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Pathology report in - should we commend with HT?

Pathfinder
Posts: 55
Joined: Jun 2016

 

*THREAD TITLE ADJUSTED 16/8 - Surgery was performed on this day, and related questions are further down the thread.

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Hi all,

New to the board and desperate for your knowledge. 

My Father in law has been diagnosed with PC, result of the biopsy is Gleason 8 and his PSA is 24. Based on his medical records the PSA appears to be doubling yearly (don't ask why this wasn't addressed earlier, it's not a nice story!).

His bone scans and MRI came back negative for mestastatis, and he has no symptoms.

From all of my research it seems to me like surgery ASAP is the best option. We're all extremely worried about the cancer being aggressive based on the numbers and don't want to give it time to breach the prostate.

However the doctor has reccommend three months of hormone treatment first, including a monthly injection and pills to diminish testosterone. I understand that the reccommendation is based on making the surgery safer, however as the PSA is doubling yearly at a rate of almost 1 a month, that seems like a long time to wait.

And here's the serious part: He's in China. Chinese hospitals are fairly dark. If they can make an extra 10,000 in treatments prior to the surgery, they probably will regardless of his biopsy results. This is the main reason why we're seeking a second (or third) opinion (this week), but I'm fairly wary of the reliability of the system here from experiences passed down by other people.

I hope you can help. If I sound frantic, I am! I feel as though this is a race against time and I'm not comfortable with his biopsy numbers at all. If someone can give me any advice regarding how 3 months of hormone therapy would benefit the surgery, how it works exactly (does it actually stop cancer cell growth, or reduce its size making it easier to catch-all with prostate extraction?) I would appreciate any information you have.

Thank you so much for taking the time to read this.

 

Pathfinder
Posts: 55
Joined: Jun 2016

As you are aware if you have been following this thread, my father in-law has now been on RT treatment for approx 3 weeks. After the first week we did a PSA check and found the PSA had risen from the previous 0.25 to 0.3, consistent in speed with his normal rising PSA pattern. We then discussed the pros and cons of combined RT and ADT treatment here, and opted to combine ADT with the RT for the remainder of the course.

We did another PSA check yesterday, at approx 3 weeks of RT and 2 weeks of combined RT/ADT and the PSA has continued to rise to 0.332, in line with the speed we had experienced prior to starting RT.

Prior, VascodaGama suggested that a rise during RT was a good thing and suggested that the treatment was causing an inflammation of the cells and therefore the increase was not abnormal. 

However, with almost 2 weeks of ADT combined, there has been no impact on the increase.

"The radiation treatment will cause inflammation and such will increase the PSA which result has no significance to judge cancer status. This is a normal occurrence and the increase can only mean that some cells are receiving the rads blow. This is GOOD."

Does this thinking remain unchanged at this time? We're obviously concerned because ADT always reduced the PSA very quickly when he used it initially after his RP. We're not sure why it's having no effect now.

Also, we did every check possible to ascertain if the cancer had spread anywhere in the body and there was no indication. The doctor also believed it was confined to the pelvic area and therefore that's where the RT course is focussed. 

But even in the event the cancer was somewhere else in the body and undetected, would ADT still have no effect after 2 weeks combined with RT?

Thank you for your insight once again guys, really appreciate it.

 

Old Salt
Posts: 732
Joined: Aug 2014

It seems to me that PSA tests for your Dad during his current treatment are useless and I would not get nervous about the results.

Vasco expressed the same opinion, I believe, but he used more diplomatic language.

Pathfinder
Posts: 55
Joined: Jun 2016

Thank you for your input Old Salt. We're trying not to get nervous. We're just confused because of all the conflicting information.

In the same hospital we spoke to other patients whose PSA results taken during RT decreased dramatically, and this seems to be a common outcome when searching for information of RT impact on the PSA. And we assume that's because the RT is having an effect on the cancer in the region being targeted.

Vasco also suggested that RT can prompt abnormal PSA results, but the results don't seem unusually inflated, they're following the same steady rising pattern they always followed prior to treatment. I suppose the most unusual thing is the ADT no causing any reduction after 2 weeks of being administered. 

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