Retroperitoneal adenopathy & bone mets

A bump in your dad's journey
Roxy (daddy’s little girl)

Welcome to the board.
I am sorry to read about the recurrence.
After failure of major radicals, cancer recurrence is usually found in the lymph nodes and bone. This is probably the results from the image study reported by his doctor. However, what is surprising to me is that the metastases could be detected in a CT scan even in the presence of a low PSA of 0.01. This is rare.

Can you share more info on his PSA chronology along the years of treatment?
What Gleason score were attributed to your father’s case initially?

Some high grade cancer cells (Gleason scores of 9) are known to produce less PSA because they are highly differentiated and therefore very aggressive to metastasize. However, your dad is a veteran survivor of 14 years which makes us to believe that he got a lower grade Gleason. But you describe his diagnosis as very advanced and probably systemic, which seems not to be a cause of a resent fact.

Probably his doctor’s recommendations for a PET scan maybe to check for the presence of oligometastatic cancer which could be radiated with focal treatments. In any case, your dad should get a densitometry bone scan to check for bone loss.
I would also recommend you to inquire on the contrast agent used in the scan. F18 (sodium) is good to detect bone metastases. For soft tissue such as lymph nodes and organs, the newer PET with C11 (choline contrast agent) is acclaimed to be very reliable.
Still another image study, the newer Feraheme USPIO (Ultrasmall SuperParamagnetic Iron Oxide) done with a high resolution 3 Tesla power magnetic field MIR, is claimed to reliable locate cancer colonies as small as 2 mm in the lymph nodes.
You may find details on these tests googling their names and then discuss with his doctor.

I am sorry to be so inquisitive, but cannot understand what is the reason for the doctor7s choice in chemotherapy instead of the more traditional hormonal treatment (HT). Surely chemo post radicals are part of protocols in PCa treatments but the side effects are more drastic than the side effects from hormonal therapies.
Has your father ever tried hormonal drugs? Is he hormone refractory?

Both treatments are palliative and can hold control on the advancement of the cancer. In any case, I do not know of cases where chemo was administered in long periods of time such as 5 years. Guys on HT with hormone dependent type of cancer have reported control over 10 years and continuing the control with a second-line drugs after failure. Only after complete failure of HT they have started chemo.
More over, there are also a series of newer drugs which have gotten FDA approval to be used in the treatment of naïve chemo patients. Alpharadin have shown to be successful in the treatment of bone metastases. Zytiga is another drug that acts in intertumoral cancer activity. Your dad may have to start Zometa (a bisphosphanate) the soonest.

I would recommend you to investigate on both treatments and the drugs. They can affect other illness treatment (eg; heart problems, hepatitis, etc) and they can interact with medications taken for other problems.

Just do your investigations and discuss with his doctor.

I hope that you find answers to your queries.

Wishing your dad luck in his continuing journey.

VGama

RoxysDad said:

Great Feedback
VGama,
Thanks for your feedback! I did forget to mention (my apologies) that my Dad has been on the hormone shots (Lupron-Depot sp?) every 3 months since 2007 as well.
In addition, his oncologist mentioned that there is 5% of PC cells that can grow (sounds very similar to what you have mentioned in your initial response), and do all the 'cancer-stuff' without raising the PSA marker. So, even though Dad's PSA has been next to nil (and still is 0.01 as of his latest blood work a week ago) for years, the disease may have been working behind the scenes. His oncologist has already set him up on the monthly bone shots - Rx Xgeva. He will receive his first injection this week.
The whole testing started back in Feb. 2012, when Dad had some pre-op tests done in preparation for the AUS 800 (new value, 2nd attempt). His first valve failed after only a few short months, and the urologist felt awful about it. So, this last attempt was successful - so far (not at the 8 weeks post-op yet). Dad has a lot of scar tissue from the radiation and finding good, healthy tissue was challenge for the doctor. So, 2 days before this surgery - we were told he has possible bone mets. Ever since then, it has been none stop tests and appointments.
First the MRI, then CT Scan, then CT Scan with contrast, now PET scan. In the middle of all this - Dad broke 3 ribs while trying to pull an undershirt off over his head. Crazy? I know...
All Dad wants to do is get better so he and Mom can get on Goldwing and ride. I am afraid that if can break bones that easily, riding the bike could prove to be an issue. But how do you tell a very determined man that he cannot do what he loves.
Dad is no stranger to the big C. He has also battled several skin cancer bouts on his face, ears, and back – he was a hard working farmer’s son in his younger years.
Daddy's little girl
Roxy

Chemotherapy
Roxy,

I'm sorry to hear of your father's situation. Chemotherapy is used much less with prostate cancer patients than those with other cancers where the cells are dividing fairly rapidly. Prostate cancer cells typically divide very slowly so traditional forms of chemotherapy have not been shown to be very effective. For elderly patients there is also a concern that the ill effects of chemotherapy will be less well tolerated than in younger men.

In the past few years, however, there have been some studies that suggest that chemotherapy using the drug docetaxel is modestly useful in interrupting the history of castrate-resistant metastatic prostate cancer.

If you do a Google search on the effectiveness of chemotherapy in prostate cancer (or any other cancer for that matter) you may be dismayed with what you learn. Frequently studies discuss the "response rate" of prostate cancer to chemotherapy. This is basically an indication that the cancer is reduced or shrinks. Unfortunately you can't relate a response rate to long term survival and very few studies show a correlation between chemotherapy used to treat advanced prostate cancer and measurable extended mortality. I've even read that a confidential survey of oncologists found that more than 90% would not recommend chemotherapy for a family member or undergo the regimen themselves. Much of the anti-chemo literature is from those proposing alternative cancer cures but there is enough information out there to give one pause.

As Vasco suggested, I would question the doctor on why some other treatment other than chemotherapy.

Your father's doctor should be candid and frank when discussing these options so that he can make the best decision in balancing quality of life against the potential incremental increase in longevity. And, in situations like this which have such a large potential impact, I do hope you seek second opinions. Frankly, the statistics don't suggest that chemotherapy will produce a five-year increase in longevity for an advanced cancer patient but everyone responds differently and as you wrote, your father seems to be a fighter.

Wishing your family the best.

K