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How long can pca treatment be put off?

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Posted 8/18/2011 10:11 PM (GMT 0)
My husband was diagnosed in April 2011 with prostate cancer, after a rising psa of 7.5 in January to a 10.4 in March. He had 10 of 12 cores positive (25%-89%), 5 cores with PNI and a gleason 7. Most recent MRI showed cancer had escaped capsule and possibly in seminal vesicles. He has had to put off this treatment due to medical issues where he needed a colonoscopy and endoscopy performed first. Colonoscopy was okay(cut out 14 polyps) and endoscopy showed a nodule, so he was sent for further testing and ultrasound. Just got results yesterday from UNC that he has a GIST gastrointestinal stromal tumor. He meets with GI surgeon next week but they are saying he may have to have this surgery first. How long is it safe to keep putting off this treatment based on his findings for pca thus far?

He is supposed to get gold seed markers on 8/22/11 and simulation radiation 8/30/11 with the 45 IMRT sessions to begin in early Sept.  

Any help would be appreciated. Thanks much.

Diana

Posted 8/18/2011 10:50 PM (GMT 0)
It is never safe to put off treatment given this diagnosis. However, this is a medical emergency, so hubby needs to do the most important things first.

One plausible possibility (and I am not a doctor) is to go onto HT (Hormone Therapy). This should keep the PCa at bay while hubby attends to the more important matters -- and of course if you decide to do this, all doctors involved would need to know.

Good luck.
Posted 8/18/2011 11:00 PM (GMT 0)
Going on HT is a good strategy for a couple of reasons. It will stop the cancer from growing and it will shrink the prostate which makes radiation more effective. I would look at just doing Casodex as it is well suited for a short period with much less side effects than other HT meds.
JT
Posted 8/18/2011 11:41 PM (GMT 0)
John T's advise is good, as usual...Not only will the HT suppress the cancer but it will make the upcoming radiation treatment more effective...It should have little impact on his other issues...Talk this over with your R-doc...
Posted 8/19/2011 11:39 AM (GMT 0)
I also am not an expert, but if it were me I would make sure that all of the different doctors involved in Dx and treatment consult with each other and determine which surgeries or treatments should take priority.

Good luck and we are all pulling for you and your husband.

Terry

Posted 8/19/2011 2:24 PM (GMT 0)
Thanks guys. This is exactly what the urologist and RO have been trying to get my husband to do since his diagnosis of pca, long before this new stomach cancer diagnosis. He absolutley refuses HT at this time and would only consider as last resort if radiation fails. I am hoping that with this turn of events, he will reconsider HT. The GI doctor said most likely he would have a partial removal of the stomach and that the GI surgeon would be contacting the RO after our meeting on Wednesday to discuss which treatment takes priority. I know stomach cancer is serious, but it just worries me that the prostate cancer has been left untreated for over 4 months now and its already shown signs of spread. Thanks for your help and best of luck to all of you on this journey.

Diana

Posted 8/19/2011 3:49 PM (GMT 0)
The side effecs from 50 mg of Casodex are not that bad, about 20% of those of Lupron. They are also completely reversible when you stop. Since he will be taking it for only a few months it will be no big deal.
JT
Posted 8/19/2011 8:45 PM (GMT 0)
If your husband's doctors agreed, I think Piano's original suggestion makes sound sense for now. Obviously his PC needs to be treated, but with his other maladies, going on HT, even for short term use, should help keep it in check while the other matters are being tended. I wish him well, sounds like he has a lot going on at one time.

David in SC
Posted 8/19/2011 10:51 PM (GMT 0)
I really appreciate the excellent information and well wishes. I will try and help my husband to understand the benefits that HT can provide, assuming all doctors agree. He is still on for the gold markers on Monday and after Wednesday's meeting with the GI surgeon, hopefully we will know more. Many thanks!
Posted 8/19/2011 11:47 PM (GMT 0)
Ditto: John T, Fairwind, Piano

Why more uro-docs don't mention casodex and similar? (-:

Many patients have done just that and had surgery or radiation thereafter, it could make surgery more difficult, gland shrinkage and I guess it gets like sticky effect, but still surgeons can do the job, they might not like working more to do so. (-:
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