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Cryoablation

Iris6
Posts: 3
Joined: Apr 2018

Hello, I have some questions about prostate cancer and I hope someone could help me. My father was an international patient from Asia. He was diagnosed with prostate cancer with multiple bone metastases in March 2017. He got endocrine therapy (Bicalutamide and Goserelin) for one year. Currently his PSA is going up and we are looking for better treatment for him. Could someone let me know which hospital is the best in treating prostate cancer with bone metastases?

In addition, as surgery may not be suitable for him at this time, he would like to get cryoablation if possible. Could someone let me know which hospital/doctor have more experience in prostate cancer cryoablation? 

Thank you very much in advance!

 

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

Iris,

Welcome to the board. You do well in helping your father in his anguish against the cancer. I hope he manages to find what he likes and believes. I wonder in which country he has been/wants to be treated.

In any case, the endocrine therapy (hormonal treatment ADT) is the one typically recommended to systemic cases of multiple bone metastases, apart from chemotherapy. Patients in advanced status with widely spread cancer rarely are subjected to focal treatments (surgery, cryoabalation, radiation, etc) with intent at cure. These radical therapies have attached risks with permanent side effects that may prejudice more the quality of life of the patient already deteriorated. These are only justified when any extension of life can be assured or if any improvement in treating cancer effects (such as pain) is necessary. Surely one may do what he believes and comforts him.

I think that your father should consult an experienced medical oncologist specialist in advanced prostate cancer. These doctors care PCa using a series of drugs balanced according to each patient's overall health status. The most famous is Dr. Myers that has retired in 2017, but I believe you can contact his office to consult doctors that follow his principles. Google and search about him. Dr. Myers has published many videos on his views in treating PCa and how drugs do better in certain cases, in here;

https://askdrmyers.wordpress.com/

In this old video he talks about treatments when the initial one fails. Please see it;

https://www.youtube.com/watch?v=kkak51haCPo

Dr. Mark Schulz of PCRI (https://pcri.org/insights-blog/2017/7/24/2017-moyad-scholz-mid-year-update-recap) is also a specialist in PCa and has written several articles on the treatment of advanced cases too. At big institutions you can find oncologists like Dr. Mario Eisenberger at JH or Dr. Susan Slovin at SMKCC. If your dad lives in Asia then he can try consulting Dr. Steven Tucker who now practices in Singapore (http://www.tuckermedical.com/about-dr-steven-tucker/).

It would help if you share more details on your dad's case. The increase of his PSA could be due to many reasons. The drugs have been badly administered, or the combination therapy (Bicalutamide and Goserelin) is not sufficient. Some of the doctors above listed use strategies moving the patient to a triple hormonal blockade adding to the above a 5-Alpha reductase inhibitor like Avodart or increase the cocktail with drugs regulating the immune system like Leukine, or even change the protocol when the initial drugs lost effectiveness, such as to a second line hormonal manipulation like Zytiga/prednisone combination.

The worrisome in using antiandrogens like bicalutamide is that the cancer may start feeding on the drug itself. ADT functions by blocking the cancer’s access to androgens but when refractory is evident the cancer may have changed its androgen receptors to absorb the bicalutamide (Casodex) that is made of similar biostructure as the real androgen. One only knows about this via histology of testosterone tests done and compared with PSA tests. While on drugs, the PSA increases but the testosterone maintains its low levels in circulation. In such occurrences the patient needs to stop taking the androgen. Please read this;

https://pcri.org/-aawr-the-anti-androgen-withdrawal-response

About Leukine;

https://malecare.org/leukine-a-second-line-hormone-therapy-part-3-of-a-series-of-posts-on-second-line-hormone-therapy/

 

Do your researches and try finding the reason for the increase of the PSA. Is it due to refractory? What is the present real status of your dad?

Best wishes for his journey.

VGama

 

 

Iris6
Posts: 3
Joined: Apr 2018

Vasco,

Thank you so much for your information. They are very helpful and I do appreciate your time and suggestions. My father is living in China now and he plan to come to the United States for treatment. Below is some medical test result of him. Any advice will be really appreciate. 

On March 2017 my father presented with hip joint pain, difficulty in walking, and pain accompanying vibration of chest ribs. He was diagnosed with prostate cancer with multiple bone metastases. Then he started on endocrine therapy (Bicalutamide 50mg/D, Goserelin 10.8 mg/86 days, Disodium Clodronate Capsules 1600mg/Day). He had post-treatment hot flashes but the pain sensation was gradually alleviated. The Gleason score is 4+3=7. Current his PSA continue to go up so we are trying to figure out what the next step is.

 

03/2017 PSA 447.6

04/2017 PSA 42.7

05/2017 PSA 3.92

06/2017 PSA 0.667

07/2017 PSA 0.23

08/2017 PSA 0.113

09/2017 PSA 0.074

10/2017 PSA 0.062

11/2017 PSA 0.174

12/2017 PSA 0.287

1/2017 PSA 0.588

2/2017 PSA 1.07

3/2017 PSA 2.19

4/2017 PSA 3.53

 

12/2017 Testosterone 0.41ng/ml

 

03/2017  Alkaline Phosphate  121

08/2017 Alkaline Phosphate  101

01/2018 Alkaline Phosphate  71

 

Thank you so much!

 

Iris

 

Old Salt
Posts: 720
Joined: Aug 2014

As Vasco already pointed out, you need to find an expert MEDICAL ONCOLOGIST as soon as possible. Where does your Dad live? Could he travel to the USA for treatment?

Unfortunately, please inform your Dad that cryoablation is of no use once the cancer has left the prostate.

Iris6
Posts: 3
Joined: Apr 2018

Thank you Old Salt. My dad is living in China now and he plan to travel to the USA for treatment. 

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