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Opinions - dad’s treatment plan

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Posted 3/30/2019 10:54 AM (GMT 0)
Hi there,

A few weeks ago my dad reluctantly boarded the advanced PCa train due to a rise in PSA to 1.4 and a PSMA pet scan showing a spot on his spine. He will start hormone therapy in a week and radiation for 2.5 weeks to the spine met then 6.5 weeks of radiation to his prostate bed.
For some background, he had davinci back in 2010 for a localised Gleason 7 PCa. A slow rise in psa over 9 years has led us here.

He is 67, relatively healthy and in no pain besides having an ageing farmer’s body. The MRI revealed that the met is outside the spinal cord at present.

Are we on a good treatment plan here? I feel like his urologist let him down so I need to make sure we are making the best decisions this time..
Posted 3/30/2019 11:15 AM (GMT 0)
If it is already systemic why radiate the prostate bed? Are there known tumors there? Radiation there will likely cause some negative side effects. I would get another assessment. I am surprised Medicare has approved the reimbursement of the prostate bed radiation.

Radiating the tumor and starting ADT makes sense. Make sure he has a corse of Casodex for a couple of weeks before the Lupron to prevent the testosterone flare as it can cause problems with the spinal tumor and any others that may enlarge suddenly.
Posted 3/30/2019 11:20 AM (GMT 0)
I’m in Australia sorry so I don’t know if the drugs will be the same and we have universal healthcare here fortunately.
He is having the hormone shot the same time as radiation starts on the met... is this a bad idea? Should I phone his oncologist?
Posted 3/30/2019 11:20 AM (GMT 0)
Kmac it looks that a good plan to me, although I am not a doctor. They hope to get any remaining cancer. It may be that they recommend long term hormone treatment after that. Good for you for continuing to research on this. One thing your dad will need is to increase his exercise. If possible he should start resistance training and aerobic exercise. This will help with the hormone side effects and possible weight gain. Best wishes!

69 yrs., marathon runner, 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 3.2.19 PSA .04 T.Tot 440, 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012 TTot 686 ng/gl. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, May 21, 2018 T. Tot 686ng/dl; Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 94 yrs.
Posted 3/30/2019 12:33 PM (GMT 0)
Thanks for the clarification on your location.

The ADT should start before the radiation to help the radiation be more effective as the ADT weakens the cancer.
Posted 3/30/2019 2:33 PM (GMT 0)
Overall, that sounds like standard of care for your Dad's diagnosis, although as JNF pointed out, typically the ADT would proceed the radiation by several weeks. Glad to see you hear advocating for your Dad...wishing you all the best!
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