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oncologist versus urologist

rooster6
Posts: 9
Joined: Oct 2014

Like most on these boards one tries to find their way to making the right decisions in care.  Husband had prostrate removed in 09, psa rose in 2012, radiation done,  Started passing blood cystscope reveiled possible bladder cancer, biopsy proved prostrate cancer instead. Two urologist discouraged further surgery gleason score 9.  Started Dh on Trelstar and generic casodex 50 mg.  Would it be better to seek out  a cancer specialist?   we are struggling emotionally trying and determined to stay positive, taking it one day at a time. This board certainly helps.

VascodaGama's picture
VascodaGama
Posts: 3356
Joined: Nov 2010

Roaster

Welcome to the board.

There are urologists with a master in oncology. Your husband’s doctor could be one of them. However, his next treatment(s) will not involve surgery or localized radiation so that medical oncologists (experienced in treating prostate cancer) may be a better option. Such oncologist should became the prime doctor able in following his case along the years and that would recommend or assist other specialists, would this become necessary.

As you commented, surgery is not advisable (due to loss of quality of living) and radiation cannot superimpose previous radiated areas (that most probably have included the bladder). Hormonal treatment may be the best choice for the moment. The treatment will consist in a combination of drugs more familiar to oncologists.
His new doctor will monitor any progress of the cancer and any interaction between drugs, and look for possible changes in protocols if additional medication becomes necessary to address sudden health issues.

Typically they start ADT to treat PCa with a double or triple blockade (your case) using an agonist (Trelstar)to cause chemical castration (halt testosterone production) plus an antiandrogen (Casodex) to stack cell’s androgen receptors (cancer mouths), and a 5-ARI to avoid the production of a more powerful androgen, named Dihydrotestosterone.
When these fail, oncologists move to second line hormonal drugs that work at intratumoral levels, before moving to chemo or immunological therapies. This “collection” of treatments does not cure but they manage to control cancer progression during many years, some cases over 15 years. I wonder in what basis or statistics his doctor based his comments in regards to the period of 5/10 years. Nobody knows how a patient’s body and cancer will react to certain drugs. The importance is to find the best combination that blows the cancer to the canvas leading to remission (a PSA lower than 0.05 ng/ml) and keeping it down during long periods of time.

Oncologists of the grade of Dr. Charles Myers are very good in treating difficult cases but they are expensive. However, one could look for a satisfactory oncologist close to where one lives, and propose a condition that he (the local doctor) agrees to accept following the recommendations passed by a specialist (like Myers), at a distance.

In another post of yours I read that your husband is 67 years old and that the cancer found at the bladder was PCa but of higher grade and score. It increased from a Gs 7 to Gs 9. Gleason rates of 5 are the highest in aggressivity and may produce lesser PSA serum because they are composed of poorly differentiated cells. But these may continue to respond to treatments for many years. Probably a more aggressive approach will be required to get a grip on the case.
Recently, it was published the results of a trial involving treatment of PCa with two combine therapies which proved to lead to better outcomes. This is a combo therapy using the agonist Lupron (similar to Trelstar) plus the chemo drug Taxotere. The improvement reached 20% longer period in remission (therefore longer period in control). You can read details in this link and should discuss with your husband’s doctor if such could be applied to him;
http://am.asco.org/adding-chemotherapy-hormone-therapy-improved-survival-men-newly-metastatic-prostate-cancer

Any progression will be identified using the PSA as a marker and symptoms. Another test required in ADT (hormonal) treatments is the testosterone. I would recommend your husband to include this test when he does the PSA. High levels of testosterone circulation in the body would indicate that the drug is not doing its job.
On another aspect, if the testosterone is low but the PSA increases, it may mean that the therapy is not working so that the doctor has to change the protocol, probably using a more aggressive approach increasing the power of the antiandrogens, adding other drugs, or moving into the second line ADT.

Hormonal manipulations will cause bone loss so that he should also check bone health periodically with a dexa scan. He may need to add Fosamax or similar bisphosphonate to the protocol. Heart health and diabetes are also aspects requiring monitoring.

Diet and a change in live tactics become important to counter the treatment effects. Physical fitness programs and proper nutrition are important when dealing with prostate cancer. UCSF got a publication on Nutrition & Prostate Cancer, which copy I highly recommend you to get.

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

Best wishes and luck along his journey.

VGama

rooster6
Posts: 9
Joined: Oct 2014

Thank you for your post it was helpful.  Todays dr visit determined that the tumor at the mouth of the bladder had returned even though DH was on the 1st round of hormones.  He goes in for his 2nd cat scan and us scheduled for surgery to remove obstruction so he can continue to urinate.  Soon he will see an oncologist, think I will feel better as his urologist knows the psa no longer detects numbers where the cancer is concerned.  His hormone therapy to the stronger higher priced drugs isn't  secured because the cancer hasn't spread to the bone marrow. Hopeful that an oncologist has seen this particular type of cancer and has a viable treatment .  Trying to stay positive for DH.  He is a strong man  mentally despite the fact that this has cost him many functions, he does not complain......  Me I want to tear something in two.....

tarhoosier
Posts: 195
Joined: Aug 2006

Rooster:

It is prostate cancer. No second "r" in the word.

If he has no other urologic issues, no stones, incontinence and so on, then I would consider moving to an oncologist, if a highly competent one can be found within reasonable distance.

If he has uro issues still which require a uro regularly and he has a good feeling about this one then, for the time, it could work to stay where he is. The future requires a move eventually so he can be considering alternatives over time and make a decision when he is ready. If a well known prostate specialist oncologist is within reasonable distance then the move should be considered forthwith.

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