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Confused about my grandfathers prognosis

SERosen
Posts: 2
Joined: Mar 2013

Hi everyone,

First i would like to thank you in advance for any information offered here, and wish you all luck with your journeys.

My grandfather was diagnosed with prostate cancer in 2008 at the age of 88. This isn't his first bout with cancer, he had a kidney removed due to the disease, likely over 30 years ago now. I am aware that at his age it is unlikely that the prostate cancer will be his demise, but I'm still worried nonetheless. I appreciate tact and sensitivity in your responses.

After diagnosis, my grandfather decided on Lupron shots to slow the process of the cancer as he refuses chemo, radiation, or surgery, and rightfully so. Initially everything was as expected, but after a considerable amount of time on lupron with increasing PSA levels, his doctor suggested ending the treatment and discussing his options with an oncologist. My stubborn grandfather is currently refusing the need for an oncologist, which I can understand, to a point. My concern is that his recent PSA test came back at 30, and because he is stalling, I worry that the cancer will spread, making life much more miserable than a visit to an oncologist or other treatments. 

Am I wrong in feeling a sense of urgency in dealing with the matter? I'm not overly familiar with prostate cancer, so any information on what to expect, how to help him, and detailed information about the condition would be very much appreciated.

Thank you.

VascodaGama's picture
VascodaGama
Posts: 1544
Joined: Nov 2010

seROSEn

 

I am sorry for the condition of your grandfather. I agree with his refusal for radical treatments which at his age wouldn’t have any meaning. Chemo is scaring too but the newer drugs are “friendlier” than what many may think or know about it. I would not be surprised if your granddad’s refusal is more due to a scare than a stubborn issue. Chemo and oncologists go hand-in-hand and the side effects of the older drugs were not very convincing for a “try”; that may be part of his refusal for a consultation too.

 

In any case, the doctor treating him is following the usual “course” with Lupron shots. The rising PSA is indicating that Lupron is not enough and that additional drugs may be required. It is typical to add antiandrogens to the cocktail or still better yet, drugs known as second-line HT, such as Xtandi, Zytiga, Ketoconazole and Orteronel (TAK-700).

You could discuss with his doctor in regards to add a daily antiandrogen like Casodex or Cyproterone. These will not add any substantial side effect to those caused by the Lupron. Once failure become apparent, then he could start with cytochrome P17 inhibitors, such as Zytiga or Ketoconazole. These second-line hormonal drugs are more “delicate” and would require vigilance (periodical lipids tests) but they are oral drugs and one can be in control at the comfort of his home and family.

 

I would say that his PSA is not so high at 30. I would think that there is still “room” to tackle the bandit with hormonal manipulations. Have you any image study result in hand? Is there any apparent metastases or symptoms?

 

Your granddad should get other tests to verify for the drugs effectiveness and causes. I would suggest him to get a testosterone test along the PSA and do a dexa scan to verify for bone loss. It is common to have older patients on bisphosphonates (Flomax) when administrating agonists (Lupron) for long periods. Lipids should also be checked in particular to avoid any anemia that PCa medications may cause.

 

Still another drug in pill form used in older patients (when others have failed) is oral diethylstilbestrol (DES) estrogen. This requires care in particular for those patients at high risk of cardiovascular problems but it is a valid approach for your granddad.
http://prostatecancerinfolink.net/2011/08/19/low-dose-des-in-the-management-of-crpc/

 

In all, your grandfather would require “someone” (medical oncologist) experienced in target medication. His other body functions must be checked for any interaction caused by the drugs he may add/take for other existing illnesses.

You can help him in controlling the effects if he really does not like to meet the doctor constantly.  Do things coordinately and do not let anxiety take over the situation.

 A very good book to help you understanding the hormonal treatment (including the added drugs) is;

“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers.

 

Here is a link with references to an introduction of HT;
http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-hormone-therapy

 

I am very pleased of seeing you in the care of your granddad. He couldn’t have better and surely he is very fortunate. You are a ROSE to him and to us all in this boat.

 

Wishing you peace of mind and good results in his continuous treatment.

 

Welcome to the board

VGama  Wink

 

hopeful and opt...
Posts: 1305
Joined: Apr 2009

Additional viligence needs to be done for male family member for prostate cancer since the likelihood of developing the disesase is greater than the rest of the population. It is recommended that these men start being screened at age 40. Also if younger, a benchmark PSA is advisable at about 35.

There have been studies that show a gene in common, where women are more likely to develop breast cancer. so screening tests are advisabl for blood relativee.

Eating heart healthy is prostate healthy so improvements to diet is advisable.

SERosen
Posts: 2
Joined: Mar 2013

Thank you very much for your kind and extremely knowledgeable response. I really appreciate all of the information you offered. I have shared your advice with my mom, who is my grandfathers caretaker. She is scheduling an oncology appointment for him and I believe that this will be very useful for their meeting and helpful in giving my grandfather a chance at making an informed decision. I hope to have some news somewhat soon to share, as i will undoubtedly have more questions. Thank you again very much! 

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