Any hope?

First of all greetings to everyone.
I have been reading this forum for last couple of days (for hours on end) and I am really glad I found a place with so much knowledge, compassion and courage.
English is not my first language, so I will try to give my best with medical terminology.

I live in small country in Europe where the health care options and standards are not so high as in USA or some other bigger countries, and people especially in my family have bitter experiences with medical professionals, so sadly often they chose to avoid them at all cost

Yesterday after MRI we found out that my father aged 78 (no other chronic illness, still working and active) most likely has prostate cancer, and judging by the results it doesn't seem to be one of the less aggressive ones
Short story:

03/2022 - having trouble urinating, primary doctor orders urinary cultures and PSA, urinary test comes positive and he is treated with antibiotics, PSA is 9 and there is a suggestion to visit urologist, which feeling better my father declines.
10/2022 - he is again having huge problems with urinating, he visits primary doctor again, this time urinary culture is negative, he still get antibiotics
12/2022 - still having problems after antibiotics I force him to visit private urologist(he still doesnt wanna visit hospital), he does DRE which was fine, and ultrasound of prostate which reveals big prostate (150ml), he orders PSA which is 23 now, he recommends MRI/biopsy
02/2022 - I finally make him visit hospital urologist, PSA is 31 now. Urologist orders prostate biopsy in two months. I ask him to order him for MRI which he refuses claiming it wont give us conclusive evidence of anything and he will still have to do biopsy, he gets pills for BPH in meantime (Dutasteride/tamsulozinklorid)
03/2022 - his PSA is 41 now, having been reading alot I still think MRI is useful to do before biopsy, so I drive him 200 miles to other town where we do MRI 3T scan and I get worst possible news

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MRI RESULTS :

Findings and Opinion:

A standard mpMRI of the prostate was performed using T1 and T2 sequences, multiparametric analysis, pre-contrast and dynamic post-contrast sequences, and diffusion imaging in a patient with an elevated PSA value of 41. The prostate is enlarged, with dimensions of 6.6x5.6x8 cm (APxLLxCC, 146 cc, PSA density=0.16 ng/mL/mL). The transitional zone of the prostate is hypertrophic, with BPH nodules and degenerative changes, and the peripheral zone is laterally reduced in width, with visible prostatic calculi apically.

The posterior part of the prostate is infiltrated by a PI-RADS 5 lesion measuring 7x5.6x8 cm, which infiltrates the spermatic cord, seminal vesicles, the posterior part of the prostate's predominantly peripheral zone, the initial part of the urethra, the MRF, and the mesorectal space up to the rectum, which it is inseparable from, and which is probably infiltrated. The lesion also impresses upon the posterior wall of the urinary bladder and the peritoneal fold. The neurovascular bundles are infiltrated.

Lymph nodes adjacent to the common iliac vessels are up to 1.2 cm in diameter, with the left external lymph node up to 1.5 cm, while the inguinal lymph nodes are not enlarged. The urinary bladder is poorly distended. No free intraperitoneal fluid is detected. Small focal lesions are visible in the pelvic bones, and bone scintigraphy is recommended.

Conclusion:

A permagna PI-RADS 5 lesion is seen in the posterior part of the prostate.

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I then call urologist again, and present him with MRI findings.
He is not pleased that we did MRI on our own accord and claims he still need to do biopsy to coniform cancer (which I understand), but I also believe MRI could be useful to target suspicious area...

He tell me that after biopsy there will be bone scans and CT/PET scan, and then the treatment will begin with probably combination of hormone therapy and radiation.
He reassures me that this is still treatable, and you can live with this condition, and that I shouldn't write my father off (I was very distressed at that moment).

I now know we should have reacted sooner where it would more manageable but as I said my parents harbor big distrust to medical community which they will have to change now.
I blame myself allot also, not taking things in my hands before and not forcing him to go through with exams, I will have to wear this cross with me now. I feel like I failed my father, and he was nothing but a good unselfish person his whole life, giving everything to others and not caring for himself and his own needs.

So my questions would be, is 1 month to wait for biopsy too much (considering his big and quickly raising PSA)?
Is there hope for my father to be with us at least few more years ?
I really need some positive outlook/news, and maybe some tips during this grim road ahead of him.

Guilt is as bad as cancer and can interfere with clear thinking. You have acted as a good son and have taken responsibility for your fathers care. You have made the best decisions you could in your' circumstances with what you know, one of those is coming here for consult. Retaining a positive, optimistic and upbeat attitude will be of great profit for this task before you.

My personal opinion is that 1 month wait for biopsy will not make any difference. This cancer is slower than other cancers. We have members here that have PSA much larger than your fathers'.

Many of us here were told we were not going to be around much longer...many years ago. I have been fighting metastatic prostate cancer for more than 10 years now and have a very high quality life. There is great hope for your father to continue for a long time.

An American Native advice is "If you keep your eyes to the sun, you will not see any shadows." We have access to some very powerful drugs that will stop the progress of the cancer for many years. There are surgical, chemical and radiation treatments than can stop the cancer from growing, moving and even kill it. He can improve his condition with good diet, exercise (as best he can), getting sufficient rest/sleep and maintaining a good emotional state. That means being optimistic and enjoying his normal activities, family and friends. These have all proven to be helpful to us cancer patients. The road is challenging (there is a cost to every benefit) but it is not grim.

PSA is high but prostate size and inflammation can add to it's rise.
Biopsy will give you a good idea of type and volume of it.
A month is okay to wait.
There's a lot that can be done so keep upbeat.
Welcome and good luck.

Glen

Thank you so all much for your words of wisdom and encouragement.
I am now feeling a bit better and have already started to gather info about best oncologist in my area and also further away.
@Jack, I am 35 now, I should probably check it in the future seeing the situation, and also learning fathers brother had it...

I will keep all of you in my thoughts and prayers

According to the NMR image the affected area is huge and definitely not contained in the prostate but I guess you already know that. However, even advanced prostate cancer with distant extensions, an unfortunately real possibility in this case, growths slowly and it is usually very sensitive to an initial hormone treatment. Therefore, have a justified hope that he still can remain some, or even many, years at your side.

Thank you guys, your posts give me strength to cope with this new reality, and I keep coming back to read them.
I just hope his therapy will give results and be well tolerated.
Lately there has been one bad news after another and I keep hoping for at least one somewhat positive turn of events.
Wish all of you best

Just remember the worst case almost never happens. Don't let the fear fool you Most older men die with prostate cancer, NOT because of it.
I remember reading by age 80 most men do have prostate cancer and don't even know !

The delay in getting to this point won't make much difference in the final outcome for your dad. You are a good son, and I wish you both the best.

May have missed it but what country are you in ? By the way your English is just fine too !

MrMoon - Please do not be too aggressive with your father at this point until the treatment path is determined. Any diets or supplements are longer term solutions. This link might point you in the right direction as there are many articles and videos on diet and supplements. The key is finding valid ones backed by medical testing and research.

https://www.pcf.org/prostate-cancer-and-eggs-dairy-supplements-your-questions-answered-part-1/

My father is 95 and suffers from all the major medical problems: heart failure, kidney failure, prostate cancer, diabetes, blood disease, and a few more, all beyond treatment at this point. Our family wants to help but who is to deny him an ice cream cone or a beer at this point. It is tough to do as one thinks lowering his blood sugar or abstaining from alcohol might change something but it will not. He deserves to have happy moments from time to time as much as seeing doctors and getting blood tests.

Your father clearly as a problem based on symptoms alone. The scans and biopsy will finalize the diagnosis and a plan will be determined. It sounds like you are doing all you can as a son and providing the necessary encouragement and assistance to have everything properly evaluated. The key is a good oncologist at this point but he has a number of urological issues that may need to be looked also.

Duck2 said...

Pratoman said...
MrMoon, there is always hope. Especially in prostate cancer. Most important, keeping your comments about the healthcare system in your country in mind, to find an oncologist who is up to date on recent advances in care.( Maybe you can visit another country if you have the means? ).

We have one member here who was diagnosed about 13 years ago, Todd1963. His PSA was 3200. He is still with us and enjoying life

Try to stay positive, you are doing everything possible for your father

30,000 men in the US die every year of prostate cancer, there isn’t always hope.

<ROLLING EYES>

My reflex response was to delete this post, but i decided not to, it doesnt break any rules, it just is the opposite of being supportive to the original poster who came here looking for some support, and after all, we are a support forum.
Not saying we should speak UN Truths to make our members feel better, I'm just saying keep it in context. Lets just leave it at that.

To put that statistic into context, it means that 90% of men diagnosed per year survive their diagnosis. 300,000 cases per year

Mr. Moon, yes there is hope and it sounds like you are doing the right things. Forget the guilt, look forward and do the best you can to advocate for your dad.

Jim

I have not forgotten this forum and I am reading it every day, I didn't have strength to post, both from mental and emotional exhaustion.

It has been a tough week but things are in progress.
I have identified 4 good oncologist in my regional hospital, and two bad ones to avoid.
Now I have to found out who among them is best at treating PC, and I have to found out the way to get my father to that oncologist (the things are still unclear at that front, some people say we can chose oncologist, others say he might have too many patients to receive us etc.)

One good thing that happened is that melatonin is helping him sleep better, less night visits to bathroom, so he is now much more energetic.
Bad thing is it seems he have pain in his pelvis (I found out from my mother, he is tough to get info out..)

I am learning allot about possible courses of treatment, to prepare myself for talks with doctors.

I know I am repeating myself but I wanna thank you guys again. You were to help me first.
I can only aspire to be more like you , having your own battles but still finding time and will to help others in need. It might seem trivial for you to be like that, but trust me in todays world it isn't, most of the people (especially younger generations) choose internet anonymity to be vile...
I thank God I have found this forum.
I will pray for your health, love you all