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Treatment options???

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Prostate Cancer
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Posted 10/8/2017 5:36 PM (GMT 0)
Update. MRI last week showed dads cancer seems to be contained. Too big for Brachy. Surgery an option but probably not nerve sparring. eBRT and ibrt may be options. Meet with RO end of Oct and surgeon nov. (Drs don't seem to be in a hurry to treat) don't know if that's good or bad. I've seen several posts of people who wish they had done SBRT but I'm not sure if that's even an option at the Huntsman cancer institute at university of Utah. That's the closest treatment center with the most experienced Drs. Our first Urologist was new only been Dr for 2 years. The second was too old, doesn't do surgery any more and even then only did open not robotic. Now at Huntsman, but they aren't warm and fuzzy. I was hoping experienced Drs could give some hope, but they were pretty negative and dad left knowing he would die soon. Its hard to see him so depressed. We went golfing yesterday and he never even laughed at my jokes. I feel like my mom and me are hurting as much as he is but we are trying to stay positive.

Would like info on treatments from anyone with similar disease. Active healthy guy would really like continued quality of life but SE's sound unavoidable.

Gleason 8 but mostly 7's 10/12 cores positive. August PSA was 53
Posted 10/8/2017 6:45 PM (GMT 0)
Has he had a bone scan and CT?

SBRT has only been tried experimentally for high risk PC. I would be very wary of surgery with a PSA that high.

A much more reliable option is the combination of high dose rate brachytherapy, external beam radiation and hormone therapy. Since you are in SLC, you are lucky that one of the most experienced practitioners is right there -- John Hayes at Gamma West Cancer Services.
Posted 10/8/2017 8:41 PM (GMT 0)
I believe the "too big for brachy" only refers to Low-Dose brachytherapy or seeds. I don't think it's an issue for HDR brachy. Plus if he's on hormone therapy (which would be typical for radiation for a high-risk patient), that shrinks the prostate.

BTW, the treatment that Tall Allen mentioned above (HDR brachy, IMRT and hormone therapy) is what I had as a Gleason 9, and several other high-risk guys here have had it with generally good success.
Posted 10/8/2017 9:15 PM (GMT 0)
Good luck with these initial tests that can help inform a treatment decision.
I, too, would want a CT and a NM Bone Scan, for a baseline, if nothing else.

In the meantime, your Mom and Dad might find it helpful to attend a face-to-face Prostate Cancer Support Group where they can meet other men & their caregivers who have been dealing with local doctors, and with similar issues as they made their own initial decisions.

This Group may be currently active. Give them a ring. It can be really helpful to be in a room with people who "get it", and are happy to share their own stories, and to listen to your present fears, uncertainties, questions, and concerns.

UTAH

Salt Lake City | UsTOO | Sorenson Unity Center, 1388 South 809 West | 1st Wed. 6:30pm | Craig Blouin | 603-724-0532 | [email protected]

Charles
Posted 10/8/2017 10:47 PM (GMT 0)
He had bone and ct scan in August both were negative. But they wanted to wait for MRI to determine if surgery was a good option worried about size. Now that it is we have to decide. Not sure why we would want to do surgery if there is a good likelihood we would need radiation anyway.
Posted 10/8/2017 11:27 PM (GMT 0)
Skip the surgery and head for RT any time they suggest both. No need for that.

I am all for TA's suggestion: HRD brachy, EBRT, and HT. For high risk, it's a great combo.

Andrew
Posted 10/8/2017 11:42 PM (GMT 0)
As mentioned earlier, I'm a successful (so far) high-risk "triple play" guy. And much of my motivation was avoiding the SEs of both surgery and radiation since I was likely to need both. And I'm doing really well. But...

...you mentioned a large prostate. Does your dad have any urinary issues due to that? If so, there could be some benefits on the surgery side. (Sorry, not trying to make your decisions more complicated!)
Posted 10/9/2017 1:02 AM (GMT 0)
Worrykid,

I would say that you father's situation is far from hopeless. There are lots of treatment options. I wouldn't presume to tell you what to do. Your doctors have several advantages to us forum participants: they have medical degrees, presumably they are experts in their respective fields, they actually know something about your father's actual condition, etc.

All we know is that your father has a large prostate, a very high PSA, Gleason 8 and that the cancer appears to be organ confined. From this information we can draw some general inferences about your father's disease, but prostate cancer is such a weird disease and generalities aren't helpful to you.

The medical community knows a whole lot about prostate cancer, but has not figured out a way to determine what treatment is best in any given case.

This one says that RT is better for high risk:

http://www.medscape.com/viewarticle/863329

This one says that surgery gets better results, but RT may still be a viable option:

http://ascopubs.org/doi/full/10.1200/jco.2010.28.9561

If it's a really hard decision, then it means that neither choice is markedly better than the other, so either choice would be reasonable.

I would find somebody more experienced than the urologist who's been a doctor for 2 years. Consult with a surgeon who has performed hundreds (preferably over 500) RPs and who performs robotic surgery whenever possible. Same for your RO. Ask them what their cure rates are, with high risk patients. If the tumor is confined, I think a cure is possible.

Post Edited (nyc lawyer) : 10/8/2017 7:07:55 PM (GMT-6)

Posted 10/9/2017 1:45 AM (GMT 0)
The doctors will always recommend the treatment they specialize in as being the best treatment..or at least they will include their recommended treatment along with others..Yes, they will try to cure your cancer but they also are businessmen who expect a high income..So when you are talking with them, don't lose sight of that...While your Dad's numbers might suggest "terminal cancer" with prostate cancer you can't ever be sure of that...Many men with numbers far worse than your Dad's live long and enjoyable lives and many of them live long enough to die from something other than prostate cancer..Tell Dad to cheer up, it's not the end of the world....
Posted 10/9/2017 1:55 AM (GMT 0)
I have read posts from men whose initial PSA's were 3200, 5200, and 8000. Yes, EIGHT THOUSAND!

And, all three of them were posting 10 years or more after their diagnosis.

This is not to diminish the fact that your dad has a high risk case, but rather to inform that, with treatments, it is unlikely that "he would die soon".
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