Advanced Prostate Cancer

maya1234

I needed some advice and found this website to be very helpful. I have been reading all the posts and I wish everyone here the best of luck with their teatments. I pray for a cure. My father-in-law was diagnosed with prostate cancer November 2009 and he was on hormone treatment and finished radiation in May 2010. Treatments were delayed since he underwent torp surgery (I believe this is the name). Everything seemed to be going ok but he was experiencing bone pain and this past August we found out it had spread all over his bones. I am confused by the doctors and his complaints of pain and they never re-checked his PSA score or did another bone scan until it metastasized everywhere. Also, we just found out that it had spread to his liver. My question is, did anyone have this happen and what can we expect, are there any treatments (chemo) that helped anyone. I forgot to mention his initial PSA score was 1,600 and it went down to 150, then it was 33 and now back to one hundreds. It seems the hormone treatment is not working but we are waiting to see the latest PSA score. I hope it went down since hormone treatmetns at the moment seems to be the only treatment to keep the cancer under control. Anyone have the cancer spread to the liver and what treatment did you have? Was liver surgery an option at this point?

Kongo

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.

maya1234

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.

Kongo,
Thank you so much for
Kongo,

Thank you so much for all the information that you provided. There is just so much to learn and deciding what the best treatment is overwhelming. I just hope that he starts to feel better soon and the treatment improves his quality of life. I feel like we are constantly waiting for lab results, I wish they could have them done in a day!

Take care and I really appreciate your comment.

2ndBase

Treatment
The cancer had already spread to the bones and probably the liver years before it was found out. I am in hospice care with the same situation. I chose quality of life and am still working and playing golf every day. I had some treatment in the beginning 7 years ago but knowing there is no cure and wanting to be able to function as normally as possible I stopped further treatments that were available. My cancer may be in my liver now but if so there is nothing I would do about it and I doubt that any doctor would recommend that anything be done. Once you accept hospice care you are not allowed to keep it and take treatment for cancer. I can opt out of hospice but it is what I want. There are no bills to pay now, all is covered. I am very lucky to have survived this long and at age 59 am very happy to be alive.