Everything is positive because it''s negative?

VascodaGama said:

Look for a Second Opinion before committing
Joe

You by experience know that cancer is a tricky affair and that there is a lot of “guessing” when choosing a treatment. Only surgery or radiation (and their alike) actually can offer a chance at cure, but the side effects and risks are high and one should not only think at the cancer but at the quality of life after treatment.

You have not shared with us info on the diagnosis of your father (PSA, DRE, Clinical stage, etc.) which plays a big role in any decision. Many survivors here are quite acknowledgeable on the matter of PCa and could help you in understanding the case better.

From the info you have posted I can tell you that cancer cells with Gleason grades of 4 and 5 are very aggressive types and that the Gleason score 9 is highly risky for spread. This type of cancer is best handled with a combination of treatments, one of them being what your father’s doctor has suggested of radiation plus hormone therapy.
The negative bone scan and negative CT scan may indicate that the cancer is localized (no metastases at far places such as the bones) but If considered contained (the whole cancer is set within the prostate gland) then surgery could be an option.
In localized cases radiation is usually recommended. The protocol for the areas to be irradiated changes depending on your father’s other info from the diagnosis. Some of these protocols can be more risky than others for a series of side effects which in some cases could become permanent.

Your father is fit as you commented but how healthy is he?

Radiation is not recommended in guys with a story of ulcerative colitis. Radiation can damage the blood vessels and nerves that control erections and it can affect the sphincter’s tiny muscles causing incontinence too even if such is not common. You dad should be aware of the treatment risks and side effects before committing.

The hormonal treatment (HT) has added side effects too. HT is a palliative way of controlling the advance of the cancer by manipulation of the testosterone levels in our body. In cancers that respond well to the hormone manipulation the control can last many years (12-15), and on an intermittent modality (on/off drugs) one could have a relief from the drugs' side effects when on the OFF period. That would allow a return to normalcy and to a better quality of life. This could as well be the solo treatment of your father.
Nevertheless, the drugs may also interact with other medications used in other present/future illnesses which may restrict its use too.

His doctor may be suggesting the right treatment to your father but I would get a second opinion from another specialist on both, the treatment and on the protocol, and would then act the soonest.

A good book I recommend your father to read is;
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on diagnosis and treatments. This famous oncologist specialized on PCa is himself a survivor of a challenging case on his 12 year of survival, where he battled the bandit with a combination of radiation and hormonal.

Wishing you both luck.

VGama

Old-timer said:

Question and comments
Has your dad had any treatments, or will the radiation and hormone treatment be the first?

Based on my treatment history, I have no answers that would likely be helpful to you. As you say, every case is different. However, I think Vasco's recommendations look good. Get a second opinion, then study the options and have your dad make his decision.

Best of luck to you and your dad.

Jerry

Old-timer said:

I will stress that I am not qualified to diagnose and proscribe treatment. However, if your dad's Gleason score is 9, radiation plus hormone treatment seems to be an OK way to deal with it. Best to rely on the experts' recommendation and your dad's wishes. Your dad should be the decider, in my opinion.

I'll watch for reports on his progress.

Jerry