Advanced Prostate Cancer

Kongo said:

Sorry
Maya,

Welcome to the forum but I am sad for you that your father-in-law's prostate cancer has progressed to this advanced stage. In late stage cancer hormone treatment often has to be redone. While most doctors agree that hormone therapy for advanced cancer is one of the most effective treatments, there is a lot of controversy about how it should be administered and whether it should be a single drug, multiple drugs, and how long it should be administered. As you may know, there are some adverse side effects associated with hormone therapy too. In men with advanced prostate cancer, many quit responding to hormone treatment at some point as the disease progresses.

Many treatment courses for advanced prostate cancer involve hormone therapy in conjunction with other treatments. When prostate spreads beyond the prostate it typically goes to the bones, liver, and lungs but it can go to other areas of the body as well. Sometimes radiation can be used to treat distant tumors and can be effective in reducing the pain, particularly when it has settled in the bones. Chemotherapy is also an option.

You would need to check with specialists to know if liver surgery or a liver transplant would be an option but my guess is that it would not be recommended.

The age and general health of your father-in-law is also a factor here that may limit what types of treatment that could be effective.

As prostate cancer advances and spreads to other parts of the body, the immune system is tricked into not attacking the cancer cells. There is a new drug available called Provenge which has just been approved by the FDA. Basically, they take cells from the patient's blood, ship it to the manufacturer of Provenge where it is exposed to insect cells that have the Provenge drug in them. The cells are then shipped back for re-infusion into the patient. Patients are injected three times...the first time is supposed to reprime the immune system to recognize cancer cells and the follow-on injections get the body to launch its own anticancer response. There are some side effects with this drug too but they seem to be more easily tolerated than long term hormone therapy.

Depending on the type of PCa, one option may be to remove the sources of testosterone in your father-in-law through orchiectomy where the testicles are removed and replaced with prosthetics (artificial body parts) that resemble the shape of testicles. Most types of prostate cancer is triggered by testosterone and the testicles are a major source of where testosterone comes from in men.

The doctor's may also wish to completely remove the prostate, lymph glands, seminal vesicules. When they do this, they usually remove the nerve bundles as well. There is some controversy as to whether or not this surgery makes a difference or not so if your medical team is recommending this, I hope you get second opinions.

While your father-in-law has several options, he really needs some first class medical care that can explain to him (and the family) what the prognosis for these treatments might be and the affect on his lifestyle and quality of life. Reading between the lines on your post, it appears to me that you're not entirely satisfied with your existing doctors...I would not hesitate to get another medical team that is more responsive to your needs.

Be sure to insist that a knowledgable family member go with your father-in-law for these doctor meetings as he is likely scared, confused, and will not remember everything the doctor's tell him. Another family member taking notes and asking questions will be a big help.

Best of luck to you and your family as you deal with this difficult situation.