Nov 14, 2013 - 8:22 pm
In follow-up to my earlier posts, we finally met with a radiation oncologist today. We both really liked the man and his CV is pretty impressive. He answered all of our questions. In particular, we told him how confused we were over the relatively low Gleason score (6) vs. the pretty high PSA (40) and the positive cores on both sides vs. the negative bone scan. Altho he said it would not make any difference in the treatment recommended, he is repeating the PSA. That will do little other than put our mind at ease whether it was accurate or not. It will not effect the treatment decision - unless it's hugely increased and even then it might not. The rad onc explained that lower grade Prostate CA cells often produce more PSA than higher grade because they are more like normal prostate cells - just more of them. This is why it is not unusual for someone to have a really high Gleason score but a low(er) PSA score. And, of course, there are exceptions but most of the time this is how it works. I think this explanation as well as repeating the PSA is about as good as we can get at this point.
We also expressed our concerns about the hormone therapy and the fact that the urologist acted like my husband could just go ahead and have surgical castration (consistent with his cavelier attitude about the whole thing). The rad onc explained that most men don't want to have surgical castration (duh) and that the hormone thereapy started about a month before radiation sensitizes the cells in the prostate and makes them respond more to radiation. He felt any radiation oncologist would recommend hormones before starting radiation for my husband. He also said that they will discontinue the hormone therapy after some time (he wouldn't commit to a time) in order to get a new baseline PSA since the treatments do have an effect on PSA. If his PSA is negligable after being off hormone threapy for however long they say, then he will probably not have to continue and his body will once again produce testosterone after some time. Of course, if it isn't, then we're looking at continuing and it is what it is. But we feel pretty good about this approach.
So the plan is to start hormone treatment with the urologist and have the urologist insert marker seeds for radiation. He probably won't actually start radiation until January.
When we asked about a second opinion, he said he believed that the treatment recommendations would be the same. I feel we got our concerns put to rest with this consult and the concerns that remain will remain. I'm confident about the future for this prostate cancer. His other health issues I'm not so confident about. . .