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A Concerned Son - Overwhelmed!

IbsAlwa
Posts: 1
Joined: Apr 2017

Hi Y'all,

 

Thank you for this outlet and the community support that adds tremendous hope for everyone involved.

 

My father was diagnosed with Prostate Cancer around 3 weeks ago. I do not know how to feel yet.

We booked him an appointment with a recommended Doctor with Dr. Ashutosh Tewari in Mount Sinai Hospital in New York in 10 days from today for a second opinion.

This is his diagnosis so far:

 

Age: 68 years old.

Past Medical History: Diabetes mellitus, diabetic retinopathy, blood pressure, and trauma of lower right ribs after a fall.

PSA 11.6 ng/mL

He went through transrectal ultrasound prostate biopsy.

Pathology Diagnosis: 10 locations ranging from Gleason scores 7 to 9.

Clinacily, gigital rectal examination showed cT3 Prostate Cancer.

MRI showed Prostate diffusely enlarged, measuring 48 cc.

Assesment: High Risk cT3b N1 M0 Prostate Cancer, Gleason Score 9 (4+5).

The current doctor recommended him to start hormonal tratment followed by radiotherapy, while his lower urinary tract symptoms will increase. And that curative reasult is low.

 

Hopfully our upcoming examination with the new doctor in New York will be more positive.

We are new to this. I would like to hear any similar experiances or any kind of advise would be really appreciated. I do not kow what to do for him.

 

Kindly, which hospital or Doctor in the US would be best to look into his case?

I have heard of several hospital like Memorial Sloan-Kettering Cancer Center in NY and University of Texas MD Anderson Cancer Center in Huston.  I heard that there are various specilicts and treatments, so I am a bit overwhelmed. 

 

So I am seeking your help and experiance in this matter. I really want my father to have th best possible experiance, and I don't really want him to suffer, or at least limit his suffering as much as possible.

 

Thank you for your time and patiance.

 

Best Regards,

 

Ibs

RobLee's picture
RobLee
Posts: 259
Joined: Feb 2017

Welcome to the forum, and your feeling of being overewhelmed is certainly understandable. Others with experiences similar to your father's and your own will chime in here with perhaps more pertinent information. For now, let me say I have heard of Dr Tewari and understand that he is very good. All of the facilities you mentioned are well renowned. You have done your homework well and your father will be in good hands. You as his caregiver will be under considerable stress, so be sure to take good care of yourself.

To be honest, your father's scores are bad, and his other conditions will further complicate his treatment... or lets say, will limit his choices. However, he most likely has an excellent chance of this being successfully treated, and (to be blunt) living long enough to die from something else, other than prostate cancer. Personally I am myself a T3B but without N1 involvement, and the most difficult decision I had to make early on was how to inform my two adult sons of my condition. Just a few months later we were faced with also telling them that their mother has lymphoma. They took it pretty well.

We were all new to this at one point. Within the coming weeks you will come to know more about cancer than you would have possibly imagined just a few weeks ago (I'm assuming you are new to this also). I wish your father good luck in the months and years ahead. Please don't forget to ask him how HE feels about all this.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

 Dr. Ashutosh Tewari in Mount Sinai is a world renowned surgeon who has perfected a technique to avoid erectile dysfunction from surgery, however in my layman opinion surgery is nappropriate for your father for the following reasons: your father has been diagnosed with aggressive cancer that is extensive, so it is very likely that the cancer has escaped the prostate anxx surgery will not cure, so he will still need radiation and hormone treatment. The side effects, which can be very severe,  of each of these treatments are cummulative. Addditionally, a surgeon can perform the exact same surgery on a man of 50 and a man of 68, but because of age, a man of 68 may show side effects such as Incontinence while the man of 50 will not have side effects.

Your father needs to see a Medical Oncologist, the best that you can find to be in charge of your fathers case. He also needs to interview a radiaiton oncologist. Probbably a combination of the two as your original doctor recommended is approproate.

Where does your father live? There are great doctors in various parts of the country. We may be able to recommend one.

You his son, also needs to be tested, say a PSA benchmark at age 35, REcommend that you and your father eat heart healthy. I, since I was diagnosed do not eat red meat or dairy. Additionally, women in your family are also more likely to develop breast cancer than the rest of the population, so they need to have those mamograms.

We are here for you. Keep asking those questions.

H

 

Clevelandguy
Posts: 393
Joined: Jun 2015

Hi,

Looks like you have the right doctors at the right hospital. Study all of the treatment avenues and their side effects.  You should meet with both the urologist & oncologist to get their viewponts.  Sounds like with the T3c that surgery might not be your best option.  Radiation & hormone treatments might work the best once the cancer has progressed past the prostate wall.

Dave 3+4

Old Salt
Posts: 720
Joined: Aug 2014

I am sorry about your father's prostate problems. In that context, the previous comments are all on target.

As mentioned, Dr Tewari is among the very best surgeons for prostate removal. But I concur that surgery probably isn't appropriate for him. Your Dad should be referred to an institution that specializes in complex cases. Both Sloan-Kettering and MD Anderson qualify. In that context, please report what Dr Tewari recommends.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

IbsAlwa said: "My father was diagnosed with Prostate Cancer around 3 weeks ago. I do not know how to feel yet.  We booked him an appointment with a recommended Doctor with Dr. Ashutosh Tewari in Mount Sinai Hospital in New York in 10 days from today for a second opinion.

<snip>

The current doctor recommended him to start hormonal tratment followed by radiotherapy, while his lower urinary tract symptoms will increase. And that curative reasult is low."

---------------------------------------------------------------

Although you are apparently going to consult w/a "renowned" PCa surgeon shortly, I agree w/the others above that surgery probably is not a suitable method of treatment for your father at this point in time. 

While I am generally opposed to surgery in any situation for the treatment of prostate cancer. the opinion of the others above is primarily based on your father's age and the assumption that the cancer has -- more likely than not -- already spread beyond the prostate capsule.  If this is the case, then chemotherapy -- not hormone therapy -- would be called for. 

So, I'd suggest holding off on any hormone treatment  until further tests are done to determine the primary location and likely scope/extent of the cancer.  This can be best done w/an MRI/MRSI 3T spectrographic scan.

Once you know whether the cancer has escaped the prostate or not, you can then decide whether chemo or HT would be the better treatment.   The effects of chemo can be devastating alone and I wouldn't even want to think about the effects when combined with hormone therapy, which has it own set of potentially debilitating side effects.

The MRI/MRSI scan will also help to determine whether radiation treatment is still appropriate and where the radiation should be focused/directed. If the cancer is still confined to the prostate, I'd higly recommend using Cyberkinife a form of stereotractic radation body therapy, which is the most accurate method of radiation delivery currently available. 

If the cancer is not confined to the prostate but remains within a relatively well defined area close to the prostate, then IMRT - intensity modulated radiation therapy -- which is widely used and available for prostate cancer treatment would be sufficient.

One other thing you might consider doing is to request a 2nd Opinion on the biopsy slides by sending them to Dr Jonathan Epstein at Johns Hopkins Medical Center.  Dr. Epstein is regarded as one of the leading experts in prostate cancer biopsy grading.  A differrent grading either higher or lower could greatly affect the decision regarding which course(s) of treatment to pursue.

Good luck!

 

 

 

ASAdvocate
Posts: 108
Joined: Apr 2017

I concur with Hopeful and with Swing. Dr. Tewari has an excellent reputation as a highly skilled surgeon, and a caring man.  BUT, your father's case may be beyond what any surgeon can cure, and there is no sense in adding the significant side effects of surgery to his burden if radiation is needed anyway. That's what this looks like to me, in my humble opinion.

VascodaGama's picture
VascodaGama
Posts: 2932
Joined: Nov 2010

Ibs,

The info you share above regards an advanced case, not contained in the gland and composed of aggressive type of cancerous cells. I wonder what did the MRI indicate apart from the size of the gland. How did they diagnose positive lymph nodes (N1)?
Can you tell if any other examination has been done?

If the clinical stage T3b N1 M0 is correct then the suggestion of his doctor is proper. Dr. Tewari is a surgeon and may suggest surgery but in such a case surgery would be done not to cure but for the purposes of debulking a big chunk of the cancer (the gland). Radiation and probably hormonal would still be required.

I think you doing well in getting second opinions. Not just from urologists but also from radiologists experienced in PCa treatments. The data collected (including the films of image studies) should be available to these physicians for their review. They need to know your dad's other health issues and, in this contest, I would advice your dad for getting additional examinations regarding issues that may interfere with the decision on a therapy. DEXA scan (bone health), ECG (cardiovascular health) and colonoscopy (existing ulcerative colitis may prohibit radiotherapy) are all conditions that may exist but just like the cancer, one doesn't know it to be there.

Fitness and diet are important while fighting the cancer and the treatment side effects. The quality of life is in jeopardy.

Here are past threads that may add details for your understanding;

https://csn.cancer.org/node/202020

https://csn.cancer.org/node/191395

https://csn.cancer.org/node/225403

https://csn.cancer.org/node/235655

https://csn.cancer.org/node/307534

Best wishes and luck,

VGama

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