The Treatment Plan

My Dad decided to cancel his appointment with the Doctors at Marina del Rey. He felt that he was getting the best care at UCLA. However, this week his treatment plan was unveiled. It includes anti-hormone pills and shots with possible chemo later on. My Dad was really wanting them to add radiation to the plan but was told that it wasn't necessary.
We kind of feel that they have written him off as too far gone to help. He is now looking into second and third opinions. I think I have see a few people on this board send their reports off to Doctors for over the phone consultations. One of the places my Dad is interested in is Dattoli Cancer Center in Florida. Does anybody have any experience with this faculty?
Interesting information is that his psa was 28 in April and now its 24 with no treatment.
Soft tissue scan showed that cancer has not spread to organs. It is only a 1 centimeter mark on his lilac bone. Gleason score 8. So, Stage 4 metastasized in bone!!!!
Anybody have any good ideas or suggestions?

If the PC has metastasized, then radiation to the prostate bed might have only limited effect. HT is a good thing to do. RT may or may not be useful until the scans are done.

Reconsider the Marian Del Rey docs. There are among the best in the business. To me it would be silly to travel to FL when you've got first class folks in your back yard.

Andrew

I don't share the positive opinion of the above posters about P.O.S.in Marina Del Rey for radiation oncology. I think they are very good at medical oncology, but radiation is not their forte. In fact, there is no one there who has specific expertise in radiation oncology. I agree that getting a second opinion from Dattoli may be a good idea. They can check his LNs with a feraheme MRI at Sand Lake imaging. Or, he can get a second opinion from Mack Roach at UCSF, one of the widely-acknowledged experts in the field.

I think the issue is whether the cancer is systemic or oligometastatic. Usually by the time it has reached the bone, it is systemic because it had to get there via the blood or lymph. The typical spread pattern is prostate -> prostate bed -> pelvic LNs -> bones -> etc. Bone scans are not good enough to find smaller mets that have settled elsewhere and can't tell one anything about micromets. A high PSA (over 20) and high volume of high grade disease are usual indicators that it may have spread systemically. So I can certainly see why the doctors at UCLA are reluctant to radiate the entire pelvis and the known bone met when it might do nothing more than ADT+Taxotere to delay further spread.

Oligometastatic disease is a theory that sometimes the cancer hits the pause button for a while before pressing the accelerator pedal (excuse the mixed metaphor). Early evidence is that it does not occur frequently. But I agree with you, that with reasonable expectations, it may be worth pursuing. But first you have to do a better check for mets than just a bone scan.

If you are in LA, you can get a NaF18 PET scan at UCLA that may be covered by insurance. They also offer a C-11 acetate PET that will not be covered by insurance. Stanford University is now doing some anti-PSMA PET/MRIs that may bring detection to a whole new level - I suggest you call them to see if he can get on a clinical trial there. Another test is CellSearch which checks for circulating tumor cells - if more than 5 cells are detected, radiation will not help him much.

- Allen

I was treated by Dattoli. They have been focused on treating only prostate cancer since the 1980's. If they still have the free phone consult take advantage of it, if nothing else to get more information on what's possible. I am very pleased with the facility and my treatment plan.