Husband Newly Diagnosed Gleason 9 - Clinical T3

VascodaGama said:

Palliative Treatments are recommended to older guys
DH

I would like you had finished your question as it gives rise to many interpretations. I take your “at this point” as a meaning in regards to your husband’s age of 82. And I agree with 2ndBase’s suggestion that even without any treatment your husband could live many more years and probably die of something else, if he is asymptomatic at this time. Fortunately, prostate cancer is a slow growing type giving many years (over 15 years) of survival to the holders.

Doctors usually recommend radical treatments for older patients if they can foresee positively that benefits are assured from the treatment. In such regards, I do not understand why his doctor have rejected surgery and accepted radiation. Both treatments have risks and side effects some nasty, which would not be preferable to your husband’s last period of his life. Treatments for prostate cancer in Gleason score 9 are very subjective to failure too. Your husband must be fit and in general good health to sustain the treatment.

Hormonal plus IMRT is common to similar cases but not suggested in patients over 75 years old. In older guys it seems proper to recommended palliative type of treatments for PCa such as hormonal therapy. Firmagon alone or in combination with an anti-agonist like Casodex, could handle his case and assure him many years of control, with much lesser risks.

I would recommend you to get a second opinion from an independent oncologist before embarking on the treatment.

Wishing the best to both of you.

VGama

Swingshiftworker said:

Fitness & Radiation?
Vasco: I don't think there's any basis for your comment that the urologist, who has recommended hormone w/radiation treatment for this 82 year old man, "is not to be be trusted." How do you get there?

The type of radiation treatment to be used has not been specified, but I assume it is IMRT. HT w/IMRT is the commonly recommended treatment for patients w/advanced PCa and has been used successfully w/men of all ages, when the PCa has not yet spread beyond the prostate.

Although dhrocks' husband has early stage dementia and some infirmity associated w/his age, I don't believe that anything has been stated to indicate that he is not fit enough to "endure" radiation treatment. The critical question for me is whether the PCa has migrated beyond the prostate or not and, based on their bone/CT scans, it apparently has not.

I certainly doubt that the urologist & radiologist would recommend radiation treatment if there was any reason to believe it would adversely affect their patient. The radiation oncologist will be able to advise the couple of the risks of radiation for a patient his age and physical condition and there is no reason to believe (based on what has been stated to date) that s/he will not do so "honestly."

If there's any doubt in their minds, dhrocks & her husband should (of course) consult another urologist & radiologist for confirmation regarding the advisability of the HT/radiation recommendation and (from what I gather) that's already what they are planning to do.

BTW, my mother (who is currently 97) received over 20 IMRT radiation treatments to treat a lymphoma in her left chest/arm pit when she was 89. She had no adverse effects as a result of this treatment and I don't think dhrocks' husband necessarily will either.

Just my 2 cents on the topic. Ciao!

Swingshiftworker said:

Gold Markers & Hormone Therapy
The placement of gold markers is consistent w/IMRT (intensity modulated radiation therapy) as well as other forms of computer guided/assisted external beam radiation therapy (EBRT), including IGRT (image guided radiation therapy), 3D conformal radiation therapy, SBRT (stereotactic body radiation therapy) and PBT (proton beam therapy).

SBRT (most notably Cyberknife or CK) and PBT are normally used with men with early stage PCa and are probably not appropriate for your husband. EBRT w/o some form of computer assistance/guidance is seldom used to treat PCa any more because of the much greater risk of damage to adjoining organs/tissues caused by the unfocused application of radiation.

Just be sure to ask your radiation oncologist which form of radiation treatment s/he intends to use and why s/he recommends the use of that method as opposed to the others mentioned above.

You might also want to discuss whether LDR BT (low dose rate brachytherapy), which involves the permanent placement of radioactive seeds in the prostate, or HDR BT (high dose rate brachytherapy), which involves the temporary placement of radioactive implants in the prostate, would be an appropriate alternative to IMRT (or which ever other method of computer assisted/guided EBRT is to be used).

FYI, LDR BT is normally used w/men with early stage PCa, are would probably not be appropriate for your husband. HDR BT is used w/men with later stage PCa but also involves a long hospital stay and multiple visits and may also not be appropriate for an elderly person w/dementia. But, you should hear what your radiation oncologist has to say about it before ruling them out as possible treatments.

I don't know anything about Firmagon and not much about Hormone Therapy (HT) generally but you should obviously discuss w/your urologist whether your husband's sodium/potassium problems negate it's use and, if so, what alternatives are available.

I do know that one of the main complaint about HT is the loss of libido and sexual performance following treatment. That probably isn't a major issue for your 82 year old husband but there is a long list of possible physical side effects that could be problematic for your husband, including: hot flashes, swelling breasts, nausea, gas/indigestion, fatigue, loss of sleep/appetite, flu like symptoms, headaches/dizziness, confusion, drowsiness, dry mouth and vision changes (inability to adjust to different light levels or to perceive color). More seriously, HT can also result in an increased risk of diabetes and heart attack/stroke, increased fracture risk as a result of the loss of bone density, weight gain, decreased muscle mass, increased cholesterol levels, anemia and memory loss.

I got this info from the Prostate Cancer Foundation site at http://www.pcf.org/site/c.leJRIROrEpH/b.5836631/k.3CD9/Side_Effects_of_Hormone_Therapy.htm and from Prostate-Cancer.com at http://www.prostate-cancer.com/hormone-therapy/side-effects/hormonal-side-effects-anti.html.

You should discuss all of these possible side effects from HT w/your urologist, especially given your husband's age and reduced mental capacity.

Good luck and best wishes!

Swingshiftworker said:

Something else to consider
You're welcome, DH.

Something else you should ask the urologists/radiation oncologists that you speak to are:

1) Despite all of the possible side effects of HT, would it be advisable to forgo radiation treatment for the reasons that Vasco suggests; ie., will HT w/o radiation be effective w/o exacerbating the your husband's dementia, diabetes, heart condition & risk of fractures?).

2) In lieu of HT, should your husband consider surgical castration instead? The purpose of HT is to reduce/eliminate testosterone production which is linked w/cancer growth and is, in effect, medical castration. Actual physical/surgical castration achieves the same result w/o all of the side effects of HT (other than impotency). If impotency is not an issue and if some of the more serious side effects of HT (including possible additional memory loss and increased fracture and heart attack/diabetes risks) are of greater concern, then perhaps physical castration would be better way to go.

Not suggesting that you choose either of these alternatives. Just that you consider and discuss them w/the specialists you speak with.

Again, good luck & best wishes!

hopeful and optimistic said:

WHAT THE........
I belive that there are many suggestions to OVERTREAT.

I believe that surgery for an older man with heart disease is not appropriate.

I believe that surgery for a younger man with high gleasons, high volume is not appropriate since the cancer may have escaped the prostate.

I believe that hormone theapy increase risk of heart disease, especially in an older man with heart disease. Also there are other major side effects.

I believe that this man with dementia will not understand why he is castrated.

I beleive that watchful waiting where this man can live the rest of his days in digity, going on with his life with comfort, not suffer the negative effects of major treatments.....there is a very excellent chance that he will die with this disease , not becuase of it.

PS: My Mother who was diagnosed with breast canceer lasr year when ahe was 92 has elected not to have any radiation, and go on with her life. She wants quality of life and has elected not to suffer any treatments. When you have prostate cancer , less is better in a lot of situations.

I personally am doing active survreillance with delayed tretment if necessary.