My Dad just diagnosed with PC - starting HT and IGRT need advice

My dad is currently 76 with recent 10/20/2011 diagnosis of PC.  PSA at 6.7 at diagnosis 12 cores with 11 positive.  Gleason was 4+4 and T2c.  Cancer appears to be contained to prostate and bone scan and CT scans were negative.  Urologist state the cancer is high grade and agrresive,  He is at high risk for spread.  They will not perform surgery as they believe my Dad's age prohibits a good outcome.  The plan is HT therapy beginning with Casodex today and continuing indefintely as well as shots of Lupron (I believe this is the drug)  to continue for 3 years.  He will begin IGRT January 2012 for 9 weeks.  I am worried about the SE's having both treatments at the same time.  My Dad has hypertension and his blood pressure is elevated due to stress and anxiety.  He also currrently has issues with fatigue (since Februrary 2011) which I fear will be made worse,  Has anyone undergone combined treatments and can give me advice as to the best way to handle the SE's?  The IGRT will be done at a facility with Rapid Arc from Varian Medical systems with a very experienced Radiation Oncologist.  Has anyone had IGRT with this system?  My father is very overwhelmed and anxious.  I am hoping giving him information will give him some relief.  The Urologist seems to be handling the treatment plan and has not referred us to an Oncologist.  Should we see an Oncologist?  I appreciate any help you can give me.

Kim

Definately see an oncologist. HT should be administered by a medical oncologist specializing in PC as he is better able to monitor, adjust doses and give meds to reduce the side effects.
The Prostate Cancer Research Institute website has a section on Hormone therapy, side effects and ways to minimize them.
Good luck,
JT

Considering your stats, his health and having hypertension and blood pressure type issues it is a no brainer to see a qualified oncologist. It is never dumb to get another opinion on a life and death or quality of life decision?

Onco-doc....treats the biology of the disease and your relationship to drugs, interactions and control of the disease, even as it progresses and deals with quality of life issues.
(i.e. onco-doc is more of an artist and can tailor things to suit the issues) Onco-doc makes no direct money off of treatments like: surgery, radiation, cryo freezing, hifu.

Onco-doc might even have different options for your case to consider, don't be surprised.

Yes I was treated with similar to what you are looking at currently in 2002 at age 51 (ADT3+radiations) after getting 8 opinions and choosing to do such from my choices. I happened to find on my own, and I had even worse original stats, but every case is somewhat unique in PCa. There are medications to combat fatigue and side effects on the drugs, onco doc would hopefully know, the uro likely wouldn't.

 

Post Edited (zufus) : 11/3/2011 5:14:37 AM (GMT-6)

I had combination therapy at age 60 that included three forms of hormone therapy and two forms of radiation, IMRT and brachytherapy.   I tolerated all of it very well.   My statistics look like your dad's except my PSA was higher.  

Good for the uro saying no surgery as the good surgeon's won't operate over age 70.

You should see an oncologist that is very experienced with higher risk PCa and also see at least two radiation oncologists.   Find out about both high dose brachytherapy and permanent seeds as they may be more effective with the IMRT/IGRT than the IGRT alone.   They will also allow the IGRT to be reduced which may lessen the side effects.

The key player here is the Radiation Oncologist..The HT is being administered on HIS recommendation as it complements the radiations effectiveness. Who gets to deliver the HT drugs is always an interesting battle as there is considerable money on the table..You don't want or need to be paying three specialists co-pays...Urologists love performing this service (administering the Lupron) but it's a little outside their job description. Ask your R-doc who HE recommends and why. He might work with a medical oncologist and yes, your Urologist's nose is likely to be put out of joint..Too bad, his job is pretty much over. Or you can let him have the Lupron kiss...

The Varian RapidArc is one of the latest, most accurate liner accelerators. It can deliver the dose with pin-point accuracy while minimizing the exposure to healthy tissue..I underwent 40 treatments on one with very minimal side effects..The side-effects from the HT are worse and require careful monitoring to avoid heart problems and bone loss..The hot flashes can be very annoying too.. After the third treatment, it becomes routine and boring..Be sure to drink the water like they say! That helps protect the bladder from the radiation! Good Luck!