Dad had Prostrate Cancer diagnosed - difficulty coming to terms

Two weeks ago my dad had a BPH related surgery and the biopsy showed that he has prostrate cancer. The gleason score is 4+4=8 and the PSA is 27. He is now 67 yrs old.
A subsequent bone scan showed early bone metastasis and a chest x-ray taken yesterday revealed that there are 2 nodules with the biggest one being 15mm in size in the right mid lung. CT Scan has not yet been taken which might reveal more.

Initially the doctor had suggested having his testicles removed to control the PSA instead of hormonal injection and radiation therapy. However, after coming to know of the nodules in the lungs suggested not to go with the radiation treatment. The doc says that he has less than a year to live with the cancer reaching the lungs and it is better to leave him alone.

I see stories of survivors here who also have the cancer reaching their lungs yet going on to live many yrs and undergoing active treatment.
Does the nodules have something to do with him being a smoker for almost 35+ yrs?

The family is not able to come to terms with the doctor's inference and I am ready to do anything it takes to prove the doctor wrong. I am just reading through everything available and new to understanding the implications of all this at the moment.

This forum has atleast given me some hope hearing about others who are facing their trials with confidence.

Please...any words of advise is welcome.

- John

Post Edited (john79) : 11/7/2014 4:34:19 AM (GMT-7)

John,

Welcome to the forum. Sorry your worries about your dad brought you here but glad you found us. Hope we can help.

I suspect that most of the members of this forum will find your father's doctor's advice a bit pessimistic. There are men with similar diagnoses who are gone in a year, that is true, but there are also men who respond well to treatment and get many extra years from it.

His doctor is probably right that, with two kinds of metastases and Gleason 8 disease, you dad is unlikely to be helped much by the usual first line curative treatments -- surgery, radiation, etc. -- and because of that there is not much that his doctor can do for him. But doctors tend to know their own specialties well and are sometimes a bit vague about what other kinds of doctors can and can't do.

Your dad needs to see a good medical oncologist who specializes in treating advanced prostate cancer with drugs, hormones and chemicals. There are many, many new treatments for advanced disease coming out every month, and more in the pipeline, some of them available only through clinical testing, and there is simply no way that a urologist can keep up with it all. Even medical oncologists need to specialize -- thus the reason you dad should look for one who does lots of prostate cancer.

If you tell us where you live -- in terms of the nearest big city, we don't need a street address -- we may be able to suggest a doctor he can see.

One way for the family to come to terms with things like this is to know they have done everything that can be done. Your dad has a ways to go yet in that department.

I don't have any medical advice (other than get the advice of many more doctors) but wanted to say I am sorry to hear about your dad and wish him and your family the best outcome and years more of life.

Welcome to HW, sorry you need to be here.

It's difficult to watch a loved one go through this kind of thing.

The first question I had was, are the lung nodes PC or something else? What kind of doctor where you talking to - an oncologist? What's your father's general health otherwise? Being a smoker raises the red flag of lung cancer and other medical problems not related to PC so I was wondering if the doctor's opinion was based on factors not related to the PC.

In any case, always best to seek a second opinion with a medical oncologist who specializes in PC. At the least they could try some HT to see if there would be any effect.

Hang in there and keep us updated on your progress,
Andrew

From reading HW for 5 years, there are plenty of folks with dire initial statistics who are around for MANY years.

Please find a good medical oncologist who specializes in PC.

Where are you located? We may have some suggestions.

Mel

Thank you Don! I have to check the availability of cyberknife where I am based. Thank you for suggesting Todd's blog. I am surely taking your suggestion seriously and getting a second opinion on this...
-John

don826 said...
John,

I am no medical professional but your Dad's doctor seems to be throwing in the towel a bit soon to me. I have lung mets and have had for the last year. Doctors all remark about how clear my breathing is when they do thier examination. I have multiple nodules. Two at 15 mm does not sound like a lot to me. Research cyberknife. It is a treatment used in lung cancer and has amazing accuracy. May be applicable to two nodules. Speak with Shands in FL they have a perspective on treating mets with radiation both in bone and lungs. I think the lung limit is count of 10 less than 2 cm. (Could be wrong on the size)

There is another individual on this site who has had astoundingly good results with a series of hormonal treatments and he started with lung mets at diagnosis. I think his handle is living63 his name is Todd. He has a blog you may want to read.

Get a second opinion and maybe a more optimistic doctor. There is hope.

Let us know how things develop.

Don

Thank you Peter. I am surely hoping that the doctor's advise was not correct as she did not have the x-ray report at hand at that time.

I am based in Bangalore, India and I am doing some local inquiries to find out the best treatment center/ doctor available in the city.

PeterDisAbelard. said...
John,

Welcome to the forum. Sorry your worries about your dad brought you here but glad you found us. Hope we can help.

I suspect that most of the members of this forum will find your father's doctor's advice a bit pessimistic. There are men with similar diagnoses who are gone in a year, that is true, but there are also men who respond well to treatment and get many extra years from it.

His doctor is probably right that, with two kinds of metastases and Gleason 8 disease, you dad is unlikely to be helped much by the usual first line curative treatments -- surgery, radiation, etc. -- and because of that there is not much that his doctor can do for him. But doctors tend to know their own specialties well and are sometimes a bit vague about what other kinds of doctors can and can't do.

Your dad needs to see a good medical oncologist who specializes in treating advanced prostate cancer with drugs, hormones and chemicals. There are many, many new treatments for advanced disease coming out every month, and more in the pipeline, some of them available only through clinical testing, and there is simply no way that a urologist can keep up with it all. Even medical oncologists need to specialize -- thus the reason you dad should look for one who does lots of prostate cancer.

If you tell us where you live -- in terms of the nearest big city, we don't need a street address -- we may be able to suggest a doctor he can see.

One way for the family to come to terms with things like this is to know they have done everything that can be done. Your dad has a ways to go yet in that department.

Currently we do not know what the nodules in his lungs are and if it's PCa. The x-ray report just said "2 nodules noted in right midlung, the biggest measuring 15mm indicating metastasis."

The doc didn't see the x-ray slides yet but mentioned that we are looking at less than a year if it has spread to the lungs before suggesting the chest x-ray. That obviously has left us scared. It might be some previous infection that we are unaware of and of course his smoking that has just stopped after his BPH.
I think a CT scan might be suggested by the doc when we meet her next on the coming Monday.

Thank you for your best wishes SpecialLady!

-John

SpecialLady said...
Nodules in lung do not mean PC has metastatized. I just had a family friend undergo a surgery for nodules in lung, only to find they were nothing dangerous. Nodules in lung are a common thing, most likely traces or scars of some leftover infection, smoking, Even if those were PC nodules, from my understanding, PC in lungs does not cause serious problems. With a PSA of 27, and early bone mets, your father has a good chance of many good years ahead of him. My father had a similar diagnosis and will soon reach 4th-yr mark since his diagnosis. Best of luck for you and dad.

Glad to hear that you are proving the doc wrong and keep up the good fight. The doc here says removing the source is better than hormone therapy.

Thanks!
-John

142 said...
I'll follow the suggestions above with another push to see a medical oncologist who specializes in prostate cancer.

My doc gave me three years, we are constantly fighting the battle, and I am still here five years out. He was wrong, and I would say we are both happy with that.

I am on intermittent 6-month shots of Lupron. Yes, there are side effects, but physical castration can't be reversed. You won't hear of me doing that.

John, the nodules in the lungs could be either lung cancer or Prostate cancer spread to the lung or something else non-cancerous.

Prostate cancer that has spread to the lung is still prostate cancer, not lung cancer, but could be either given his smoker history.

Good luck and keep us posted.

LupronJim