Answers - well sort of

Double Whammy

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. . .   

VascodaGama

IGRT/IMRT

Suzanne

It seems that you have decided on the combo of HT plus IGRT/IMRT. Can you tell us about the whole protocol regarding the Radiation grays+ sections and HT shot periods?
I would recommend your husband to get a Testosterone test done with the PSA before the administration of the LHRH agonist shot. This is the marker required to check the drug’s effectiveness in your husband’s future events. He can get the results from the same blood sample.

Best wishes along his journey.

VG 

Your earlier posts:

http://csn.cancer.org/node/263159
http://csn.cancer.org/node/264034

lewvino

thanks for keeping us up to

thanks for keeping us up to date. Your post has explained some things such as the low gleason high psa very nicely. Something I've wondered about when I have heard others report this.

Lewvino

mrspjd

More questions than answers?

Suzanne,

In your previous thread I suggested that your DH get baseline testosterone & DHT levels taken. These levels, along with PSA, will be important markers to see how the cancer is responding to the ADT (androgen deprivation therapy) aka hormones. 

 

In addition, when starting most ADT protocols, a bone mineral test (different from a bone scan) to measure bone density is recommended. That can be done using a QCT or a DEXA scan. My husband had the QCT (quantitative computer tomography) versus the more common DEXA scan because his PCa MO felt the QCT has better & higher definition imaging of the spine than the DEXA.  Longer term use of ADT can deplete bone mineral density. The bones, especially the spine, is one place PCa mets like to make their "home." Bisphosphonates is one class of drugs that prevent the loss of bone mass/density & are often Rx'd proactively by MOs during ADT. Osteonecrosis of the jaw (ONJ) is a rare SE of ADT. For this reason, a dental check up & any major dental work is recommended prior to ADT.  

 

ADT slows and shrinks PCa cells by starving them of testosterone (and the more potent DHT, if a 5-ARI is included with ADT--aka triple ADT). This "sensitizes" PCa cells (as your RO mentioned) to respond to RT more efficiently, which we hope kills those cancer cells off for good. Recent studies have found that neoadjuvant ADT with RT, especially in intermediate-high risk PCa cases, had better outcomes than RT alone. 

 

A heart/prostate healthy diet and weight bearing exercise are both important elements of a PCa tx plan, even more so when ADT is used. For general guidelines on nutrition & PCa, see UCSF's info:

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

 

Best of luck to you both.