My father, who will be 69 in December, was diagnosed with prostate cancer last October. His PSA was 5.5, and the gleason number was 6. He decided to have his prosate removed, which was done last November. Upon biopsy, the gleason scale was revised to a 7. He has gone in for PSA tests faithfully every 3 months, all which were 0, until last week's test. He learned yesterday that his PSA jumped to 2.4.

The doctor says the next step is radiation, which he wants to start on Monday. It will be 5 days per week for 5 weeks. Does this sound like the logical next step? I know nothing about prostate cancer, but it seems to me that maybe there should be a test to see exactly where the cancer is prior to treating with radiation.

I would appreciate ANY feedback. My dad has an appointment this Friday to talk more with the doctor, and my mom will go along. I told her I would give her a list of questions to ask the doctor. My dad was so shocked at yesterday's appointment that he really didn't ask anything.

THANK YOU,

Amy

If it is to be radiation, then please check out proton beam therapy- it's unlikely that a doctor will refer you to one of the five centers in the U.S. since they usually prefer to recommend a treatment that they can do. Most of the people receiving this are self-referred, those having done a lot of research. I'm in the middle of my treatments now at University of Florida Proton Therapy Institute. When I arrived, I met someone who had surgery earlier this year and it failed- he couldn't have been happier with his choice of treatment and wished he had skipped the surgery in the first place. I'm a layman and obviously am not capable of giving medical advice, but the proton treatments are less invasive than any other form of radiation and do as good a job. The radiation is targeted and does less damage to healthy tissue. Where I am they sometimes treat people with both photon and proton radiation if the situation warrants, as they have the latest IMRT photon radiation equipment too. To learn about protons, the most thorough explanation is in a book written by Robert Marckini- How to Beat Prostate Cancer. You can google him to get more details or look on Amazon. And look at the websites for where I am and Loma Linda University in California where they've treated 7,000 prostate patients since 1990. The facility in Jacksonville is a little more than a year old, with state of the art equipment. (It cost $125 million.)
Another path to pursue could be hormone treatments, either before or after the radiation. At the UFPTI in Jacksonville, they've been treating high-risk patients with a weekly, low dose chemotherapy drug in many cases. That can make people tired, as it has a cumulative effect, but it was well-tolerated in the 50 patients that took part in the trial. That is considered experimental treatment and may or may not be warranted in the case of your father.
If you choose traditional radiation, make sure you inquire which generation equipment is being used at the center you are going to. I think they are up to generation 3 1/2, with another advance to 4 coming around the end of the year. It's not inexpensive equipment, so some centers just keep using what they have.
Hope this helps.

daff,

Perhaps you can answer a question that amm8589 asked which has been bothering me as well. She asked, "...it seems to me that maybe there should be a test to see exactly where the cancer is prior to treating with radiation."

Almost all radiation treatments are targeted at a specific site, are they not? In the case she described, where is the radiation aimed?

daff,

Perhaps you can answer a question that amm8589 asked which has been bothering me as well. She asked, "...it seems to me that maybe there should be a test to see exactly where the cancer is prior to treating with radiation."

Almost all radiation treatments are targeted at a specific site, are they not? In the case she described, where is the radiation aimed?

I'm not aware of any certain way that one can determine where the cancer is- so that if it has spread far from the prostate, radiation probably doesn't help- and proceeding with that type of treatment would do no good and probably some harm, as healthy tissue would be unnecessarily radiated.

There can be tests, like chest x-ray and bone scans, to try to find where there may be issues. Lymph nodes can be biopsied.

If the surgery didn't remove enough tissue, and the cancer remains just outside the prostate shell, it's possible that radiation could help, as it would be targeting the prostate bed. I don't really know how they decide how great an area to radiate; I assume that MRIs and CT scans would be done but these would be questions for a doctor.

I'm not sure I answered your question- but it's a good one.

Typically bone scans and CT scans are done next to determine where the cancer has progressed to. Unfortunately, we've had experience with this with my father in law.

As the PSA rises, the bone is the typical next step of progression.

You didn't mention the type of surgery your dad had. Were lymph nodes removed? clear? Clear margins? Seminal vesicles removed? Clear? All those things, if not removed are highly suspect first.

Radiation has a lot of forms. It helps in many ways. My father in law still gets radiation in final stages to help the bone pain..... It works well.

Hormone therapy typically slows the progression. PC thrives on testorone, so, female hormones are used. It does make them quite uncomfortable.

Hope that helps some.

Does this sound like the logical next step? "
No: logical next step is another PSA test, and a 2nd opinion.

Questions to ask:

Doesn't a PSA rise soon after surgery suggest distant metastases?

What is the purpose of radiation tratement unless there is local recurrence?

Unfortunately it's difficult to find the location of recurence as it's unusual for bone scans to find anything until PSA rises above 20. An MRI or eMRI might assist.

Systematic treatment might be necessary: it's worth reading Mr Myer's book "Beating Prostate Cancer: Hormonal Therapy & Diet".

The urologist seems to think the sooner we act, the better. He said that after radiation, my father should go with hormone therapy. My main concern is that the cancer came back to quickly, only 11 months after surgery. While the PSA level is not high, it is certainl higher than the zero it was three months ago. On the one hand, I feel like it is not too bad and that we should be aggressive before the cancer spreads more. On the other hand, I don't even know where the cancer is. I'm developing a list of questions for Friday's appointment. Thank you for your input, and please feel free to add anything more to this thread. I have until Friday at 9:00 a.m.

Amy

My father, who will be 69 in December, was diagnosed with prostate cancer last October. His PSA was 5.5, and the gleason number was 6. He decided to have his prosate removed, which was done last November. Upon biopsy, the gleason scale was revised to a 7. He has gone in for PSA tests faithfully every 3 months, all which were 0, until last week's test. He learned yesterday that his PSA jumped to 2.4.

The doctor says the next step is radiation, which he wants to start on Monday. It will be 5 days per week for 5 weeks. Does this sound like the logical next step? I know nothing about prostate cancer, but it seems to me that maybe there should be a test to see exactly where the cancer is prior to treating with radiation.

I would appreciate ANY feedback. My dad has an appointment this Friday to talk more with the doctor, and my mom will go along. I told her I would give her a list of questions to ask the doctor. My dad was so shocked at yesterday's appointment that he really didn't ask anything.

THANK YOU,

Amy

I asked my urologist his opinion about any rise in my PSA since my da Vinci surgery in Jan2007 and he said he would not do anything until my PSA exceeded 0.2

He said at 0.2 he would "immediately" refer me to a specialist to being radiation treatments.

That's it! Short and sweet!;)

Your hunch about there being some tests to see if the cancer has spread is sound. ;) (That's in my educated survivor's opinion, graduate of the School of Hard Knocks plus some excellent mentors, with no enrolled medical education.)

One of the best is a Fusion ProstaScint scan that combines the ProstaScint images with the images from a CT scanner. The CT isn't much good for detecting PC -- it take a pretty big tumor for CT detection, but it is great for displaying the anatomy around the body. While the ProstaScint scan is not much good displaying anatomy, it is quite good at detecting prostate cancer. When the two are combined, the resulting images reveal a lot about the spread of the cancer, and particularly reveal whether it is in the range of potential radiation therapy. :)

ProstaScint works by combining an antibody manufactured to seek out prostate cancer cells with a radioative marker. You get an infusion of one and a shot of the other, as I recall, then have baseline images done. You wait a while for the antibody and its pal to find the cancer, then images are again done while the pal broadcasts its radiation, revealing its (and the cancer's) location to twin cameras (better than one) that circle the body. Many images are taken in several sessions, one per day, of an hour or two that stretch over several days. The images are then combined by computer and analyzed. Well over a hundred images were taken for my own ProstaScint in early 2000, which was done without fusion. That earlier technology could get the job done, but interpretation was much more difficult than with the fusion technology. My own result opened up the possibility of radiation as no metastases were detected, to the great surprise of my doctors. :D I eventually chose not to go that route.

The early knocks on ProstaScint were that it was difficult to interpret (true - took some real expertise) and that there were too many false positives. My impression is that many doctors who haven't invested the time to understand ProstaScint still tell patients there are too many false positives. :( But for years it was the best scan for metastases throughout the body (not so hot with bone though - need a bone or special PET scan). Then it turned out there were fewer false positives than originally thought. :)

That happened because the original researchers recorded a false positive every time the ProstaScint scan indicated cancer but a surgical check of the area could not find any. Well, guess what happened as more years ticked by: cancer did appear in many of those so called "false positive spots." The cancer had just been too small for the surgeons to find.

Fusion ProstaScint (or ordinary ProstaScint) also works throughout the body, not just in the pelvic area. An expert said it detects about 80% of cancers in lymph nodes, and it also detects prostate cancer that has spread to organs like the lungs and liver.

It is expensive, and it is not justified for apparently low-risk patients deciding on therapy. But it is appropriate for patients with challenging cases like mine or for patients with recurrences after local therapy. My insurance covered every cent. :) Mine cost $3,400 in 2000. An expert said in 2004 that the fusion version runs about $5,000.

Another emerging tool is known as Combidex, Sinerem, or USPIO (for ultra small superparamagnetic iron oxide) lymph node scanning. It appears to be superb for finding cancer in lymph nodes throughout the body. I think it is much cheaper than Fusion ProstaScint, but I don't believe it can detect cancer that is not in a node. It can be used to help decide whether a local therapy is worthwhile. Unfortunately, the main US site in the Boston area has had some problems with the technology, and those problems combined with inadequate evidence led an FDA advisory panel to recommend against FDA approval at the time. :( However, a doctor in the Netherlands has established quite a reputation for excellent results. :) My estimate is that the FDA will approve Combidex in time.

Dr. Myers book, referred to in an earlier post, discusses these and other case assessment techniques and alternate therapy choices.

One clear alternate choice is to go straight to hormonal blockade and not do radiation therapy at this time. That said, the approach outlined by the doctor is also commonly used. Personally, I would want to make sure the cancer was confined enough to make use of radiation worth the possible side effects, which will likely be greater since the body will now have to cope with a combination of radiation and surgery. In particular, if you dad has had greater than usual urinary issues, he should think hard about radiation as it is likely to make those issues worse. A "medical oncologist" not associated with your dad's doctor would be well worth a consultation, in my opinion. (Even a medical oncologist associated with the doctor might help, but you need to be aware that he may be reluctant to differ with his colleague.)

Good luck,

Jim