Prostate cancer back? after cryosurgery

illoozions
illoozions Member Posts: 32
in Prostate Cancer #1

My husband had Base of tongue cancer in 2010 and has fully recovered from that.  He was diagnosed with Prostate Cancer in 2012 after a rising PSA and a biopsy resulting in 5% affected with a Gleason score of 8 (4=4).  After undergoing his first cancer, we asked which treatment would give the most permanent results.  He advised us that Cryosurgery was the most permanent and would completely kill the prostate.  We decided to go with it and this was done in Dec 2012.  In Jan 2013 his PSA was a .5 (never went to undetectable) the Dr didn't suggest any other treatments. 

Fast forward to 2016 (3 1/2 years) and his PSA had doubled from Dec 2014 to Dec 2015) and has been creeping up since, it is now a 3.8.  His current Dr where we now live has told him that this assures him that my husband has cancer so there is no need for a biopsy. He told us that my husband was too old for surgery (he is a healthy 78 yr old with no other issues) and can't do seeds because of the cryosurgery in the past so he sent him to a radiologist who advised him to get 42 radiation treatments.  Both Drs don't feel the need for a biopsy to determine the extent of prostate (if any) that is affected, or a new gleason score.

Does this sound like a standard form of diagnosis or is something wrong with this picture??  it cannot be insurance related because my husband has 3 insurances.  I am worried that they are assuming something that may not be correct, is there any scenario where a rising PSA may not mean cancer?

Comments

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    edited June 2016 #2
    SRT protocol should be defined after reliable image studies

    Illoozions,

    I wonder if the biopsy discussions with your doctor were started by you. His doctor is correct. At this stage there is no need in diagnosing cancer or in identifying its Gleason rate. The initial diagnosis of 2012 prevails. I also agree that surgery may not be a feasible salvage therapy or practical treatment step. Radiation may be his best shot to tackle his case.

    In any case, radiation should be administered to targets previously identified; or decided according to past experiences with proven successful rates in treatments outcomes. Usually doctors get image studies (PET, MRI, etc) and scans (bone) to look for cancer’s hideaways, so that they can target with radiation. In case of negative exams then they use one of the traditional fields (isodoseplanning) typical in SRT (salvage radiotherapy for prostate cancer). The decision on the 42 sections of radiation is just guessing work. They should identify the best modality after completing the exams.

    The doubling of the PSA signifies that the cancer is aggressive. Gleason score 8 (4+4) are typically aggressive types prone to spread. I would suggest you to consult with your doctor on the possibility in having a PSMA PET/MRI (or PET/CT) or F18 choline PET/CT, before deciding on the SRT protocol.
     I also would suggest you to research about other types of exams that reliably can identify PCa; and combination therapies (ADT + RT, or ADT + Chemo + RT) that can better address his case.

    All treatments have side effects and the patient needs to be fit to counter them as well as the treatment. Drugs may interact so that existing illnesses need to be considered and discussed in advance. I also recommend you to get second opinions from various specialists, in regards to the collected data or suggested treatment.

    Here are links regarding PET image studies using different contrast agents you should consider;

    http://www.eurekalert.org/pub_releases/2015-05/sonm-rop050415.php

    http://www.europeanurology.com/article/S0302-2838(15)00513-8/abstract/initial-experience-of-68ga-psma-pet-ct-imaging-in-high-risk-prostate-cancer-patients-prior-to-radical-prostatectomy

    http://www.ncbi.nlm.nih.gov/pubmed/25738559

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456485/

    Here you can read about SRT (Salvage Radiotherapy);

    http://www.cancernetwork.com/prostate-cancer/salvage-external-beam-radiotherapy-prostate-cancer-after-radical-prostatectomy

    Best wishes and luck in his continuing treatment.

    VGama

     

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