Father recently diagnosed with recurrent prostate cancer

Hello, my father was recently diagnosed with recurrent prostate cancer by the VA. he was treated with radiation therapy 8 years ago.

so far, his PSAs are
7/17 1.18
2/18 2.55
4/18 2.89

his bone scan and PET scan have been negative, no spreading outside of the prostate. under VA's direction, we are watching waiting before starting hormone therapy.

i want to consider all options, i know radical prostate surgery is an option, but has a lot of side effects. however my father is 72, so this surgical option maybe only an option now given his age.

i am also working on his diet with him, to reduce red meat, dairy, sugars, and add more vegetables, fruits

i wanted to ask what other approaches we should be considering, i am just getting up to speed with all this.

thank you

Thanks Fairwind

Originally diagnosed in 2010. Radiation therapy applied in 2011. PSA less than 1.0 from 2011 to 2016

his Urologist (who is outside of the VA) wants to start hormone therapy now, however VA wants to wait until next PSA test in July. VA I believe wants him to start Lupron when the time is right.

I dont know his gleason score...he has not had a biopsy yet. is this what i should push for next?

thanks in advance

Post Edited (sierraDon) : 5/16/2018 10:08:25 AM (GMT-6)

Since there are no metastases discovered, he still has curative options before he jumps to lifelong Lupron. Which PET scan did he have - Axumin? If so, did it show cancer in the prostate/pelvic LNs and not in any distant locations? If that's the case, then he can pursue curative salvage options.

Recent studies have demonstrated that about half the recurrences after radiation were still curable - and that was before the Axumin PET scan became available.

/pcnrv.blogspot.com/2016/09/most-of-recurrences-after-primary.html

Assuming the Axumin scan told you exactly where the recurrence is, he can have focal treatment just to the site of recurrence. This is a relatively non-toxic procedure, compared to salvage surgery. But you will have to talk to experts in doing those specialized procedures. they are described here:

/pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html

Hopefully, some spot brachytherapy will get the remainder. He cannot talk to a urologist or medical oncologist about this - they just won't know. He has to talk to a radiation oncologist or ablation specialist who has specific experience in doing this kind of procedure. Your location says "Ice Coast" - I don't know where that is - if you mention a nearby larger city, I might be able to recommend someone.

Don, TA's advice is spot on, we are lucky to have him here..

I might add, or reinforce what TA said, If you can find the Radiation Oncologist that performed the original radiation treatment and visit with him, see what his insights are..

There are some very advanced scans available today that might not be available at the VA which might be able to spot the exact location of the tumor that's producing the PSA If the tumor can be located, treating it becomes much easier and more effective..

Thanks a lot for your valuable insight. it sounds like i have more digging to do.

we met originally with the Radiation Oncology who treated him originally, it didn't seem like they wanted to re-treat with radiation again, that is why they referred to Medical Oncology. at that time it wasn't clear to me what radiation treatment options he had.

i will find out what his pet scan results are, so we can identify if it is truly curative or local to the prostate...whenever we spoke to Oncology, they just told usthey were negative for metastatic growth.

I believe my dad can get referred outside the VA network if there is a service or treatment that they don't provide. so, if some of these more specialized options are a good fit, he could probably request the referral

Post Edited (sierraDon) : 5/16/2018 12:00:42 PM (GMT-6)

Thanks, yes my dad has both Medicare and VA coverage.

i learned yesterday at his urologist appointment, that they wont retreat with radiation for him. its not clear to me if its due to them not doing those procedures or if he is not a good candidate. so, i will have to followup with the Radiation Oncology department at the VA again to confirm.

Per Tall Allen's advice, i am going to contact the people at Fox Chase and Sloan Kettering for second opinions. We have a consult appointment with the VA about focal cryoablation to identify that.

i want to rule out all potentially curative options first before hormone therapy. the PET Scan, Bone Scan, and CT Scan all show no metastis growth outside of the prostate (lymph nodes or bone). his PSA 'doubles' around every 11 months. However due to my dad having a pace maker he cannot get further imaging like MRI.

thanks again for your help

fairwind, thats the problem, none of the imaging so far show a defined tumor. not sure if there is another imaging diagnostic outside of the MRI, of which he cannot get due to the pacemaker.

Sierra,

The reason that Tall Allen keeps asking what kind of PET scan your father had is that not all PET scans are the same. The main difference is the sort of radioactive chemical they inject before the scan. Axumin is a newer tracer agent that does a better job of attaching to prostate cancer cells, making them easier to see on the scans, and allowing for detection of smaller (earlier) metastases. It's probably the best current agent for recurrent prostate cancer. The most common agent (that is taken up as glucose) doesn't work nearly as well. There are other tracer agents that are in the middle (C11-acetate is one).

Another thread that reminds me what an amazingly helpful group of people we have on this forum.

-Gedman