My dad was just diagnosed with prostate cancer

LondonLady

Hi everyone, I have been so thankful to find this forum. It has brought me a lot of hope during one of the hardest moments in my adult life. I wanted to share my dad's story for some guidance on what to expect next:

My dad- very healthy 69 year old male. Had all normal PSAs through his 50's; last one checked was 1.3 at age 60. PCP stopped checking at that point I believe because he was considered low risk. Fast forward to now- he's retired, spending several months overseas in Portugal where he is from orginally, and some time here in the U.S with his family. During a routine exam in Portugal to keep his insurance, his PSA was noted to be 45 repeated again 3 days later as they surely thought there was an error and it was 41. We flew him back for an evaluation, repeat PSA here was 35 (~4 weeks ago)

In the meantime, I was able to get him in to Temple/Fox Chase Urology (helpful that I am a Nurse Practitioner). We completed initial work up:

10/27/2025: MRI: Large PI-RADS 5 lesion in the left peripheral zone mid gland as detailed. Questionable invasion of the left seminal vesicle root. Broad-based abutment of the capsule without contour deforming extracapsular extension otherwise.

10/30/2025; Repeat PSA 63 (4 weeks later)

11/3/2025: Prostate Biopsy (results pending)

I had mentally prepared myself that he likely had distant metastasis and today he completed the PET CT Skull To Thigh POSLUMA.

IMPRESSION:1. This scan utilized a F-18 PSMA - POSLUMA tracer, typically used for evaluating prostate cancer. 2. The large lesion in the left periphery zone is active (SUV 18.7), consistent with viable tumor.3. There are active lymph nodes at the level of L2 (SUV 5.5) and L3 (SUV 7.1) with another left internal iliac node (SUV 18.7). Those are likely metastatic disease.4. No other active lesion in the remainder of the scan, no active bony lesion.

I feel somewhat relieved with the results, but I know we still have an uphill battle. From what i have been reading, he will likely still be a surgical candidate, am I correct with this thinking? And likely benefit from some salvage radiation/ADT? I am just trying to prepare for this journey with him.

rhobo23

London,

I am a bit older, than your father, now 75. About 30 months ago my PSA zoomed thru 5 to almost 10 during the pandemic. My HMO pointed me to radiation but I choose surgery and expected to follow that up with radiation, and that is what happened. Neither surgery nor radiation is a breeze. It took me a good 3+ months to recover contenace after surgery and was mostly laying down during that time. But I do not regret chosing the surgical route, feeling it will give me the best chances.

One recommendation I would make is if your father is on blood thinners is to leave the catheter in for at least two weeks. They gave me only 8 days and it required a return trip to reinsert the catheter for 2 more weeks due to bleeding.

jc5549

London I am so sorry you and your Father are dealing with this. You all picked a center of excellence in Fox Chase. I would ask the same questions because surgery is really a controversial step in a man with known lymph node metastasis. It will not cure him so the question is will surgery benefit him enough to be worth the problems that accompany a prostatectomy.
I think hormone blockade will certainly be part of his treatment and possibly radiation. Good luck to you and please keep in touch on this site. There are a lot of guys with great information.

jc

Clevelandguy

Hi,

If the cancer has spread outside the Prostate the normal convention would be to treat the Prostate with radiation and also the other metastatic hot spots. ADT drugs will weaken the cancer but not kill it. Find the best doctors plus the best facilities to get the best results. Radiation types such as Cyberknife(trade name) are commonly used. Proton therapy can be used after you have maxed out an area with traditional radiation. Your doctor team can recommend various treatment protocols, second opinions are not a bad idea either. As a 11 yr. survivor of Prostate cancer keep a positive “this aint gonna control me attitude” also helps.

Dave 3+4

Josephg

Welcome to the Board that nobody wants to belong to.

It is pretty clear to me, in my non-medical professional opinion, that his cancer has metastasized outside of the prostate. At this point, in my opinion, you should be looking for a Medical Oncologist (MO) specializing in prostate cancer (PCa), and you should be able to easily find one at your Fox Chase center. The reasoning here is that he will most likely need adjunct Androgen Deprivation Therapy (ADT), also known as Hormone Therapy, to be delivered along with either surgery or radiation options. ADT has proven to significantly improve the outcomes of both surgery and radiation, by weakening the PCa and making it more susceptible to the other treatments.

The MO is the specialist in delivering ADT, and should become the leader of his care team going forward. The MO will engage other specialists as needed (Urological Surgeons, Radiation Oncologists, etc.) to deliver the agreed-upon treatments. Those specialists are one and done for the most part, but the MO will follow up with him on a regular basis and monitor his PSA for the rest of his PCa journey.

I'm a 13 year PCa survivor that has had surgery, radiation twice, and ADT twice along my PCa journey, and my MO has been at my side for the entire journey.

One other important item ⇒ Both him and you should consume as much PCa-related content from reputable sources as you can, so that you can educate yourselves on this disease, so that you'll both be in a better position to make informed decisions regarding his treatment options and anticipated changes in quality of life.

I wish him the best of outcomes on his PCa journey.

swl1956

Hi LondonLady,

Also at 69 I too am being treated at Fox Chase Urology for the last couple years. Their doctors are very competent however may have differing opinions on treatments. You can always ask to get a second opinion from one of the other doctors there. My situation was different from you dads. I originally opted for an ablation procedure which I was deemed to have been a good candidate for. Several months later I had metastasis to pelvic lymph nodes likely due to micro metastasis that was not detected on PSMA PET scan. At this point I was told that surgery is no longer recommended. I was started on ADT and 40 sessions of IMRT. I'm not out of the woods yet, but my PSA is now in the undetectable range. Your dads biopsy results will have a definitive bearing on the decision process. Surgery might be an option, but as others here have indicated, I suspect your dad will be recommended ADT + radiation of some sort. They will likely assign a medical oncologist and a radiation oncologist to his team. None of this is a walk in the park, but very likely your dad will have many years of life going forward. There are many options on keeping prostate cancer at bay even if a complete cure is not possible.

I'm curious which doctor you dad is seeing? My urological oncologist is Dr. Andres Correa whom I like very much. From my dealings there and from readings I understand that Dr. David Chen one of their best oncologist surgeons. A friend of mine had a prostatectomy performed by him and has had many years of cure with no lasting side effects.

LondonLady

https://csn.cancer.org/discussion/comment/1725133#Comment_1725133

Thanks so much for the kind reply! We’ve been doing our initial work-up with Dr. Randall Lee — he’s been phenomenal. I’ve known him for many years, as he was one of our residents and top-notch back then as well. We also considered Dr. Correa, I've heard nothing but great things.

I’m just wondering how it works if they deem my father not a surgical candidate, if he will continue care with Dr. Lee (I am not sure if his main focus is Urological Oncology or if we will be transitioned to someone like Dr. Correa)?I was hopeful that with only two potentially active nodes outside the pelvis, they might still consider him more like an N1 rather than M1a. I feel lucky even with some distal node metastasis because from what I've read the prognosis is still more favorable than with bone metastasis.

LondonLady

https://csn.cancer.org/discussion/comment/1725131#Comment_1725131

Thank you! After my initial post and some further reading, I realized that the two nodes are considered distant, which would place him at M1a. I know there are clinical trials exploring cytoreductive radical prostatectomy in cases like my father’s, but I’ll need to read more about it. Thanks again for the recommendation- I’ve been reading quite a bit, but if you have any trusted sources or references you’ve found helpful, I’d really appreciate them!

swl1956

https://csn.cancer.org/discussion/comment/1725136#Comment_1725136

Dr. Correa is a urological oncologist surgeon. He performed one biopsy on me prior to him performing the IRE ablation. Sometime after which he performed a second biopsy which showed all clear. 6 months later my PSA spiked which after a PSMA PET scan indicated metastasis to lymph nodes in pelvis area. He immediately referred me to Dr. Fern Anari a Medical Oncologist and Dr. Shelly Hayes a radiation oncologist. They're supposed to adhere to a team approach. Dr. Correa is still involved with my case even after radiation and ADT, however at this point Dr. Anari is managing the medications for ADT which currently is the treatment I'm enduring. As you're likely to find out, there are many options on how to treat Pca which makes it very stressful making choices. I am deemed N1 or stage 4a which I think is the same thing. Yes, the odds are better if cancer has not spread to the bones. I believe you're in good hands at Fox Chase but keep asking questions. I recently discovered that brachytherapy has higher cure rates than beam radiation even though it's not promoted as much. Sometimes Brachytherapy and beam radiation are used together. As smart as these doctors are, they are extremely busy and you need to be diligent asking lots of questions before you commit to a treatment. If it were me, I would ask for consultations with both radiologist and Medical oncologist before committing to anything. Please keep us posted on the recommendations he gets.

VascodaGama

Hi London,

You have received very good advices from the survivors above.

Well, the biopsy results will complete the diagnosis but for the moment it seems that his case may be a T3 N1 M1, for the comments on the invasion of the left seminal vesicle and the localized and far lymph nodes involvement.

In my opinion, I think that your dad can choose prostatectomy if such is his preferences, even if that doesn't fully cover the treatment of the identified spread. Surely, he should consider the risks and side effects involving all procedures as these will deteriorate his quality of life along his retirement.

Dissecting those lymph nodes need to be considered. These are the cause of the high PSA in circulation that could be seen as the cause and route to further far metastases.

Radiation treatment is also an option but that also involve risks that are typical in prostate cancer therapies. Rp is known to cause ED and RT to cause cystitis and protitis in localized organs.

I live in the Algarve (southern Portugal). I have been fighting PCa since 2000 and have managed to survive prostatectomy, radiation and hormonal therapy. For me, maintaining a good quality of living is the most important effort, we patients can exercise.

You are wonderful for helping your dad in this journey. I wish him the best of luck.

VGama