Metastatic Prostate cancer (Gleason 7, PSA 72)

I think that the process you outline is the best available, considering the differences in practice there and elsewhere. The scans are equivalent to those available here.

Honvan, an estrogen derivative, is sometimes used in such cases in India, but may best be saved for now.

The difference in doctor recommendations is similar to what one would find here, as well. With no more of the information available and based only on my amateur and incompetent experience I think either doctor could be right. The first one is more aggressive and focused on immediaate treatment and the second is more deliberate, waiting to see results before introducing new actions. Each can be supported. This patient SEEMS to need the efforts of an oncologist rather than a urologist, and if in the US I would generally advise an advanced prostate cancer patient to move from uro to onco sooner rather than later. I have no idea if this is relevant or advisable in the current case.

The lmits to advice here, third-fourth hand and from thousands of miles, across languages and cultures, dimnishes the value of all my typing.

No one here can confirm the diagnosis based on what you provide. Certainly orchiectomy is not performed without certainty of this diagnosis.

You do not give the age of the patient.

ralph.townsend1 said:

Age?

what is the age? Is the prostate remove? What was the result of bone scan and CT scan. Gleason 7 of many point?

Supreet

Welcome to the board.

From the info you shared I think that your family member was diagnosed with metastatic cancer because of findings from the biopsy and probably a positive result of the X-rays.

I think that the PSA of 72 you comment is of a test done before the Orchiectomy. It was a high level which may relate to a big tumour. However, the CT and bone scans (of 16^th January) will provide more details and a better diagnosis of his case. Maybe with such results both doctors will recommend different actions from those described by you.

I hope you share here the results of the scans latter.

I wonder the age of your family member and his other health conditions. Most treatments are decided based on the status of the patient including his life expectancy, and, of course, if his case is systemic.

http://www.ssa.gov/oact/STATS/table4c6.html

Older patients are more common recommended to palliative treatments such as hormonal treatments (HT). These do not cure but can control any advancement of the cancer for long periods of time. Younger patients diagnosed with localized cancer are usually recommended to treatments with intent at cure, such as prostatectomy and/or radiotherapy.

The Edinburgh doctor who diagnosed your family member may have seen HT as the best approach of treatment and advanced with Orchiectomy (removing the testicles) which will stop about 95% of the production of testosterone in which the cancer feeds. This is a cheap way of getting the job done and there is no problem with it but nowadays is more common to administer agonist drugs similar to Lupron, Zoladex, etc, as the prime option to lower the testosterone circulating in our bodies.

The adrenal glands manufacture the other 5% of testosterone but this “factory” cannot be stopped. The only way to avoid the cancer from feeding on those small amounts of androgens is with antiandrogen drugs similar to Calutide tablets (bicalutamide).

Accordingly, the recommendation of the Onco-Physician doctor to start taking Calutide seems to be proper. He also adds Zoledronic Acid Injection (Zometa) to avoid bone loss that will be an effect from the castration status (orchiectomy). The radiotherapy recommended to pain relief is also common when the cancer has spread to bone and is causing any compression at the nerves (probable reason of pain).

You have not shared info and we do not know about the medicines prescribed by the Edinburgh doctor. Recently newer drugs become available and can substitute drugs like Calutide. Some of those have shown to be more successful in holding further advancement of prostate cancer. A famous drug is Xtandi (a more refined antiandrogen) and Zytiga (acting at a much refined intratumoral level of cancer cells).

You can read details searching the net.

In any case, the tests both doctors recommend will provide more clues on the prognosis of your family member.

I would recommend you to wait for the scan results and prepare a list of questions to expose to the doctors on your next visit.

Here are some ideas to help you;

http://csn.cancer.org/node/224280

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Here is a “compendium” on Prostate cancer and care;

http://www.lef.org/protocols/cancer/prostate_cancer_01.htm

Wishing your family member luck in his journey.

VGama 

Answer:  No.

Naturopaths may be of some help to otherwise healthy patients; reformng diet, keeping vitamins replete, healthy weight emphasis and so on. For advanced cancer patients we need ammunition with real gunpowder.

tarhoosier said:

Last question

Answer:  No.

Naturopaths may be of some help to otherwise healthy patients; reformng diet, keeping vitamins replete, healthy weight emphasis and so on. For advanced cancer patients we need ammunition with real gunpowder.

Supreet

I am sory for the advanced status of your family member. The tests confirm wide spread which requires systemic treatment. Hormonal therapy may help but he will require targeted medication which only specialized oncologists can administer. Your family member needs to fight in two battle fronts. The cancer and the side effects from the drugs.

He should continuously check the Lipids, particularly anemia.

Regarding Dr. Simoncini, you may know that his theories in treating prostate cancer is not a valid option. You can read about him on the net and my comment in this link; 

http://csn.cancer.org/node/209972

I wish you find a doctor you trust and that your family member gets better.

VGama