Need help for my dad - is this treatment plan reasonable?

    I'm sorry you have had to join us to help your father.  The decision you make has to be made for You and your Family.  All we can do is share our stories.  All I will say is that although the ED and in my case Incontinance side effects can be problematic.  Most of the time they can be dealt with.

    We are wishing you well in your decision and treatment.

    KW

His PSA was .05 following surgery.  It is such a difficult decision and while my dad was so concerned about the side effects of the treatment....and still is...the rest of the family is more concerned about the effects of the disease.  It is a lot to get your mind around and I wish you and your family the best.  Keep us posted.

Your Dad's projected stage of PCa appears similar to mine was when I was diagnosed.  He would be a prime candidate for some form of beam radiation treatment.  Please read my thread referenced in my footnote below and learn all you can about proton radiation therapy for your Dad as part of the educational process in making a treatment decision for him.  If your Dad is on Medicare, which I am assuming he is at age 65, Medicare pays the full cost of proton radiation treatment at one of the several proton treatment centers in the U.S.

Keep in mind that hormone therapy slows down the cancer, but does not eradicate it.  There can also be unpleasant side effects from hormone therapy.  I am just wondering why his doctor wants to start hormone therapy now and then get to some form of radiation treatment two months later.  He may have a good reason, but you should know what the reason is.  Perhaps the reason is to shrink his prostate before treatment.  I don't really know how important it is to reduce the size of the prostate if a patient is having radiation treatment.  I would ask his doctor this question.

There is always some degree of  probability that the cancer has spread beyond the prostate, depending of the Gleason score and other tests.  Tables have been constructed to give a projected probability percentage--I assume that is how the 43% probability was determined in your Dad's case.  I did not put a lot of emphasis on this statistic when making my treatment decision, especially if the post biopsy scans are negative (which they were in your Dad's case).  No matter what treatment one elects (including surgery),  there is always some probablity that the cancer may recur (hopefully it is a small probability if the cancer is treated early enough).  If the cancer is treated early enough, many studies today indicate that the chances of a cure are relatively close for all forms of treatment, especially in older patients.   

Did your Dad get a 2nd opinion on his prostate biopsy?  This is very important because determining the stage of cancer by reviewing the biopsy slides is more of an art than a science.  Many patients have their slides sent to Johns Hopkins for a 2nd opinion.  The potential concern in your Dad's case is to make sure that a 2nd opinion does not result in a Gleason 8, which would be cause for greater concern.

Best of luck to your Dad. 

Dave

Hi Dmid

We are all here to help!  You are most welcome!  Here are the questions you asked me in a separate thread which Bluebird has posted above.

1.  How does one go about getting their biopsy slides sent to John Hopkins, and how long does that take?

Tim G did an excellent job in responding to this question which I am copying here:

"My biopsy slides were sent to Dr. Jonathan Epstein at Johns Hopkins for a second opinion.  My urologist initiated the request and the pathology lab here in Seattle sent them to JHU.  I had a confirmatory second opinion on the slides back in about 10 days. Dr Epstein confirmed the positive biopsy and the Gleason score of 3+3."

2.  Is proton radiation different from the radiation that you normally hear about? 

The experts claim that proton radiation is a safer form of radiation than photon or x-ray radition. "Protons deposit their radiation differently than x-rays do. Compared to an x-ray beam, a proton beam has a low “entrance dose” (the dose delivered from the surface of the skin to the front of the tumor), a high dose designed to cover the entire tumor and no “exit dose” beyond the tumor."  X-ray radiation enters and leaves the body at the full dose of radiation with the potential for more damage to good tissue surrounding the prostate than with proton radiation.  However, x-ray radiation has become more sophisticated in recent years (e.g., IMRT) in which the dose of radiation is more controlled to help reduce damage to good tissue surrounding the prostate. If you read my thread on my journey with prostate cancer, I have given more detailed information about proton radiation and why I chose it.  https://www.healingwell.com/community/default.aspx?f=35&m=1002871

3.  Regarding the hormone treatment - the urologist recommended this, but dad will be seeing a radiology oncologist on Thursday, so I am so happy you brought this up so they can ask.  The urologist said that using the hormones would kind or "arrest or freeze" the cancer from continuing, and then at that point they would zap it with the radiation.  Do you think it could be a problem to wait for so long to start the radiation?

As I said in my first posting, it appears that your Dad's stage of cancer before treatment is similar to mine.  From the time I was diagnosed with PCa, I did not start my treatment until  almost 5 months later.  The delay resulted because I needed time to research my treatment choices and make a treatment decision.  A good majority of my waiting time had to do with getting an appointment with my radiation oncologist of choice at a proton radiation threatment center and then getting an opening for treatment.  From my research, a waiting time of a few months before treatment is not usually considered a problem because prostate cancer is usually slow growing (but not necessarily for all men).  In your case, you should become as educated as possible in your Dad's treatment choices and not be swayed solely by either the urologist or radiation oncologist who are treating your Dad at the beginning of this process.  They, of course, will be part of your education process.

I know that this is a very stressful time for your family right now.  The key to stay as calm as possible and become as thoroughly educated as you can in your Dad's treatment choices.  It seems that you have already boiled his treatment down to some form of beam radiation treatment.  Therefore, you need to explore both x-ray radiation (IMRT) and proton radiation.  You need to be familiar with the pros and cons of each treatment and the potential side effects.  While many men (including many members here) who are your Dad's age or older have had their prostates removed surgically, I agree with your Dad that the potential side effects from surgery may well be more problematic than those with radiation treatment.  The medical oncologist that I consulted with told me that I had about an equal chance of a cure with any form of treatment I selected.  It was then a matter of deciding what treatment gave me the best chance for quality of life with the fewest potential side effects after treatment.  Some men feel the need to have their prostate removed surgically no matter what the potential side effects are after surgery.  I think it makes sense for younger men (in particular) who are unwilling to gamble that some other form of treatment will give them the remaining longer life spam that they expect.  Younger men often seem to overcome potential side effects better then older men (but not always). Because I was almost 69 years old when diagnosed, it made the decision to opt for radiation treatment very easy for me.

Keep us posted as to the progress you are making.  Don't hestiate to keep firing questions at us because members here are more than willing to help and share with you their experiences with prostate cancer. 

Best of luck and God Bless!

Dave