My dear Dads diagnosis.

JDD,

I am sorry for your dad's diagnosis. As you expect his case is locally advanced, the cancer is of an aggressive type, and cure may be elusive. The clinical stage is T4N1M1 (due to the invasion of the bladder); however his case is treatable and he will enjoy many years of live. You dad's age though may restrict the type of intervention or even the medication if any other illness exist or may be accounted for future usage. To such extent probably it may be a good idea of involving a medical oncologist in his team of doctors.

I believe that the data you share above is from a PSMA PET exam using the advanced radiopharmaceutical 68Ga. I wonder if you can provide us the details of the biopsy, done by the pathologist when your dad was initially diagnosed. I also would like to know if your dad has of had any other health problem, or is taking any medication. How fit is he at 78 years old?

The good news from the PET scan is that they did not identify cancer in bone which makes me think that the fast doubling of the PSA is due to the metastases in the lymph nodes. This may be the reason for his doctor starting the hormonal treatment (ADT) the earliest. He is trying to contain the spread so that the bandit will not trot to far places via the lymphatic system.

Regarding treatments, the NCCN guidelines (which also includes Australia doctors) recommends palliative treatments for patients older than 75. Radical therapies with intent at cure (surgery and radiation) are also recommended for localized cases but not as advanced as your dad's situation. T4 guys usually are moved to chemotherapy and/or hormonal treatment (systemic therapy), reserving radiation as a palliative intervention to alleviate pain at latter stages (radiation of tissues should be administered only once).

His doctor may have follow those guidelines by starting ADT, but my lay opinion in your dad's case, is that a combine therapy involving three approaches (radiation + Chemo + ADT) may be a possibility. In any case, the risks and side effects from the three treatments are cumulative which would prejudice the quality of life of the patient. Depending on the extent of the metastases at the bladder, radiating the area (trigone) may or may not be a possibility (you need to consult a radiologist). Chemo would be recommended, and the lymph nodes plus the whole gland could be attacked with radiation. The hormonal treatment will not kill the cancer but make it indolent. Your dad's PSA after two weeks of Casodex is already lower and it will go further down after the Lucrin injection.

ADT alone is also to be considered if your dad's cancer is hormonal dependent and if his status does not permit chemo administration. There is a wide variety of drugs in ADT weaponry providing a series of blockades so that one could expect many years of treatment before becoming refractory to the treatment.

Apart from the above, systemic cases can avail now of treatments based on radiopharmaceuticals. Sort of stealth missiles delivered directly to the cancerous cell. There are clinics in Germany already providing treatment using LU 177 that attached to PSMA isotopes (similar approach to the PET scan) manage to kill cancer where it hides. You may try goggle the subject.

I wonder who those intelligent participants in this forum are, you refer above. In any case, please note that we are not doctors but survivors trying to help the many with lay opinions based on our own experiences or researches done while on treatment. 

I think you are writing from Australia, where Lupron is Lucrin and the units used in your PSA lab becomes in ug/L (microgram/liter = nanogram/milliliter) instead of ng/ml. Am I right mate?

Best wishes and luck in your dad’ journey.

VGama

JDD,

From the info you share, it seems that your dad has been cared and treated by laparoscopy specialists. The urologist may have a degree in oncology but I would recommend you to get opinions from radiologists and oncologists that may be more appropriate to care for his continuing cancer journey. No more bandaid surgeries.

I am not aware of the full story behind your dad’s health issues but something seems not correct. You may be right in regards to the lack of attention given by the urologist towards the prostate cancer issue, in not testing the PSA since 2013 (when this was 3.7 ng/ml), particularly if bladder cancer was at play. What is difficult to believe is that any PSA was reviewed at the initial times when your dad started the urinary problems that led to the bladder cancer findings. I would think that this urologist focus more on his specialty as a laparoscopy operator then as a medical oncologist preventing and treating cancer.
The analysis of the specimens that found PCa this time also suggests that your dad has not been cared properly. Wasn’t for the findings on the adenocarcinoma in the bladder no one ever suspected that the prostate was in jeopardy.

I wonder if I would trust your comment in regards to the grade of fitness of your father. They are always old to us and always in good shape looking fine but that doesn’t reflect health wise. What do the health markers tell? Is there any heart health issue? What about the liver and bone health? Did the bladder cancer treatment include chemo therapy apart from the nephroureterectomy? Is he under any additional medication other than the ADT issue?

I think you should get a full lipids panel, the testosterone (better before the Lupron shot), a DEXA scan, ECG, etc. These markers will serve to investigate his proper status and will be compared in future testing, providing details on the efficacy of a therapy. He should get consultations with a radiologist to certify the pros and cons regarding an RT attack. A medical oncologist would be regulating the use of the several drugs that may interact with each other or prohibit a certain treatment. The ADT will provide time for your dad to get all the tests in time while consulting on treatments. 

In regards to the LU 177, you can investigate if your dad could participate in the clinical trial using the radiopharmaceutical, now running in Australia (no need to come to Europe). This would be a great opportunity for having the treatment free of charge and done and cared by proper specialists. Your choice of a medical oncologist could be procured among the team doing the trial. I am not sure if the bladder issue would oppose your dad from being qualified but guys that have been on chemotherapy and ADT have been included and are in trial. Your dad should be assured of taking the real stuff. Not being included in the placebo group. Please try to contact participants to access the doctors/clinics in the trial using this link;

http://forums.jimjimjimjim.com/index.php?/topic/1548-lupsma-177-clinical-trial/

You do not need to apologize for the questions. You are as we a sufferer of the disease. I wonder if you are a male because if such your risk for PCa is 4 fold higher than the usual folk. If female you also are at risk to contract breast cancer as this bandit got origins from the same genes. Try getting the due tests yourself.

You can find a good collection of reading material in here;

https://csn.cancer.org/node/311252

Though been from Australia, this forum welcomes you. The site is American, most of the participants are Americans but many other nationalities use it and discuss/share their issues because we all speak the same language, the Cancer. I am Portuguese and live at the lower tip of Europe, the country of the navigator Vasco da Gama. A good friend and survivor in this forum live close to you in Sidney and uses a famous PCa medical oncologist based in Singapore. We all share our experiences and learn from each other. Some guys are like me and spend hours researching about the matter to the extremes (I have exchanged the bible with a PCa book at my bedside table). I do not think that I am more intelligent than others here but simple got more years on the trade (17 years).

Best wishes,

VGama 

If clinical trials is important to you do your research and pick your doctors wisely because many facilities/doctors tequire the patient to be treatment naive to be included. In other words your choices can lock you in or exclude you from other options.

George