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New Member - Father has been diagnosed with PC

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Posted 6/1/2011 1:48 AM (GMT 0)
Hello
I am new here. My Dad, 80 , has been diagnosed with PC. Gleason 7 to 9 in all 12 cores. PSA 27.
He got Lupron 1 month back. PSA down to 5.8 in one month.
Is this a good drop or is it too less for 1 month? Any insight would be much appreciated.
Thanks
Patty

Post Edited By Moderator (Steve n Dallas) : 6/1/2011 3:28:39 AM (GMT-6)

Posted 6/1/2011 1:49 AM (GMT 0)
Padgan, Welcome to this site. I am sorry for your fathers condition. P.S.A. has a half life of 6 weeks so this s a good drop. I hope this helps
Todd
Posted 6/1/2011 2:23 AM (GMT 0)
Welcome. At your dad's age, Lupron seems like the right thing to try and the PSA drop confirms this. Many of us here have great support from the women in our lives and your dad is lucky to have you.
Look at the top of the topics list for many resources for learning more, including several good books. You don't mention any other tests -- have they done a bone scan or MRI on your father? In any case, know that you have joined a very caring community and we are here for both of you
Posted 6/1/2011 3:05 AM (GMT 0)
Thanks so much for your replies!
My Dad had a bone scan and was positive for 3 vertebrae. However the radiologist and oncologist I consulted said there is nothing to be done for it. I am enquiring about Zometa.
Posted 6/1/2011 3:07 AM (GMT 0)
Not sure we are on the same page re half-life

The term means the time period when the original measurement decreases by half due to decay or elimination etc...

If PSA half life were 6 weeks. They wouldn't expect a zero reading 6 weeks after surgery
Posted 6/1/2011 4:24 AM (GMT 0)
Padgan, the hormone therapy is pretty much standard for people in your Dad's situation..The idea is to lower his testosterone level as much as possible, the lower the better. Your goal should be to get it down into the single digits..Not all men respond to Lupron and similar drugs the way they hope so you should always get a "T" level test along with the PSA to be sure the drug is working effectively..

Many Oncologists that specialize in PC use a technique called "Triple Blockade" where three different drugs, Lupron, Casodex and Avodart which all work differently to remove or block the effect of testosterone are used in combination to achieve the best possible response..The Gleason 9 requires an all-out effort on your dad's part to control the progression of the cancer as long as possible..

To broaden your understanding of what is happening to your Dad, two books are worth reading..Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" and the books written by Dr. "Snuffy" Myers ..

While your Dad's situation is not ideal, don't give up hope and become fatalistic! Many men get a terrific response to hormone therapy which when managed by an expert medical oncologist can control the cancer for many years...In many cases, bone mets can be treated with radiation if they become painful..It all depends on how hard your dad wants to fight...
Posted 6/1/2011 11:13 AM (GMT 0)
I dont know sfigato. That is simply how my onco doc explained it to me. Maybe because after surgery you have essentially removed the cancer while at the same time advanced guys have to shrink it away.
Posted 6/1/2011 11:25 AM (GMT 0)
That kind of drop in psa is fairly typical, it should drop more in the following 1-2 months being on that. It should do most of its so called magic likely within 3-4 months as to your lowest psa level may show up around then. Do consider looking into intermittent possibilities or adding supplement drug to minimize some of the side effects. If doc would let him go onto estradiol patch (additionally-small doseage)...it will cut the side effects and help against the bone density loses and it can kill directly some of the hrpca cells. Of course the doc may be totally against it, which wouldn't surprize me. You could get a second opinion from some of the reknown oncologists whom specialize in PCa, but that is your choice.

Of course you should have been given casodex prior as a pre-caution to 'flare' issues, the wisest of PCa docs know better. Good thing with verterbrae envolved that you didn't get spinal compression and other such things that could happen in such a scenario. You could consider doing ADT2 or ADT3 (fairwind mentioned that).

He will need your support and will likely go through some tough changes at his age on this drug. Might as well read up at www.hrpca.org (proven treatments for advanced PCa). Best to you.
Posted 6/1/2011 12:14 PM (GMT 0)
Padgan,
The Idea of hormone treatment is to get testerone under 20. The doctor should be checking his "T" monthly and adjusting his meds to achieve this result. I hope he is going to a medical oncologist that specializes in Prostate Cancer and not to a regular doctor or urologist. As zufus mentioned he should have been given Casodex 14 days prior to the Lupron. If this was not done then you have the wrong doctor treating him.
JohnT
Posted 6/2/2011 2:44 AM (GMT 0)
Thanks so much for all the replies. I do think we havevthe ' wrong' doctor because he does not return calls etc and refuses to pit him on cadodex ad well.Also he is yet to return my call on zometa.
Is there any disadvantage to switching to an oncologist rather than a urologist?
Posted 6/2/2011 2:58 PM (GMT 0)
Padgan,

We deal as patients with three types of doctors, but these may be combined skills -

Urologist, who may also be a surgeon or perhaps an oncologist as well, but he practices mainly in urological issues. Once Prostate Cancer metastasizes to bones/ other organs, it is no longer just a urological issue.

Surgeon, who may also be a urologist or oncologist. We try to find surgeons who specialize in Prostate removals, in expectation of better results.

Oncologist. Here things get complicated. Onocolgists also specialize (radiation, different cancers, etc.). You want a medical oncologist who specializes in Prostate Cancer.

My urologist was also my surgeon for my prostate removal, and I had Adjuvant Radiation with a Radiation Oncologist, but as I now have psa levels beginning to rise, I will go to a medical oncologist for discussions of hormone therapies. I will stay with my urologist for questions of ED and incontinence. My relationship with the Radiation Oncologist ended when that treatment was completed.

 

Posted 6/2/2011 3:07 PM (GMT 0)
Sorry, after all that I forgot to welcome you to our corner of the internet.

Welcome to HW.

Posted 6/2/2011 4:01 PM (GMT 0)
There is a major backstage battle between urologists and oncologists..Virtually all other forms of cancer are treated by oncologists, that's what they were trained to do. Urologists on the other hand were trained to treat all sorts of urological disorders in both men and women. Their medical education concerning the treatment of cancer, especially advanced cancer, is quite limited and here is where they get into conflict with medical oncologists..Once the cancer has spread outside the prostate gland, once surgery has failed, the urologists role should be limited to treating specific urological complications (the ability to urinate) and not the cancer itself.

It is my personal OPINION that many urologists try to continue treating prostate cancer far to long simply because it is very profitable to do so and in many cases this puts them into conflict with medical oncologists.

Having said that, there are a few urologists who have cross-trained into the surgery and oncology fields and have become prostate cancer specialists. They are seldom shy about letting their patients know about their broader skills and their focus on prostate cancer...

In your Dad's case, 80 years old and not a candidate for surgery or radiation, I would limit the urologists role to urological problems and let the best medical oncologist you can find treat his prostate cancer. Try to find an oncologist that specializes or focuses on the treatment of prostate cancer..If your urologist is put out by this, then find another U-doc...

Like everyone else on this forum, I am not a doctor and the above statements are just my opinion..
Posted 6/2/2011 5:26 PM (GMT 0)
I suggest your dad consult with a medical oncologist who specializes in - or at least has deep experience with - prostate cancer. I agree with the view stated above that some urologists tend to "hang on" to their patients for too long, when the patient would be better served by transferring primary cancer care to an oncologist. That happened in the case of my father (who died of prostate cancer). You might also inquire about "spot radiation" to the vertebral metastases. I am not a doctor, so I am not qualified to recommend this, or any other, treatment. But it might be worthwhile discussing with a knowledgeable doctor about whether such spot radiation (radiation directed at the mets) would be likely to reduce or delay pain, slow further spread, or reduce the risk of spinal cord compression. The doctor who would administer such radiation would be a radiation oncologist (which is different than a medical oncologist). But when you see a medical oncologist, you could ask him about this, and if he thinks it is worth considering, he (or she) could refer you to a radiation oncologist. Best wishes to you and your father, Medved.

Post Edited (medved) : 6/2/2011 11:37:33 AM (GMT-6)

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