Father 80 years prostate cancer

Hello All,

I am new in this forum. My Father was diagnosed with prostate cancer and was recommended hormone therapy with radiotherapy. But he has also heart problems and i am worried about the adverse effects on his heart. The cancer is localized and has not spread yet. My question is why cant he get radiotherapy alone without hormone therapy? Should that be tried first? Can you give some advices? Thank you.

Thank you for answering. The results say:

Adenocarcinoma of the prostate.

07: cylinder 50% envolved in discontinued form. Gleason 6 (3+3). Prognostic group 1.

10: cylinder 95% envolved in discontinued form. Gleason 7 (3+4). Prognostic group 2.

11: cylinder 5% with Gleason 7 (3+4). Prognostic group 2

Intraepitelial Prostatic neoplasty on 06

Sample 5 is minuscle and sample 16 like muscular fragment only. Both without neoplasty.

Conclusion:
Acinar carcinoma of the prostate.

At age 80, his life expectancy is not real long. The cancer does not appear to be that agressive. I agree with you that hormone therapy could be avoided.

My Father is also taking anti arrythmic drug propafenone. So it might be a risk. Thank you for all responses. Upon researching today i just found that a new technique is being used for some years now, its called irreversible electroporation, any One heard about it what are your thoughts?

While it is considered a proven benefit by most oncologists, there is some debate as to whether there is a benefit to using ADT in conjunction with radiotherapy in less aggressive cases. It would seem to be with your dad‘s Gleason 7(3+4) it’s really a judgment call, As to whether he should go on ADT to help the radiation. and he should make that call , or at least discuss it further with the radiation oncologist. I was Gleason 7(3+4 ) and my oncologist gave me the choice. He was in favor of it but told me that I should consider that it will affect my quality of life for a short period of time it did that, but not drastically.

One mitigating factor in your dad‘s case is his PSA of seven. That’s not off the charts but it’s not very long either. An important question; have any scans been done to try to determine if the cancer has spread or they just look radiating the prostate

Good luck.

I would also consider the quality of life issues. Knowing what I know now, if it was my father (who passed away at 73 with PCa) I would suggest with a Gleason 7, low PSA, and low tumor burden to just do active surveillance. Quarterly PSA's and yearly ct scan (to make sure it hasn't spread to the bones) and biopsies. But I place a high value on quality of life and ADT really lowers that with the hot flashes, body changes, lack of strength, lack of testosterone and bone strength etc.

Hello Isit:

First of all your dad is lucky to have you researching and helping him with this. I know it will be a lot of stress on you but in the end I'm sure he will be better off with your help.

The first thing I can suggest to you is that you arrange for sending his biopsy slides to a prostate pathology specialist. One of the best is Dr. Jonathan Epstein. Look at the sticky thread at the top of our forum and you will find instructions about how to get this done. Don't accept from your doctor that this isn't necessary because it is. Prostate pathology is as much art as science and a garden variety pathologist might not get it right but Dr. Epstein will.

Secondly, please take your time to make a decision. The statement from a urologist that radiation is not effective w/o ADT is simply not true, especially in a case like your dad's which is "favorable intermediate". You should not get radiation advice from a urologist who doesn't have the requisite training in many cases to know what he/she is talking about.

Also, not all radiologists are the same. Most of them specialize. In your dad's case it seems to me that a full course of IMRT plus ADT is overkill (of course I am not a doctor). But I suggest that you guys contact doctors who specialize in LDR Brachytherapy and SBRT. With your dad's stat's both of those options are minimally invasive and have a high likelihood of curing his cancer. If you will give us your geographic location I suspect that some of our members may have doctors they can suggest.

Finally, depending on Dr. Epstein's review of the pathology, don't rule out active surveillance. Prostate cancer is generally slow growing and it may be that your dad will die of something else well before PCa gets him. Also if a rigorous AS program is followed the data has shown that later treatment of the cancer is just as curative as if it's done right away. Truthfully, many doctors don't even do PSA tests on 80 year old men since at that age there is an approximately 80% chance of some sort of prostate cancer and in most cases it is slow growing and non fatal.

In any case, good luck and let us know how we can help.

Jim

Im gratefull for all your answers. We have decided with my family to be firm with the doctor and tommorow we will show our firm decision to not give any ADT but to have only radiotherapy based on the fact that the cancer is low to intermediatte risk.

I hope that on the following months i can share news about the treatment and how it is important not to let us illude by a unresponsible doc decision

A few random observations with no particular advice:

Since your dad is sort of on the borderline in terms of risk a second opinion on his biopsy slides seems like a good idea. Generally, Gleason 7(3+4) requires less aggressive treatment than does Gleason 7(4+3).

Your dad's heart problems are probably not a big issue with short-term ADT.

Its a good idea to get advice about radiation from a radiation oncologist. Urologists are not experts in radiation therapy and may not have the latest information.

Many, if not most, problems caused by short-term ADT can be improved if the man stays active. If your dad is relatively sedentary then ADT will affect him more than if he is vigorously active.

Most men find radiation treatments very tolerable and they carry less of a side-effect load than do other treatments for prostate cancer.

There are several different kinds of radiation. Ideally, your dad should talk to several doctors who use different sorts of radiation before he makes a decision. The acronyms to ask about are IMRT, SBRT, LDR Brachytherapy, and HDR Brachytherapy. IMRT is the most common form of radiation therapy and usually involves daily treatment sessions for around five weeks. SBRT is a more recent treatment mode that uses fewer sessions to get roughly equivalent cure rates with (maybe) slightly fewer side effects. LDR and HDR brachytherapy both involve poking radiation sources into the prostate to kill the cancer. With LDR (Low Dose Rate) the "seeds" are less radioactive and are left in the prostate while HDR (High Dose Rate) involves much stronger radiation sources that are inserted, left in place briefly and then removed. Any of these would probably cure your dad's cancer. He should mostly be shopping for the doctor with the best story about side-effects.

Prostate cancer is usually a slow-moving thing and can often just be monitored. Your dad is on the borderline for "active surveillance" but that might be an option, especially if he gets a second opinion on his slides and the results are reassuring. It's best to find a urologist who has an established AS program. AS can be quite safe for well-qualified patients but it depends on the doctor knowing which tests to run, how often to do the tests, and which test results require moving ahead with treatment.

For a man your dad's age, prostate cancer is one of the annoyances of growing old but it is unlikely to shorten his life if managed sensibly.

Tudpock18 said...
Isit, I hope this doesn't come across as rude but demanding the doc not use ADT based on some random thoughts from people on the internet may not be your best approach. Let me reiterate that you should get a second opinion on the pathology slides and then speak with some different experts in radiation. That's doing your homework.

Jim

Jim, i did. And i will not demand it on "random thoughts". I will kindly ask for it to be done. When some users share their experiences that they had same grade cancer (3+4) and treated only with radiotherapy ADT, i dont consider that random.

I also did some homework - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4985515
"Results
For low risk patients, radiotherapy without ADT is indicated (evidence level 1)"

And no, for me ADT is not acceptable for an 80 years old with commorbities. Its kill.

Post Edited (isitlyme) : 10/30/2019 2:26:29 PM (GMT-6)

Isit, I may not have expressed myself very well. Providing your doc with evidence re ADT is a good approach; telling him you have heard of others who did not have it will probably not impress him. Heck, I also had favorable risk PCa and was successfully treated with radiation w/o ADT. My bigger points, which have been reinforced by others and I hope you will consider are:

1. Get an expert second opinion on the biopsy slides as that may change the treatment options.
2. See multiple radiation doctors since they specialize.
3. Depending on the outcome of the second biopsy opinion, consider Active Surveillance. Speak with a doctor with AS experience. Give your dad's comorbidities, subjecting him to treatment may not be the right approach.

Jim

Jim

You may also consider asking your Dad's cardiologist about his risk for issues with ADT.
I did so in my case (multiple bypasses) and my cardiologist 'approved' ADT (for me). This obviously doesn't mean that this will be the case for your Dad.

Some say the bone scan is a waste of time but it is relatively inexpensive compared to more advanced scan technology which would require a cause/reason to be used. From my experience, the bone scan will flag arthritis in joints but the radiologist will explain that in the report since they see this all the time. I can see all the white areas on my scan and they all correspond to known problem areas such as knees, shoulders.

Many times they also do a CT scan of abdomen at the same time for similar reason, looking for any obvious spread of PCa prior to treatment which would change the situation .