New here, seeking advice on what to do next for my father

Hello,

So glad to have found this resource, have bee reading the posts and would like to ask for a bit of advice on my dad's behalf. Here's his story, in short:

Diagnosed with Gleason 7 (4+3) and a PSA of 12, back in 2001. Was treated with IMRT and the cancer went into remission till 2011. In 2011, it started creeping up from a base of 0.5-0.8 to a PSA of 6 (over a year). At that point, his urologist initiated dual IADT therapy using Trelstar and Casodex 50mg. Testosterone levels were down where they needed to be, and his PSA was suppressed to 0.02. After 12 months of therapy, he went off, and through out 2012 and 2013, his PSA slowly climbed to 0.7 last November (2013). Today, his PSA came back at 12.4, which is totally unprecedented for his disease, such an increase over 6 months! The urologist thinks it might be a mistake, so we're retesting. He also gave him antibiotics for a potential infection (trace of blood in urine), and felt a slight bump in his prostate.

Preparing for the worst, I wanted to ask two questions:

1) Does anyone know if Dr. Snuffy Myers is taking new patients? I've been following his newsletter for a few years, and would definitely consider taking my father to him.

2) Since we live in New York City, does anyone know if there are good, "out-of-the-box' hormone therapy specialists that are similar in their approach to Myers, that we could consult, before we make the trip to Myers (or, if we can't see him)?

The one oncologist we've seen didn't even talk about triple blockade, which I know must be a next option for him. So, it'll be good to get a pointer for a creative ADT specialist in NYC, if possible, or someone in New Jersey, closer than Virginia?

Many thanks for any advice!
Arthur

Post Edited (arthur-qa) : 10/25/2014 9:08:06 AM (GMT-6)

Arthur,

It sounds like your Dad has a very good urologist who is taking very prudent next steps. Lab errors do happen. Prostatitis is more likely than a sudden jump due to PC.

His dual iADT sounds like it was working well. Triple blockade is not necessarily beneficial. What matters is not how many different hormones he is taking, but how well they are doing at suppressing his androgens. An even bigger question is whether there is any survival benefit at all to beginning ADT when there is only PSA relapse. Recent evidence suggests that there may be no survival benefit to starting ADT before signs of clinical progression are detected.

Other questions worth asking his doctor:
• Do we know if the relapse is local, regional, or distant?
• Should he have a biopsy? An advanced imaging study?
• Is the recurrence treatable with more radiation or focal ablation? (e.g., SBRT)

I agree with Lupron Jim that Memorial Sloan Kettering is the best you can do, but I would wait until after the retest and the antibiotics.

- Allen

Arthur said...
He also wants to do a biopsy. We were confused about that, because if they find cancer in his prostate, it was our understanding that it could not be treated with radiation anymore, since his primary treatment back in 2010 was via IMRT.

They can and sometimes do spot treat local recurrences with SBRT or brachy. If his recurrence is local, that will, hopefully, be all he needs.

The bone scan may detect distant mets. The CT scan may show enlarged lymph nodes. There are other, more sensitive, imaging studies that can be done, but taking this one step at a time, starting with retest and antibiotics is important. His doctor's approach sounds very reasonable to me.

- Allen

While not routinely done, there is such a thing as "Salvage Prostatectomy" where surgery is performed to remove the prostate even after radiation treatment..Depending on his scans and the possible biopsy, this might be an option for him..He may have to travel as only a handful of surgeons and hospitals perform this procedure...

Just an update. We saw the urologist today, to discuss CT scan results. They showed lymph node involvement on the left side of the pelvis, including one that was affecting the functioning of the kidney. We're starting ADT3 and next will be talking to an oncologist about the possibility for radiation therapy on those lymph nodes. We'll also ask whether my father is a good candidate for adding chemo to ADT3. I think he's still oligometastatic, no bone or organ involvement was noted as of yet, so we'll hope the addition to radiation to the lymph nodes will give him a remission.

Thanks, didn't even know about the cyberknife option. Will definitely check it out!

Arthur