Recently diagnosed with prostate cancer, gleason 10

Welcome to the board. As you expect Gleason score 10 is not a good diagnosis, however, independently of the Gleason grade, your dad got several means for treatment that will be decided once he receives a clinical stage. The first step is exactly to locate the bandit to which the PET PSMA scan is the best for the job.

You did not share details on your dad's other health issues (if any) and age but these will be also considered when evaluating his status and drawing opinions. For instance; Surgery is typically not recommended for 75 plus years old patients. Radiation may be prohibitive if the patient have/had ulcerative colitis and these are located at the critical field for RT treatment. Radiation of the area involved in the TURP intervention may not be the preferable choice as it can affect the urine sphincter, highly risky for causing incontinence. If the cancer is found widely spread with metastases in bone then radicals may not be recommended and the patient is moved to palliative approaches. In this case the quality of life becomes the prime target.

I recommend you to read about the type of treatments, their risks and side effects and discuss with other members of the family. I also would insist with your dad to get extra exams and tests to check any other health issue. The testosterone is never commented by urologists but this is an important marker in hormonal therapies. The whole lipids panel should be done at this time, together with a DEXA scan (bone health) and heart health tests. You can count with the survivours of this forum to help you understanding things. We are not doctors but can tell about our experiences. Get copies of all data and paste it here.

Here are some links for you to read. Better to prepare a List of Questions in advance of meeting the doctors.

A practical guide to prostate cancer diagnosis and management;

http://www.ccjm.org/index.php?id=105745&tx_ttnews[tt_news]=365457&cHash=b0ba623513502d3944c80bc1935e0958

Prostate Cancer Staging;

http://emedicine.medscape.com/article/2007051-overview

List of questions;

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

In this link you can read the discussions with a member dealing with Gleason rate 5;

https://csn.cancer.org/node/306682

Best wishes and luck in his journey.

VGama

Quality of life are just words for doctors.  Any treatment offered to your father will cause signifant, permanent reductions in his ability to enjoy life.

The decision looks a lot different if he is 87 versus 53.  Prostate cancer is generally slow, although a Gleason 10 may not be slow.  But a man of advanced age would be wise to be very cautious about letting doctors ruin whatever time he has left.

My meaning of a palliative approach is when the choice of a treatment is done to alleviate the burden of the malady instead of aiming cure. Typically in PCa cases palliative are recommended to those with many tumours spread at many places in the body, so extensive that cure becomes futile. In such a case one may choose to remove only a portion of the cancer with a surgical procedure (debulking a tumour) or a spot radiation (tumours in bone) or just a treatment to control the advancement of the disease (such as chemotherapy or hormonal treatment), etc. These therapies all got associated risks that would prejudice the quality of living of the patient without assuring cure, as commented by SPT above.

At this moment, your dad should give preferences to the most precise diagnosis possible as such will influence greatly in the choice of therapy and consequent risks. His doctor decided to skip the PET scan but in your shoes I would not follow his request. The traditional MRI and bone scan now advanced by the doctor are much associated to false negatives which are not what your dad wants. I would force and wait for the PET PSMA exam to draw conclusions on his diagnosis, in particular in the presence of an aggressive type Gleason rate 5. Surely there is no harm for having additional exams (MRI, CT, Bone scan, etc) but the PET is the one that will tell where the cancerous cells exist.

With regards to the other health issues, I would get a medical oncologist to lead your dad's case, as commented by Hopeful above, because of the medication for the type 2 diabetes mellitus (DM2). I wonder if the kidneys are at 100%. DM2 is a major risk factor for kidney disease and that would prohibit the use of particular contrast agents in image studies. You need to discuss the above with the physicians treating your dad and when at consultations for second opinions.
Can you describe the medications of your dad? Metformin is used in the treatment for diabetes but it also has shown benefits in the treatment of PCa. (just like killing two birds with one stone) 

Regarding DM2 and PCa;

http://ascopubs.org/doi/abs/10.1200/JCO.2016.67.4044?journalCode=jco

Regarding DM2 and the kidneys;

https://www.kidney.org/atoz/content/diabetes

Regarding DM2 medication;

https://www.ncbi.nlm.nih.gov/pubmed/27079349

You doing it well in researching and educating on the matters of PCa. Your dad is surely greatful for your help. Prostate cancer does not change overnight even in Gs 10 guys. Do things but use wisdom, move forward coordinately and timely.

Best wishes,

VGama   

VascodaGama said:

Check with a medical oncologist

I would suggest you to copy our discussions if they are dear to you. I believe that the CSN administration is not satisfied with my comments/posts to the many. They just deleted one entire thread addressed to me recently.

The best person to inquire about all drugs (your dad's taking) interaction or influence on the PET PSMA scan is the radiologist doing the exam. My lay opinion is that bicalutamide will cause no interference with the PSMA nuclear tracer as this does not use the cell's AR (androgen receptors) for its pathway to identify and glue to a prostatic cell. A LHRH agonist or antagonist (Lupron, Firmagon, etc) could have some influence as it would turn prostatic cells less active.

However, the contrast used in the CT exam or even in the MRI, may be prohibitive if your dad has advanced CKD (chronic kidney disease). As I commented above, DM2 is a major risk factor for kidney disease and many guys do have CKD without knowing. I wonder what may be his filtration rate (GFR) and creatinine level. This issue may constitute a problem in the exams required for PCa matters. A medical oncologist would provide you the answers and peace of mind.

Best

VG  

Your comment about the deletion is so sad, Vasco.

A sentence from you is worth more than everything the CSN Administration has ever done in their combined lives.

max

Clearance at 24Hours is the due exam. A very low percentage would mean the need for dialysis after any MRI or CT done with contrast. Please do the tests and discuss with his doctors.

gleason10 said:

Treatment update

Hi All,

Some updates to my dad's treatment:

We got the Bone scan and MRI done.

Bone scan - No metastates found in scan report.

MRI - Large extra-prostatic extension, more on right side with involvement of both seminal vesicles, right antero-lateral wall of rectum and right lateral pelvic wall. No evidence of retroperitoneal lymph node enlargement is noted.

Clinical stage given by doctor - T3 N1 M0.

Doctor has ruled out surgery or prostatectomy as the cancer has spread beyond the prostate. They have advised the following treatment (ADT + EBRT):

1) Currently Bicalutamide 50mg 3 times a day

2) Injection Triptorelin - once in every 3 months for 2-3 years - Bicalutamide to stop after 1st injection

3) EBRT - radiotherapy for 4 -6 weeks

followed by regular PSA follow-up.

I have taken 2-3 opinions (treating urologist + oncologist), and all doctors are agreeing on the same treatment plan. As per them, this is the standard treatment for this stage of prostate cancer.

Need your opinions on this, are there any other treatment approaches to this case?

Thanks in advance.

 

gleason,

There are always "alternatives" I suppose.  But his treatment plan sounds very thorough and reasonable.  Surgery would indeed be a bad idea for a man his age with diabetes, since there is presumption that the disease has escaped the gland.

The EBRT has some slight possibility of eradicaiting all of the disease, but regardless, HT, when played well by a medical oncoogist, can often give many years of quality life to a man, even with advanced disease.  His medical team leader needs to be the medical oncologst incidentally, not his urologist.

max

The symptoms you describe above under the items 1 and 3, are typical side effects from ADT. Items 2 and 4 could be due to Urethritis, an inflammation caused during the intervention to unclogged the urethra (done together with the cystoscopy). I believe his doctor did it using a boogie to widening the stricture. The area is now very sensitive and the wound hard to heal for the constant flow of urine. The inflammation could also be causing urgency in urinating. Your dad may have to use a catheter to allow proper healing. To improve fatigue, afternoon naps are good. To avoid frequency he may try changing his life style, eating dinner earlier and lesser liquids at evenings.
I think it better you inquire his doctor. He will provide medication to counter the effects.

SBRT will also cause inflammation in the urethra, so that it should be started after proper healing. I still think it better for your dad to do extra exams now in preparation for the treatment. A colonoscopy to verify any ulcerative colitis (would prohibit any radiation to the area) and a DEXA scan to check bone health (bone metastases would require extra treatment). Surely if the cancer is widely spread then SBRT may not be proper to care for your dad's case. Please read previous discussions.

I am curious on the PET results.

Best,

VG