It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 02-17-2008, 02:15 PM   #1
Newbie
(female)
 
Join Date: Feb 2008
Location: Chicago
Posts: 2
mastodons HB User
prostate cancer after prostatectomy

My father had a prostatectomy in 1991. His psa then was 41.
He said he had an aggressive cancer then with a score of 9 but
I never saw the documentation so I don't know what this score is.

His psa now is 14. A urologist checked his bladder with a scope
and said he had no cancer but he wanted to check him again in
6 months.

Shouldn't they be doing more tests with a psa that high?

 
Old 02-17-2008, 03:31 PM   #2
Senior Veteran
(male)
 
Join Date: Jul 2007
Location: North Carolina
Posts: 571
daff HB User
Re: prostate cancer after prostatectomy

Quote:
Originally Posted by mastodons View Post
My father had a prostatectomy in 1991. His psa then was 41.
He said he had an aggressive cancer then with a score of 9 but
I never saw the documentation so I don't know what this score is.

His psa now is 14. A urologist checked his bladder with a scope
and said he had no cancer but he wanted to check him again in
6 months.

Shouldn't they be doing more tests with a psa that high?
My layman's answer is a strong "yes". Maybe you'll get some other opinions here. Maybe an opinion from another doctor is in order too.

 
Sponsors Lightbulb
   
Old 02-17-2008, 05:52 PM   #3
Member
(male)
 
Join Date: Jul 2007
Location: Houston, TX, USA
Posts: 74
Kemahsabe HB User
Re: prostate cancer after prostatectomy

He went to a urologist and the guy only looked at his urinary tract. Reminds me of the guy with a hammer that walked around thinking everything looked like a nail.

With a PSA of 14 after an RP he needs to see another doctor - probably an oncologist. It doesn't sound good to me (a layman), but there are excellent treatments available if the cancer has returned.

Good luck!

 
Old 02-17-2008, 06:01 PM   #4
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: prostate cancer after prostatectomy

Quote:
Originally Posted by mastodons View Post
My father had a prostatectomy in 1991. His psa then was 41.
He said he had an aggressive cancer then with a score of 9 but
I never saw the documentation so I don't know what this score is.

His psa now is 14. A urologist checked his bladder with a scope
and said he had no cancer but he wanted to check him again in
6 months.

Shouldn't they be doing more tests with a psa that high?
The standard for determining that there is a recurrence after an RP is a PSA of .2; while that is not adopted everywhere, my understanding as a layman is that physicians would consider your dad to have recurring cancer.

That's not surprising as he had a case where the risk of the RP not curing the disease was high; the PSA alone would indicate that, according to the widely used Partin Tables that I and probably most of us have used to understand our chances for a cure. That score of "9" is probably a "Gleason Score," and, if so, that too indicates a high risk cancer according to those Partin tables.

I'm with Daff that a trip to a different doctor might be in order. I can't understand why the urologist would just check his bladder and then not worry about him for another six months. (Maybe the urologist has seen that he has a very slow and steady rise in PSA, or knows he has serious medical conditions that are much more threatening than prostate cancer?) A "medical oncologist" is the kind of doctor who frequently deals with recurring cancer. These doctors are usually good at managing hormonal blockade therapy, though it helps to find one who has handled a lot of prostate cancer patients. Radiation treatments might also still be timely if it can be estimated with confidence that the cancer has not spread beyond the range of radiation.

There are tests that can help determine that. One is the bone scan that many of us have had, including me. However, it takes a cancer that occupies at least ten percent of the area before it will show up as likely cancer on the bone scan. Another test is known as ProstaScint, or an improved version known as a fusion ProstaScint that combines a CT scan, and possibly also a PET scan, with the ProstaScint. I had the earlier version, and it is supposed to be quite reliable, detecting even fairly small tumors.

There is an emerging scan known as USPIO (Ultrasmall superparamagnetic iron oxide high resolution MRI), Combidex, or Sinerem, that is supposedly excellent at determining whether there is any cancer in lymph nodes throughout the body, but apparently no site in the US is expert with that scan. There is a site in the Netherlands that some doctors are recommending. (I'm a survivor with no enrolled medical education, but I've heard talks in which that doctor is recommended.)

As a layman I think your dad has at least one good piece of evidence going for him: he had his RP way back in 1991, and his PSA now is just 14. That makes me think his cancer that is recurring may not be that aggressive, but that is certainly a determination to be made by a medical professional. Therapies like hormonal blockade might be highly effective for him, even if radiation turns out not to be an option. (He might prefer blockade even if radiation is on the table.) Also, if the rise in PSA has been very steady and slow, he might be able to get away without doing anything major, depending on his age and other health challenges.

Take care and good luck to you and your dad,

Jim

 
Old 02-17-2008, 06:59 PM   #5
Newbie
(female)
 
Join Date: Feb 2008
Location: Chicago
Posts: 2
mastodons HB User
Re: prostate cancer after prostatectomy

I forgot to say how grateful I am for your speedy and informative posts. Thanks so much.

He is 87 years old but does not have any other major health issues.
I know they say older men usually die of something else before the prostate cancer kills them, but gee, this seems really strange.
I guess I should try to find out how fast his psa has gone up. Problem
is, he is really happy that he doesn't have cancer and so it might be
hard to get this information from him. I live across the country.This urologist has never seen him before. I do remember they did a bone
scan before the original surgery.

Last edited by mastodons; 02-17-2008 at 07:50 PM.

 
Old 02-18-2008, 02:59 AM   #6
Veteran
(male)
 
Join Date: Jun 2007
Location: Philadelphia, PA USA
Posts: 358
able5 HB User
Re: prostate cancer after prostatectomy

Quote:
Originally Posted by mastodons View Post
He is 87 years old but does not have any other major health issues. I know they say older men usually die of something else before the prostate cancer kills them, but gee, this seems really strange.
My experience...

My Dad died of prostate cancer in 1981. Back then, if you were diagnosed with this disease, it was probably because you had overt symptoms and the cancer had already spread elsewhere. In my Dad's case, it had spread to the bone. I was very close to my Dad and it was very hard for my Mom and I to watch the "heroic efforts" that many doctors in many specialties scared him into agreeing to have performed. My Dad was not old by any means. He was 68 years old when he died. Yet, after all of the hormone treatments and radiation treatments and tests of every sort, he looked like he was a feeble old man. Not the robust man that I knew as a kid. In spite of our feelings about all of this treatment (torture), we never discouraged him or persuaded him to stop the treatments. It was his choice the entire time. Finally, there came a day when he decided he had suffered his last treatment. He decided that, with the time he had left, he would spend it doing all of the things he wanted to do and none of the things he didn't want to do. Silently, my Mom and I were relieved at his decision. He spent the last 18 months of his life without seeing any cancer specialists and they were the happiest months since his diagnosis. I'm certainly not saying that giving up is the answer for everybody. All I am saying is that my Mom and I supported him in whatever he decided to do. We never questioned his choices, we just provided the kindness, understanding and comfort that he needed in the closing months of his journey. That's my experience with my Dad, my friend. When he died he had gained all of his weight back and his color came back and he had his pain fully under control up until the moment of death. He died in his bed, in his home, in his sleep.

I hope this story helps you understand that older people get weary and tired and sometimes just want to be left alone to find their level of comfort.

Take it for what it's worth.

__________________
robotic LRP; Jan2007

Last edited by able5; 02-18-2008 at 02:50 PM.

 
Old 02-18-2008, 02:49 PM   #7
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: prostate cancer after prostatectomy

Quote:
Originally Posted by mastodons View Post
I forgot to say how grateful I am for your speedy and informative posts. Thanks so much.

He is 87 years old but does not have any other major health issues.
I know they say older men usually die of something else before the prostate cancer kills them, but gee, this seems really strange.
I guess I should try to find out how fast his psa has gone up. Problem
is, he is really happy that he doesn't have cancer and so it might be
hard to get this information from him. I live across the country.This urologist has never seen him before. I do remember they did a bone
scan before the original surgery.
Your dad's age of 87 is a key part of the picture. (I'm nearly 65.) I'm guessing that the doctor is comfortable with a six month retest because it has taken about seventeen years for the PSA to rise to 14. What isn't known to you or the board is when his PSA started to rise and how rapidly it is moving now. Unless it is moving fairly quickly, it may never cause him a medical problem.

able5's story about the impact of treatment on his older dad sounded sadly familiar to me, as my father went through a similar experience, though he was diagnosed in his seventies, dying in his eighties, also in the early 1980s. I too am convinced the balance of side effects versus benefits is very important, as well as respecting the choices the patient makes, as able5 noted. That was hard for me in the late stages after conventional treatment, as my father was paying $100 for a quack analysis of his medications: he would hold them in his hand, and the quack would pass an electronic device of some sort over his hand and tell him if the dose was right. My feeling at the time was that a one time fee of $100 that covered repeated visits was not a major rip-off, and the quack was an attractive young woman, which probably boosted my dad's morale a bit, and I think the woman sincerely believed in what she was doing. At that time nothing else would probably have helped.

However, medical science for prostate cancer has improved greatly since the early 80s. If it were my father with your dad's circumstances, mainly because of his age I would not be pushing for radiation or cryo, although those are possible options and are far improved over what was available even a decade ago. If the PSA is rising slowly enough, doing nothing may be just fine.

There are some low key tactics that could work well. One is pursuing an anti-prostate cancer diet/nutrition/supplements program, plus exercise if possible and stress reduction (if needed - sounds like your dad may be pretty mellow). I'm doing this myself and have been for eight years; I think it's one of the reasons I've been successful despite a challenging case, though it would not have come close to doing the job by itself. Quite a bit is known about what seems to work , but almost nothing is backed by conclusive evidence. Several books are available that describe what to do if you are interested. However, my experience at support groups, at prostate cancer conventions, and with relatives and friends over the eight years is that many of the older guys just aren't willing to give up their red meat, pork, cheese and dairy products - some of the prime suspects. Other things are easy, like taking a few supplements such as vitamin D3 or getting daily lycopene from juice or cooked/processed tomato based products.

Low key hormonally-based therapy is another option. But first a word about major hormonal therapy. My own therapy is intermittent, but when I'm on the full blown triple hormonal blockade, there are substantial side effects, all of which for me can be countered, but it takes effort and attention, and some men are not able to do much to counter certain effects. (I'm grateful for the drugs because they are keeping me alive and in pretty good shape; for those of us who do not yet have late stage disease, the drugs are remarkably effective.) able5 referred to his dad suffering from some of the side effects. Any blockade involving an "LHRH-agonist" type drug, such as Lupron, Zoladex, Eligard or Viadur to name some, is likely to have a substantial side effect profile.

In contrast, the mildest kind of hormonal therapy involves the widely advertised drug Avodart or its earlier cousin, finasteride, now available generically (formerly known as Proscar, and in a lower dose for regrowing scalp hair as Propecia). My recollection is there are only two side effects that affect some men. One is that a small minority of men have somewhat decreased libido, which is probably not an issue for your dad; the rest of us are unaffected. The other is that many of us do regrow some hair in the male pattern baldness areas, a side effect I am happy to have. While these drugs on their own are not adequate for a heavy duty case of prostate cancer, the medical oncologists I have been following closely for eight years who specialize in prostate cancer, believe these drugs can be adequate for controlling a mild case. They might be enough to stabilize the PSA, to actually knock it down, or to slow the rate of increase to the point that it is of little concern and threat to health.

One notch up in aggressiveness would be what is known as an "anti-androgen" drug. While these drugs have some side effects, the effects are much milder than for an LHRH-agonist type drug. The drug of choice is Casodex, one I have been on, in combination with other drugs, for eight years, intermittently. It is expensive if not covered by insurance, costing in the neighborhood of $12 to $15 per pill. (My plan gives me a 90 day supply for $35.) An earlier drug is now available generically as "flutamide." It is not as convenient, requiring dosing every eight hours, I believe, instead of once daily for Casodex, and it has a more intrusive side effect profile, sometimes including diarrhea, among other effects. My recollection is that you can consume alcoholic beverages with Casodex but not with flutamide. (Two glasses of red wine daily are part of my anti-prostate cancer program, something I would stay away from if I had alcoholic tendencies.) Flutamide is much less expensive. Both drugs require liver monitoring at first to make sure the patient's liver metabolizes them properly. I never had a problem, but a very small percentage of patients do, including one of my support group buddies; there is a countermeasure that can be tried if a liver problem emerges. Perhaps the main side effect is breast growth, sometimes with soreness or tenderness. That is pretty common when the antiandrogen is used without coupling it with the LHRH-agonist. Brief radiation is an effective countermeasure, as are certain drugs.

One strategy is to add Avodart or finasteride to the antiandrogen. One of the doctors I follow, Dr. Mark Scholz, medical director of the Prostate Cancer Research Institute and the directing force behind last year's national convention, has stated he believes the antiandrogen plus finasteride or Avodart combination gives you 80% of the effectiveness of triple hormonal blockade at the cost of just 20% of the side effects. He opposes that for patients who need heavy-duty cancer control, and that two drug combination would be highly unlikely to work for me - I need something stronger. But it might be perfect for your dad.

An emerging therapy is estrogen delivered not orally, which caused cardio issues a couple of decades ago, but through the skin via patches, which seems to be not only safe but effective. This is something I'm watching carefully myself as a possible alternative to the triple blockade I've been on up through the present. I don't know a lot about it at this point, but my impression is the side effects are far milder than for LHRH-agonist drugs, and it may turn out to pack a big punch against the cancer. This "transdermal estrogen" approach could turn out to be superior to the antiandrogen approach, and it might be as good as or better than triple blockade. A downside is that the track record is short, but that might not matter much for someone using it for a mild recurrence, if that is what your dad has. Possibly one of our other participants on this board has more knowledge of this emerging approach.

Your dad probably, in my layman's opinion, has time to just keep an eye on his PSA or try a low-key approach and see what happens. (I still think a consultation with a medical oncologist would be a good base to touch, but that may be something you don't care to press. Helping our parents can be a tricky enterprise. ) Even if it turns out something more is needed, hormonal blockade is often still highly effective at that point. Hormonal blockade is thought to be considerably more effective when there are no detectable metastases, but blockade is impressive even when there are metastases, even in the bones. Unlike the early 80s, we now know what to watch when on blockade drugs and how to counter side effects like the threat of decreased bone density, which I've done successfully myself.

Take care,

Jim

Last edited by IADT3since2000; 02-18-2008 at 02:59 PM. Reason: Spelling (or instead of of)

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Prostate Cancer Stage and Treatment Route jawhik Cancer: Prostate 10 12-01-2010 10:16 AM
Prostate Cancer Radiation - HELP! Linda070770 Cancer: Prostate 11 08-17-2009 03:18 PM
Screening for prostate cancer - why it's wise IADT3since2000 Cancer: Prostate 21 06-03-2009 02:46 PM
Prostate Cancer Treatment Options daff Cancer: Prostate 18 04-14-2009 05:25 AM
Chondroitin very risky for prostate cancer IADT3since2000 Cancer: Prostate 4 03-08-2009 03:12 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 10:34 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!