My grandpa was just diagnosed with prostate cancer and found out from a CAT scan that it has moved to his back and head. Is this a death sentence for him? He had a PSA score of 600 and now up to 700. What treatments are recommened if any?

My grandpa was just diagnosed with prostate cancer and found out from a CAT scan that it has moved to his back and head. Is this a death sentence for him? He had a PSA score of 600 and now up to 700. What treatments are recommened if any?

How long does he have? Whew! I wish we all had a crystal ball and could answer that question. Wouldn't that be great?

Alas, I regret that I can't offer any advice to you. This kind of thing is way over my head and, if they are honest, way over the heads of most folks who post here. The best advice I, or anybody else on this forum, can offer you is advice from our own unique personal experiences. Unless the advice you get on this forum comes from someone with the “exact” same experience as yours, they are guessing or they are merely offering "cut & paste" advice copied from the medical websites, doctors websites and from web based medical journals, etc. Quite frankly, I don't often see posts on this forum from prostate cancer patients with very serious metastasis to bone. Who knows, maybe those who have had a similar experience as yours will jump in and offer to share about their journey.

I found some pretty good stuff on the Internet. Perhaps, if you do a web search for "Osteoblasts in Prostate Cancer Metastasis to Bone", you may find some reading that may help. I found a website called medscape.com that offered some pretty interesting reading about metastasis issues.

Just remember, there are very few urologists posting on this forum. Most of us are merely prostate cancer patients or relatives/friends of prostate cancer patients. If we are honest with ourselves, we will admit that we do you a great injustice by giving you medical advice about something we have only read about or giving you medical advice based upon hearsay. Let’s face it, we are all anonymous here and none of our advice can be adequately substantiated.

If you want to discuss the specific experiences of my personal battle with prostate cancer, then I can probably help you. However, if you want professional medical advice that you can count on as reliable, then you need to go ask your doctor.

Nevertheless, best wishes as you support your grandpa and as you both continue on your journey...

:angel:

I would suggest talking with grandpa about it and/or his doctor (if grandpa will allow it (HIPPA concerns and all))

His doc should have already spoken to grandpa about his prognosis.

As well, I am sure grandpa can use some support.

Treatments? That too would be something to talk with grandpa about. In many older men (you don;t give an age) hormone treatments are used to simply slow the growth of the cancer. Depending on his age, there are other treatments that may be used as well.

as able5 posted, most contributors are simple laymen and many are cancer patients themselves with no med trainig (including me) so take what you get here with a jaded eye.

We are going thru a similar type situation with my father in law. It is tough. And doctors only share with patients, what patients ask, if they ask.

I will tell you, that it is a common progression to the bone and to the brain. That is PC cancer advancing. I will tell you that PSA counts can go into the thousands... This is not unusual.

You don't mention how old grandpa is or his general health but I'm sure his doctors will guide him on this and it is time for you to talk with your parents or him about all the details.

No one knows how long someone has, not even the doctors.... only god. We can all be gone tomorrow. So keep that in mind. And as far as treatment, that is an individual type decision between the doctors and grandpa and his health overall. People here can't make suggestions or give you opinions.

My thoughts and prayers are with you. Enjoy your time with grandpa! You should always consider each day a blessing.

Debbie :angel:

There is great hope even for well advanced and metastatic prostate cancer patients today, though it is far from a cake walk and such patients may not survive the disease. But not surviving does not rule out enjoying good years. Some such patients will not only survive but do well for their remaining years. :)

I would like to offer a different opinion on getting a prognosis from your dad's doctor. While we would all like to trust our doctors, many of them do not really have a clue when it comes to advanced and well advanced prostate cancer. Your grandpa's situation is not a death sentence as no one knows enough to impose such a sentence at this time, in my survivor's opinion - no enrolled medical education. I like Debbie's line that only God knows, though there are some clues from medical studies.

For example, using my own more favorable but still challenging case, I saw two respected doctors at highly respected institutions (City of Hope, Johns Hopkins) who, at my insistance, gave me a five year prognosis (three good years, two declining years) around New Year's day of 2000. That was based on what they knew at the time: first ever PSA of 113.6 and lousy biopsy to match (GS 4+3=7, all cores positive, most 100%, stage 3) but negative scans. I'm now doing fine and feeling great in my second off-therapy period under intermittent triple hormonal blockade with finasteride maintenance. I think the two reasons they were off were that I did not have detectable metastases based on a later test, and they did not understand the potential of hormonal blockade therapy. I've attended a number of conventions for prostate cancer patients, and many, many men tell the same story of overly pessimistic prognoses. :( We need to keep Mickey Mantle, the Yankee slugger in mind: "I I'd known I would live so long, I would have taken better care of myself.":)

There have been several significant advances just in the eight years since I was diagnosed that could be relevant to your grandfather's situation. One is in understanding the great impact of triple hormonal blockade therapy, and another in the use of bisphosphonate drugs to protect bone density and even control and help reverse bone metastases, particularly under the powerful drug Zometa. :) Zometa was not even available in 2000. Unfortunately, a great many doctors do not yet appreciate the value of or need for such drugs :(, though that is changing as the medical associations emphasize these topics in their key Education Books. Also unfortunately, the evidence supporting triple blockade is not of the high quality (gold standard type clinical trials) that would persuade more doctors to jump on board. :( Yet some evidence has been published in a prestigious peer-reviewed medical journal. :)

More advances may be coming within the next year or two, though the path will likely be strewn with disappointments along with the successes. In the last month the promising drug Satraplatin turned out to be a dud, and the combo of calcitriol and docetaxel also resulted in disappointment. :( But Leukine continues to look strong, thalidomide and its cousin Revlimid are looking good in combinations, and the immune activating drugs GVAX and Provenge should be up for FDA approval within a year or so. Provenge is looking especially good in combination with docetaxel. :)

The doctors I follow would probably want your dad on hormonal blockade, preferably triple blockade, and he would probably experience a huge drop in his PSA, reflecting cancer that is declining. The question is whether that would be enough. While it probably will help him greatly, additional treatment is typically needed. It may be enough to knock his metastases back into undetectability. The doctors would also probably want bone density assessed as well as vitamin D3, both of which are highly relevant to successful treatment for prostate cancer, especially under hormonal blockade, as well as bone density health.

You are doing a real service for your grandpa. :angel: Keep it up!

Good luck and take care,

Jim

I would like to offer a different opinion on getting a prognosis from your dad's doctor.Your post is extremely informative and optimistic Jim but the doctor is still the place to look to for prognosis. It can never be exact and some are better than others but given a choice of "no idea" and " some at least somewhat educated ideas", you take what is there. We also have no idea as to who the doctor is and what training and experience he has. For all we know, he may be seen by the same doctor you are.

doctors will offer prognosis based upon comparison to similar cases. Again, nothing is etched in stone but it is still better than blindly believing "I will live forever". Many a person has been caught realizing they have very little time to do anything because they refused to realize their situation and did not do what they would do if they thought their time was actually so short.

I hope OP's g-pa has access to the treatment you have recieved and has similar results but the truth is, any treatment is a crap shoot. There are no guarantees and no sure cures for anybody.

I would never suggest "giving up" or "giving in" to this beast but one also has to be realistic in deciding what they will do and doing what the want and need in the time a (hopefully) well informed doctor suggests is what to expect.

from an uncredited author(unknown author)

"Dream as if you'll live forever, live as if you'll die tomorrow."

... the doctor is still the place to look to for prognosis. It can never be exact and some are better than others but given a choice of "no idea" and " some at least somewhat educated ideas", you take what is there. ...

doctors will offer prognosis based upon comparison to similar cases. Again, nothing is etched in stone but it is still better than blindly believing "I will live forever". Many a person has been caught realizing they have very little time to do anything because they refused to realize their situation and did not do what they would do if they thought their time was actually so short."

I do come down on the optimistic side, but I hope I'm not coming across as blindly believing or saying that prostate cancer patients will live forever. Your point is well taken that patients need to realize their situations and make appropriate decisions.

On the other hand, after eight years of dealing with many doctors of my own, at conferences, and seeing what physicians and PhD researchers write in published papers and announce in news reports, I have developed a vigorous skepticism about the ability of most physicians to appreciate developments outside their own specialties, or to give progneses to patients. I believe that is especially true for those doctors who do not specialize in prostate cancer with an almost exclusive focus. The non-specialists, such as for example the urologists who do an RP a week or so, have a tough row to hoe. Most of them treat all comers, including children and adults, men and women, and non-cancerous as well as cancerous situations in all these classes of patients, covering various stages of cancer in different organs. It's mind boggling. In their scarce discretionary time, they are probably far more likely to be boning up on robotic surgery techniques than studying developments in radiation or medical oncology, for instance.

Many of us have noticed that urological and radiation specialists are quite parochial, seeing their own specialties as much superior to other approaches; research papers have been published documenting this. For instance, even brilliant and dedicated recognized world leaders in urology (is it okay to name them?) have not recognized the great strides made in hormonal blockade therapy and the usefulness of that therapy for many patients. (But they are highly expert in their own field. Wouldn't want to go to an oncologist, no matter how expert, for a radical prostatectomy. ;)) So often I have heard respected doctors assert that first line hormonal blockade normally works for a short time, meaning two to three years, when experts in blockade find it typically works for ten to eleven years if not indefinitely (more likely in low risk cases). The pessimistic estimates are apparently based on research now nearly a decade and a half old for patients with widespread, painful metastases perhaps with performance issues, which was then fairly typical when patients were diagnosed.

I have seen that even a leading clinical trial researcher could not accept what fairly strong evidence indicates is an apparent fact about survival after hormonal therapy is no longer effective in controlling prostate cancer (hormone refractory PC). Several of us survivors were at one of the many breakout sessions in the recent IMPaCT conference in Atlanta sponsored by the Congressionally Directed Medical Research Program. (IMPaCT: Innovative Minds in Prostate Cancer Today) A respected panel member had just reported about their formula indicating that length of survival after cancer is hormone refractory is more or less 20 months, depending on case facts, a formula used among other purposes to help compare survival results in FDA advisory committee hearings for drug approval. Yet a paper published in 2004 by a respected prostate cancer research insitution, with the late past president of the American Urological Association as the senior author, indicates that survival is more like a median of 40 months if the patient has detectable bone metastasis at the time of going refractory, or like 68 months if the patient is free of bone mets at that time. Incidentally, that fifteen year old data cited above is even slightly more favorable than these favorable figures!

A key difference between the formula vs. the much more favorable study results: the formula measured length of refractory survival from the point the refractory patient entered one of about eleven clinical trials used to develop the formula; the more favorable study measured such survival from the point the patient actually became refractory. While the respected panel member was quite interested in following up on details of the study, her respected senior colleague considered the study results too favorable to be possible and asserted that the study must be flawed!

I do believe some of the fairly pessimistic prognoses given are fairly accurate if based on just local therapy followed if necessary by chemotherapy, without effective use of hormonal blockade. Since a lot of doctors either do not believe in hormonal blockade or do not understand how to use hormonal blockade effectively, they are probably seeing unnecessarily short survivals from their patients. (However, even such patients should now be doing better as chemotherapy is improving significantly.) All this said, there are a few types of rare prostate cancer where the prognosis is still often quite short, such as small cell PC.

If expert specialists outside of hormonal blockade experts are in the dark about how long hormonal blockade is effective and about such key situations as survival after first line blockade is no longer effective - both phases being key in men who develop late stage disease, how can they give us accurate prognoses?

I hope this has not been too long. As a newbie I'm still learning the ins and outs of this board. Also, I could give citations of the mentioned studies so that abstracts could be found on the Government site www.pubmed.gov, but I'm not sure that is proper here.

My two cents,

Jim

I wasn't trying to rain on your parade Jim, I actually enjoy reading your dissertations (just kidding). You actually seem to be more knowledgable than many of the doctors that deal with this unless they are very specialized doctors. That is a shame, for them.

I did not see your statements as being unrealistically optimistic, it is that a patient does need to see a realistic point of view and prepare accordingly, which you have acknowledged.

The worst part of all you have learned and have tried to pass along is; most of us do not have the ability or time or whatever reason to search out this as you have and apply it to ourselves.

Why should an individual have to do so much work? That is why we pay our doctors so much. At least that is the mindset that most of us have.

The medical proffesion has failed us.

...
The worst part of all you have learned and have tried to pass along is; most of us do not have the ability or time or whatever reason to search out this as you have and apply it to ourselves.

Why should an individual have to do so much work? That is why we pay our doctors so much. At least that is the mindset that most of us have.

The medical proffesion has failed us.

Amen!

Jim