Need Opinion

girishpd

Hi All,

My Father (age 83 and with no cancer symptoms) was diagnosed with PCa on 19th of this month, with a PSA of 62 and Gleason's Score = 3+3, This seem to have metastised in his hip bone. His Urologist recommended 2 options: 1. Surgery , 2. Hormone Therapy, however, on second opinion we were told not to go for surgery at all! He recommended to do another biopsy of the illiac region by interventional radiology and if that is negative only go for radiation but if it is positive go for radiation + hormonal therapy. 

We are not too sure what path to take, while we are also talking to other experts to take few more opinions I would also like to know if anyone here has some advice for me.

 

Thanks in Advance,

Girish

hopeful and optimistic

.

No surgery for a man of 83!!!!!!!!!!!!!!Surgery is an invasive procedure.

Additionally if the cancer is outside the prostate surgery is not curative

Most surgeons do not recommend surgery for men over 70

Recommend that you find a Medical Oncologist, preferably one who specializes in prostate cancer to manage your fathers cancer; the very very best that you can find.

Image testing that may be considered area 3T MRI and various Pet Scans. 

Depending on results, radiation plus hormone therapy, or hormone therapy only (your fathers very high PSA may indicate that the cancer has left the prostate)

Old Salt

I second that opinion

It seems to me (not an MD) that the only rational therapy for your Dad is hormone therapy + radiation.

And yes, a discussion with a Radiation Oncologist is highly recommended.

PS: Depending on your father's outlook on life and his co-morbidities, no treatment might be an option as well.

girishpd

hopeful and optimistic said:

.

No surgery for a man of 83!!!!!!!!!!!!!!Surgery is an invasive procedure.

Additionally if the cancer is outside the prostate surgery is not curative

Most surgeons do not recommend surgery for men over 70

Recommend that you find a Medical Oncologist, preferably one who specializes in prostate cancer to manage your fathers cancer; the very very best that you can find.

Image testing that may be considered area 3T MRI and various Pet Scans. 

Depending on results, radiation plus hormone therapy, or hormone therapy only (your fathers very high PSA may indicate that the cancer has left the prostate)

Thanks for your input. This

Thanks for your input. This seems consistent with one of the experts we consulted. I have not yet consulted a Medical Oncologist, I like your recommendation. I would do some reasearch and try and find someome.

I am located in Bangalore, India and my Father is in Delhi, does anyone here has s recommendation of a good medical oncologist?

girishpd

Old Salt said:

I second that opinion

It seems to me (not an MD) that the only rational therapy for your Dad is hormone therapy + radiation.

And yes, a discussion with a Radiation Oncologist is highly recommended.

PS: Depending on your father's outlook on life and his co-morbidities, no treatment might be an option as well.

Thanks for your input. I have

Thanks for your input. I have schedued an appointment with an Intervention radiologist already.

girishpd

More Updates

We had a chat with the Urologist and raised our concern with the surgery, he mentioned that he is recommending bilateral orchiectomy and not radical prostatectomy ,which apparently is ok at my fathers age. Please let me know if any of you have experience with this.

thanks.

Rakendra

Old Salt said:

Permanent castration

Orchiectomy will result in VERY low testosterone levels in the body because testosterone is produced in the testicles. Lowering testosterone is the goal of hormone therapy as well. But orchiectomy is permanent and hormone therapy can be turned on and off. Some people refer to the latter as 'chemical castration'. One member of this forum (Rakendra) has undergone orchiectomy and writes about it from time to time.

Orchiectomy

At 81 I had a Psa of 300 and multiple widespread matastasis.  The only treatment I chose was orchiectomy and Bilcalutimide.  I now believe that the Bicalutimide was unneccessary and I would not do it again.  The first year was very, very difficult.  I had huge emotional problems, crying, and all the other issues with HT, but I was always celebrating my gift of life and looking for my spritual lessons.  Now I am 85 (in Dec) and my life is full of wonder and gratitude for the cancer.  I believe that everything that comes into my life is for my benefit.  For me, winning the lottery or getting Stage 4 are equal; one is not better or worse than the other.  They both are for my benefit and both are for my spiritual growth, and that is the purpose of my life in this realm.  

    So, I would say go ahead with the castration, but get several opinions before doing bicalutimide.  Also, get an exercise program and vegan diet.  I would also try to build my immune system.  Food Grade Hydrogen peroxide is one way to do this.  https://www.youtube.com/watch?v=VeM3apCneok

https://www.youtube.com/watch?v=bkt7ZPe9_wU

and there is a lot more on youtube.  I did not know about this until 8 weeks ago.  I have been taking it and have seen my strength go up by 35%.  I suggest that everyone considering this needs to do their own investigation.  This is not an approved therapy and you have to decide if it is harmful or helpful.  My cancer is under control and will not be aproblem for me in the future.  

love, swami rakendra

ps my Psa is now under 1.5, and my prostate has shrunk to 30%, or about average for a man of 55-60, and I am 85

 

Swingshiftworker

Already made my choice . . .

I have no personal experience with this but I have read enough stories about negative consequences of HT meds to put me off of the idea of every taking any, even though their effects are theoretically reversable. 

I say theoretically because once you go on a HT regimen, you are going to be on it a LONG time, if not for the rest of your life.  So, the whole idea of the reversibility of HT medication is indeed only theoretical.

I've also read the stories about the negative consequences of an orchiectomy but those seem to be less severe and resolve themselves over time.   Not so w/HT meds which only stop messing up your body/mind after you stop taking them but how can you ever stop taking them if you continue to need to suppress the production of testosterone?  Except in rare cases, you can't. 

So, if I am so unfortunate as to see my PCa return and find it necessary to stem the further production of testosterone, I have already decided that I would opt for an orchietomy with full knowledge of that that would mean for my sex life which, at a more advanced age (older than I am now) won't matter as much as my continued survival, as Rakendra so clearly points out above.

girishpd

Rakendra said:

Orchiectomy

At 81 I had a Psa of 300 and multiple widespread matastasis.  The only treatment I chose was orchiectomy and Bilcalutimide.  I now believe that the Bicalutimide was unneccessary and I would not do it again.  The first year was very, very difficult.  I had huge emotional problems, crying, and all the other issues with HT, but I was always celebrating my gift of life and looking for my spritual lessons.  Now I am 85 (in Dec) and my life is full of wonder and gratitude for the cancer.  I believe that everything that comes into my life is for my benefit.  For me, winning the lottery or getting Stage 4 are equal; one is not better or worse than the other.  They both are for my benefit and both are for my spiritual growth, and that is the purpose of my life in this realm.  

    So, I would say go ahead with the castration, but get several opinions before doing bicalutimide.  Also, get an exercise program and vegan diet.  I would also try to build my immune system.  Food Grade Hydrogen peroxide is one way to do this.  https://www.youtube.com/watch?v=VeM3apCneok

https://www.youtube.com/watch?v=bkt7ZPe9_wU

and there is a lot more on youtube.  I did not know about this until 8 weeks ago.  I have been taking it and have seen my strength go up by 35%.  I suggest that everyone considering this needs to do their own investigation.  This is not an approved therapy and you have to decide if it is harmful or helpful.  My cancer is under control and will not be aproblem for me in the future.  

love, swami rakendra

ps my Psa is now under 1.5, and my prostate has shrunk to 30%, or about average for a man of 55-60, and I am 85

 

Thanks for your inputs Swami

Thanks for your inputs Swami Rakendra,

It is very helpful to learn your experience. For my father as well he has been adviced HT post surgery, we have not taken a call on that yet, but inputs like yours really help.

 

thanks.

Old Salt

Swingshiftworker said:

Already made my choice . . .

I have no personal experience with this but I have read enough stories about negative consequences of HT meds to put me off of the idea of every taking any, even though their effects are theoretically reversable. 

I say theoretically because once you go on a HT regimen, you are going to be on it a LONG time, if not for the rest of your life.  So, the whole idea of the reversibility of HT medication is indeed only theoretical.

I've also read the stories about the negative consequences of an orchiectomy but those seem to be less severe and resolve themselves over time.   Not so w/HT meds which only stop messing up your body/mind after you stop taking them but how can you ever stop taking them if you continue to need to suppress the production of testosterone?  Except in rare cases, you can't. 

So, if I am so unfortunate as to see my PCa return and find it necessary to stem the further production of testosterone, I have already decided that I would opt for an orchietomy with full knowledge of that that would mean for my sex life which, at a more advanced age (older than I am now) won't matter as much as my continued survival, as Rakendra so clearly points out above.

Some comments

1. Many of us are currently off hormone therapy; Vasco and others are examples. I took an 18-months course of Lupron and feel just fine right now, roughly one year after discontinuing the drug.

2. Orchiectomy dramatically lowers testosterone. This is the reason for most of the side effects associated with Lupron and similar drugs (Firmagon etc.) For a personal testimony, I lifted the following from Rakendra's post in this thread:

The first year was very, very difficult.  I had huge emotional problems, crying, and all the other issues with HT, but I was always celebrating my gift of life and looking for my spritual lessons.

I want to state clearly that orchiectomy is an option that should be considered seriously for girishpd's Dad, the subject of this thread.

girishpd

Surgery Done

Thanks everyone for your recommendations and information, my father underwent orchiectomy this monday, he is now discharged from the hospital and is doing good. The Urologist has not recommended any further treatment at this moment, we have been asked to check his PSA in 3 months. Ofcourse no HT as well. I am assuming this is a normal course of action.

VascodaGama

Congratulations

Congratulations.

Yes that is the normal procedure. He will have menopause symptoms (probably fatigue will be the worse) but in time he will get used to the condition.

Best wishes,

VG

Old Salt

girishpd said:

More Updates

We had a chat with the Urologist and raised our concern with the surgery, he mentioned that he is recommending bilateral orchiectomy and not radical prostatectomy ,which apparently is ok at my fathers age. Please let me know if any of you have experience with this.

thanks.

Permanent castration

Orchiectomy will result in VERY low testosterone levels in the body because testosterone is produced in the testicles. Lowering testosterone is the goal of hormone therapy as well. But orchiectomy is permanent and hormone therapy can be turned on and off. Some people refer to the latter as 'chemical castration'. One member of this forum (Rakendra) has undergone orchiectomy and writes about it from time to time.

Old Salt

girishpd said:

Surgery Done

Thanks everyone for your recommendations and information, my father underwent orchiectomy this monday, he is now discharged from the hospital and is doing good. The Urologist has not recommended any further treatment at this moment, we have been asked to check his PSA in 3 months. Ofcourse no HT as well. I am assuming this is a normal course of action.

To minimize side effects etc

Encourage your Dad to stay active, if at all possible. Walking is great; perhaps some weight lifting. Yes, I know, he is no youngster anymore.

Also advise him to 'eat healthy'; you don't want him to gain a lot of weight. He should also watch his Ca and vit D levels because osteoporosis is a possbility once the testosterone goes down to almost nothing.

I hope that he will stay well; please keep us in the loop.

ZetB1

girishpd said:

Surgery Done

Thanks everyone for your recommendations and information, my father underwent orchiectomy this monday, he is now discharged from the hospital and is doing good. The Urologist has not recommended any further treatment at this moment, we have been asked to check his PSA in 3 months. Ofcourse no HT as well. I am assuming this is a normal course of action.

Casodex also

A doctor at Mayo clinic provides 50mg Casodex (for life) to compensate for other testosterone in the body.  Casodex stops the testosterone from "landing" on cells and causing cancer.