see results before introducing new actions. Each can be supported. This patient SEEMS to need the efforts of an oncologist rather than a urologist, and if in the US I would generally advise an advanced prostate cancer patient to move from uro to onco sooner rather than later. I have no idea if this is relevant or advisable in the current case.

The lmits to advice here, third-fourth hand and from thousands of miles, across languages and cultures, dimnishes the value of all my typing.

No one here can confirm the diagnosis based on what you provide. Certainly orchiectomy is not performed without certainty of this diagnosis.

You do not give the age of the patient.

ralph.townsend1's picture
ralph.townsend1
Posts: 354
Joined: Feb 2012

what is the age? Is the prostate remove? What was the result of bone scan and CT scan. Gleason 7 of many point?

VascodaGama's picture
VascodaGama
Posts: 1588
Joined: Nov 2010

Supreet

Welcome to the board.

From the info you shared I think that your family member was diagnosed with metastatic cancer because of findings from the biopsy and probably a positive result of the X-rays.

I think that the PSA of 72 you comment is of a test done before the Orchiectomy. It was a high level which may relate to a big tumour. However, the CT and bone scans (of 16th January) will provide more details and a better diagnosis of his case. Maybe with such results both doctors will recommend different actions from those described by you.

I hope you share here the results of the scans latter.

 

I wonder the age of your family member and his other health conditions. Most treatments are decided based on the status of the patient including his life expectancy, and, of course, if his case is systemic.

http://www.ssa.gov/oact/STATS/table4c6.html

Older patients are more common recommended to palliative treatments such as hormonal treatments (HT). These do not cure but can control any advancement of the cancer for long periods of time. Younger patients diagnosed with localized cancer are usually recommended to treatments with intent at cure, such as prostatectomy and/or radiotherapy.

The Edinburgh doctor who diagnosed your family member may have seen HT as the best approach of treatment and advanced with Orchiectomy (removing the testicles) which will stop about 95% of the production of testosterone in which the cancer feeds. This is a cheap way of getting the job done and there is no problem with it but nowadays is more common to administer agonist drugs similar to Lupron, Zoladex, etc, as the prime option to lower the testosterone circulating in our bodies.

The adrenal glands manufacture the other 5% of testosterone but this “factory” cannot be stopped. The only way to avoid the cancer from feeding on those small amounts of androgens is with antiandrogen drugs similar to Calutide tablets (bicalutamide).

Accordingly, the recommendation of the Onco-Physician doctor to start taking Calutide seems to be proper. He also adds Zoledronic Acid Injection (Zometa) to avoid bone loss that will be an effect from the castration status (orchiectomy). The radiotherapy recommended to pain relief is also common when the cancer has spread to bone and is causing any compression at the nerves (probable reason of pain).

 

You have not shared info and we do not know about the medicines prescribed by the Edinburgh doctor. Recently newer drugs become available and can substitute drugs like Calutide. Some of those have shown to be more successful in holding further advancement of prostate cancer. A famous drug is Xtandi (a more refined antiandrogen) and Zytiga (acting at a much refined intratumoral level of cancer cells).

You can read details searching the net.

In any case, the tests both doctors recommend will provide more clues on the prognosis of your family member.

 

I would recommend you to wait for the scan results and prepare a list of questions to expose to the doctors on your next visit.

Here are some ideas to help you;

http://csn.cancer.org/node/224280

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Here is a “compendium” on Prostate cancer and care;

http://www.lef.org/protocols/cancer/prostate_cancer_01.htm

 

Wishing your family member luck in his journey.

 

VGama  Wink

supreet2000
Posts: 2
Joined: Jan 2013

Dear VascodaGama, tarhoosier & ralph.townsend1,

Thankyou very much for your insight in this case. i would like to add the following as i had missed this before:

  1. His age is 55 Years.
  2. The doctors are of the opnion, of not removing the prostate as the cancer has spread in the body. For this reason Bilateral Subcapsular Orchidectomy surgery was adminstered.
  3. 99m Tc-MDP BONE SCAN
    • Increased abnormal tracer concentration noted in:
      1. D12, L4 and L5 vertebrae
      2. Sacrum
      3. Left ilium, ischium, acetabulum and pubic bones
      4. Right iliac bone near SI joint
      5. Left shoulder and left ankel joints (Arthritic changes)
    • Tracer distribution in rest of the skeleton is within normal physiological limits.
  4. MDCT SCAN OF ABDOMEN-PELVIS
      1. Prostatomegaly with heterogenous enhancement and suspicious focal invasion of right sided base of urinary bladder
      2. infrarenal retroperitoneal lymphadenopathy
      3. multiple osseous metastases
      4. a small indeterminate hepatic lesion seen in segment iVa left lobe of liver
    • Rest of liver, gail bladder, IHBR, CBD, pancreas, spleen, adrenals, kidney, rest of the urinary bladder and opacified bowel loops appear normal

On another note:

Have any of you heard of Dr. Tullio Simoncini who is a roman doctor specialising in oncology, diabetology and in metabolic disorders. He treats cancer with sodium bicarbonate. http://www.curenaturalicancro.com/

Do you think it is an option worth looking into?

ralph.townsend1's picture
ralph.townsend1
Posts: 354
Joined: Feb 2012

Knowing of the drug Calutide 50 mg and personal experience with this drug for 6 months and using it against a metastize prostate cancer. In my case it failed and i think the doctor's knew it would, but it was apart of the protocal to follow. The side of effect were strong, but i know not in all cases. A waste of my Time and money.

There new drugs that are out there to fight micro-metastise cancers.

Leaving a cancer prostate organ in place, is giving the PC a better change to spread to other organs as you have stated it is in the bladder.

 (infrarenal retroperitoneal lymphadenopathy) The removal of Lymph nodes is a losing battle. Once PC blood born has spread into group of lymph nodes, mostly it is in all lymph nodes thru-out the whole body per the best doctors at MD Anderson cancer center.
 
Good luck with your fight.

 

 

tarhoosier
Posts: 187
Joined: Aug 2006

Answer:  No.

Naturopaths may be of some help to otherwise healthy patients; reformng diet, keeping vitamins replete, healthy weight emphasis and so on. For advanced cancer patients we need ammunition with real gunpowder.

VascodaGama's picture
VascodaGama
Posts: 1588
Joined: Nov 2010

Supreet

I am sory for the advanced status of your family member. The tests confirm wide spread which requires systemic treatment. Hormonal therapy may help but he will require targeted medication which only specialized oncologists can administer. Your family member needs to fight in two battle fronts. The cancer and the side effects from the drugs.

He should continuously check the Lipids, particularly anemia.

Regarding Dr. Simoncini, you may know that his theories in treating prostate cancer is not a valid option. You can read about him on the net and my comment in this link; 

http://csn.cancer.org/node/209972

I wish you find a doctor you trust and that your family member gets better.

VGama

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