Gleason 9 PSA 14 Advice
In October 2018, my father's PSA score was 9. After coming back to Ohio from spending the winter in Florida, he went to the same Urologist, and his PSA score was 14 in May 2019. His Urologist called for a 12-core biopsy, of which we received the results last week, with cancer being identified in all 12 cores. His Gleason Score is 9. My father is 79 years old, lives in Bowling Green, Ohio, and sees a Urologist from https://www.romiusinstitute.com/. He has the utmost respect for his Urologist.
The additional history I can provide is that he had a PCA3 test 4-5 years ago, and the results came back negative. He is on medication for hypertension, high cholesterol, and tachycardia. He is extremely active both mentally and physically.
At the appointment in which he received his diagnosis, his Urologist put him on Bicalutamide, and created orders for an abdominal CT scan, with and without contrast, and a bone scan, which will take place on June 6, 2019. If the bone and CT scans come back negative, the Urologist is recommending 8 weeks of EBRT and 24 months of ADT, along with an injection, but I’m unsure of what that injection will be. If the results come back positive, the paper my father showed me has the Urologist recommending ADT only.
I have so many questions. Please answer any you may be able to provide input on.
- Should I be getting my father a remote second opinion?
- If so, what should I be getting a second opinion on? Just the biopsy, or should I wait and have the second opinion done on the scans as well?
- As things stand right now, my father’s treatments will be taking place at Wood County Hospital in Bowling Green, Ohio. Would the radiation therapy be of a higher quality if provided by a more specialized facility? My father is willing to travel within the region to receive the best treatment possible. This would include Toledo, Columbus, Cincinnati, and Cleveland in Ohio, and Ann Arbor in Michigan, among others.
- Does anyone have any specific recommendations in any of these cities?
- Is there anything my father can do immediately, if things have not progressed too far, such as diet and lifestyle changes, or adding supplements? He is already active, exercising 3 times per week with his Silver Sneakers group.
- I assume his cancer will be staged at 3 or 4 when we find out the results of his imaging on June 13, 2019. I suspect that his cancer has spread at least regionally, and praying that it has not metastasized. With that being said, what do you think are the best multi-modality treatments if it is spread regionally vs. if it has metastasized?
- Should he consider getting a radical prostatectomy?
- Quality of life is important to my father. He would prefer to do nothing and let the cancer take him if the quality of life is low with treatment. If metastasized, what would the quality of life be, given the treatment plan? What about the quality of life with the treatment involved with a regionally spread cancer?
- At this point, why are they only ordering an abdominal CT scan, and not a full-body scan to include the brain, lungs, etc.
- Will the abdominal scan include the lungs?
- I don’t know the specifics on the type of cancer cells found in the biopsy, should I ask for that information? Will that make a difference in the treatment plan?
- My father has Medicare and an excellent supplement plan (F plan). Will these treatments be covered by the insurance?
- Are there any treatments that you are aware of that are not covered by Medicare and the supplement?
- Lastly, and most importantly, my sister and I will be present at the June 13th appointment where he will receive the results of the scans. What questions should I be asking the Urologist at the appointment?
In closing, I’d like to thank all of you that have posted your information here to help educate people like me. Also, thank you in advance for any information you can provide that may allow me to help my father. I’ll be posting updates regarding test results and treatment plans, so others may benefit from hearing the details of my father’s journey.
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