Originally Posted by mastodons
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.