Father with PSA 477.4 ng/ml

Hi there,

Can you give us more information?
I guess that he has had a PSA test and needle biopsy.
His case could be anything from fairly serious to very serious.
Wait until you have the scan results.
I had a PSA of 144, I thought I was a dead man walking but I am looking good for five and maybe ten years or more.

Best wishes,

Georges

Hi there,

I was very lucky insofar as I had a very large but very localised cancer that was confined as far as anyone can make out to my prostate and sorrounding structures.
I have had a prostatectomy with radiation and hormone therapy and I have a PSA of zero for the moment.
A PSA of 477.4 is very high indeed and would be associated with metastases but he has a very low Gleason score so the cancer may respond to hormones for some time.
It is very hard to tell with prostate cancer, all cases are different and some are very different.

Best wishes,

Georges

t3,

I understand your family worries as you are now confronting an issue with the unknown. We all have had the same experience after being diagnosed positive.
I was then 50 years old, healthy, professionally successful and without any kind of symptom. It was a big shock when after the biopsy the doctor told me “… you have cancer.” My mind blanked out. I recall leaving the hospital but still do not know how I got home, a place distant about 5 subway stops from the hospital. I only waken up when at home I heard my wife whispering me “… are you OK?”
It hit me hard and my all family suffered with the news.

In the beginning we know nothing about the cancer, and become curious on how it emerges, how it is treated or for how long more we will be living. I though in death and it took me more than 24 hours to start thinking positively. The first thought was in denying the diagnosis. I mimic the fact as being a mistake of the hospital in testing the samples of other patient thinking them to be mine. One week later the doctor confirmed the results and brief me on the issue, recommending me to do some investigations. At the time he gave me a clinical stage of T2b which was a number with no meaning for me. That is when I and my wife decided to explore the pitfalls of prostate cancer. We bought a book and took copies from extracts in the net and took notes on every detail, making it into a thick file.
We discovered what PSA was and the meaning of Gleason score (2+3) 5 in my diagnosis. The clinical stage was dubious and I decided to get second opinions with extra two biopsy needles at a separate institution to confirm if in fact I had cancer and if the Gleason rates matched the diagnosis.  This thick file of copies we made in 2000 is now being recycled to copy my daily Sudoku puzzles. Interestingly I read some of the contents and noticed that the diagnosis processes and treatments recommended back then (19 years ago) are still the same today. The only difference is the use of better image exams and a more comprehensive understanding on the results in timings and combination of treatments. No wonder as now we have a huge number of 20 years of similar cases to serve as examples when judging and recommending modalities in diagnosis and treatment. Particular cases get now more assurances of success.

Radical treatments continue to be those that can provide cure; namely, Surgery and Radiotherapy. Improvements in these therapies along the 19 years, regarding the elimination of cancer, could be seen in the outcomes from radiation with newer modalities in delivering rays and Hypofractionation. Surgery became sort of robotic to shorten the time one stays in the hospital to recover. Less cutting quicker recuperation of the patient but the treatment continues to be a success if the bandit is whole within the gland. Removing it whole provides peace of mind but if cancer has escaped out of the gland, then one will confront permanent side effects caused by the surgery which will add the side effects from addition therapies required to hold the bandit.

Proper image exams can facilitate in the decision of a therapy (surgery for contained and radiation to all others). Without identified targets radiation would also be throwing arrows in the dark. No one can expect hitting the bull’s eyes by chance. In this respect, PET scans are the best as they manage to identify specific cellular targets (smaller in size). MRI and CT provide structural anatomic images that can be identified as lesions, which locations leads to consider them as tumors. However, these anatomic finding have to be over 7 mm in size otherwise they are missed and invoke false negatives.
The tracer used in PET scans should be made up of substances that are absorbed by the prostatic cells. The best is the PSMA (a protein existing in all prostatic cells) followed by choline (18F or C11), fluciclovine (aiming the amino acid in prostatic cells) and glucose (FDG). The most common tracers in PET exams are the ones used as ligands in radionuclide Gallium 68 and the Fluorine-18. Please refer to the following links for details regarding PET scans and capabilities;

https://www.insideradiology.com.au/pet-scan/

https://pubs.rsna.org/doi/full/10.1148/rg.2017170035

https://www.urotoday.com/journal/prostate-cancer-and-prostatic-diseases/107274-the-use-of-pet-ct-in-prostate-cancer-full-text-article.html

http://jnm.snmjournals.org/content/early/2018/11/01/jnumed.118.218495

In your shoes I would read past threads in this forum, get a book on prostate cancer (PCa) and prepare a list of questions for the next meeting with the doctor. In any case, the full diagnosis that include the image exam results and any other health condition of your dad, his age and his preferences in terms of risks from therapies, should be considered in future decisions. The doctor is just helping with suggestions based on his experience, without any responsibility in the outcomes. You should procure second opinions from various specialists.
Daughters and sons sharing the same genes in the family are now fourfold higher in risk of contracting breast cancer or prostate cancer too. They should become more vigilant with periodical tests.

Here is an idea for your List of Questions;

https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/talking-with-doctor.html

Here is a compendium on prostate cancer care and issues;

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

Here is a link for books on PCa;

https://csn.cancer.org/node/311252

Here is a link on nutrition;

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

Best wishes and luck in this journey.

Welcome to the board.

VGama

t3zureislnz said:

He went to see His Urologist this morning. He has Stage 3 and CT scan showed it spread outside prostate. Good news not in his bones or other organs. Dr said he can’t do surgery anymore. He is starting casodex and lupron.

I heartily recommend a file review and second opinion at a cancer center of excellence.  Also, was radiation discussed?

t3zureislnz said:

Treatment

The doctor said radiation won’t work, and will cause unnecessary discomforts; therefore, he is doing casodex and lupron. He goes to Kaiser Permanente. I think they got their Cancer of Excellence.

There has been a recent development about not treating the prostate with radiation after it has spread— my dad is stage 4 and they just did radiation on his prostate at our wonderful cancer center because of the newly discovered benefit. 

t3zureislnz said:

Treatment

The doctor said radiation won’t work, and will cause unnecessary discomforts; therefore, he is doing casodex and lupron. He goes to Kaiser Permanente. I think they got their Cancer of Excellence.

My previous doctor and hospital told me that radiation was off the table.  I got a second opinion at Dana Farber, and transferred my treatment there.  I am now three weeks into an eight week course of radiation, with the hope of a cure.  Getting a second opinion at a major cancer center was the smartest thing I have ever done.  You really should consider doing the same.

Eric