concerned about my dad

Hi, I have been browsing these boards for a while. I am worried about my farther and any input would be much appreciated. He had PC surgery in March of 2008. The pathology showed the following: “Gleason grade 4+5, with established extraprostatic extension and perineural invasion. No definitive involvement of margins or seminal vesicles “. He did not start his radiation until a year later (March of 2009) and had 6 weeks of radiation. After the treatment his PSA was <.01, then went to .03 (3 months later) and .04 in November and he just had it checked again and it jumped to .266
I am wondering if the radiation therapy failed and the hormone therapy is his only option now… Or could it still be the post radiation “bounce”. His doctor does not seem to think so. He wants to start him on the hormones therapy.
What are your thoughts?

Thank you.

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rigagirl,

according to my own radiation oncologist, there isn't really any bounce after salvage radiation, that is usally associated with the different radiation formats used as a primary treatment. not a doctor, but based on the numbers your posted, it would appear that it failed. this means your husband has used up his curative shots at curing his PC. At this point, turning to HT would be a normal step, in order to slow down the growth of any remaining cancer.

perhaps some of the more "advanced" case brothers here could chime in on their first hand experiences with this next step.

welcome here, btw, sorry you needed to find us but you are most welcome to be here, and ask as many questions as you wish.

David in SC

rigagirl,

I sympathize. I wish this hadn't happened to your father.

Your question is a good one. I guess the answer is that although PSA is an excellent early warning in the post-treatment setting, it still has its limits. The population of cancer cells could be so low as to not raise PSA above .01 initially. That's why men have to keep getting tested, even if they have undetectable PSA scores after treatment. All it takes is a few cells that have learned to live someplace besides the prostate. Over time, those cells proliferate, and when they do, they eventually, usually, throw off enough PSA to give themselves away. This usually happens far, far, before anything would show up on a bone scan or CT. With a lot of cancers, there's nothing like PSA to ring the alarm bell after treatment. In those cases patients can go along thinking they're cancer free, until bam! one day they have symptoms, and a scan shows tumors all over the place. With prostate cancer, and PSA in the post-treatment setting, it's different. We usually find out early, which is a blessing, albeit a harsh one.

In my own case, I'm not being tested on a sensitive level as your father. My PSA results simply say "less than 0.1". I could stay at that level for years and still have a recurrence down the road, so I will probably be tested for the rest of my life. It's possible I have a few prostate cancer cells setting up camp somewhere right now.

It's good that your father continued to be tested regularly. This gives him, and his doctors, time to evaluate his situation and come up with an appropriate strategy.

I wish you both well. What a lucky man your father is to have a caring daughter like yourself.

Good to chat with you tonight - we are here - if we can be of any help.

rigagurl,

I'm sorry to hear that your Dad has likely failed salvage.

Both your Dad and I are in the same boat. I failed primary cryo and have a dilemma as to when to start hormone treatment (I do not qualify for any salvage as what is left of my prostate gland and the seminal vesicles are clean of any PCa). My Uro wants to wait until the psa passes 5.0 (presently 1.5) as there are quality of life concerns in such treatment. The reason why I am bringing this up is because I am searching for an oncologist for a second opinion (as to when to start hormones) and frankly, to guide me along subsequently. I suggest that at this point, your Dad should do the same thing. Even the best urologists are not always up to snuff on all available treatments and are usually more focused on just a few. With prostate cancer, it sometimes takes trials with many types of agents to find the one that will work the best; oncologists usually do a good job in this effort.

Best of luck to your Dad. 

Rigagirl,

I'm a prostate cancer patient as was my father. One possible reason your father's PSA dropped to zero was his very high Gleason score. Many of those high scores, and some lower scores, my not express PSA, but the cancer is growing elsewhere. A lot has been written here lately on the value of bone scans and CT scans for teeny-tiny amounts of recurrent PSA. Most prostate cancers do express a predicted amount of PSA, but some odd variants do not. The only way to tell is with a bone scan and CT scans. Have your father get the scans so you have that information and your providers can make better decisions.

HT is about the only option at this point. Mitigate the effects with diet and exercise and he'll be around for a long time.

Hello rigagirl --- good on you for looking out for your dad. What a lucky guy!

Not so lucky is the treament failure. However, I write to tell you that my father went on HT when he was in his early 60s and was still on it many years later when his heart did him in. When he had a pacemaker installed, about 10 years before he died, the heart guy asked his cancer doctor, if his cancer was going to kill him. The heart guy said to me, "No sense putting your dad through this if his time is limited." So, off the heart guy goes to phone the cancer doctor and ask, "Tell me, is his cancer going to kill him?" A few minutes later the heart guy comes back down the hospital hall grinning from ear to ear. The cancer doctor's response was, "Absolutely .... it will kill him .... but, he'd have to make it to around 150 before it started to cause him issues." The heart guy said to me, "Looks like we'd best do the pacemaker to help him reach the 150."

May your dad do so well too.

Sheldon AKA Sleepless

Hello again, rigagirl,

I'm 67 now --- check back in a couple of weeks and I'll be 68 --- and have been living with the knowledge I have cancer for a year now. It may be gone, it may not be. I can understand your dad having trouble thinking the doctors are stopping talking cure, and instead talking of beating it back.

I've no idea of what the long term success rate is with HT, but the few people I've known on it have pretty much all died in their beds of something else --- what used to be called 'old age' on the death certificates. As we get older, your dad and I, we come face to face with our mortality and it's difficult to accept that these bodies we've lovingly nurtured with extract of hops, ryr, wheat and sugar cane --- all the great food groups in liquid form --- are giving up on us. One of the problems us PCa guys have is that we know about the PCa and so we're focused on that when, fact is, it's likely the cancer we don't know about, or our plugged arteries, or the weak vein in our brain waiting to pop that's the real threat.

I don't want to make light of your dad's situation, or the possibility that it might be quite serious (I just don't have a clue) but I do think that if he's able to put this risk into perspective with other risks he may start to walk down the street as I do, looking at other men my age, and realizing that a lot of them are carrying around and growing prostate cancers, and they don't even know it. I suspect I'm in way better shape than they are, and your dad too. We've both got doctors watching over us and treatments and drugs to take to beat back the beast. Those other guys don't have this going for them.

I hope you'll keep writing and letting us know how your dad --- and yourself --- are doing.

Sheldon AKA Sleepless