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Old 10-20-2011, 04:39 AM   #1
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bartonse HB Userbartonse HB User
Psa 300+

Hi,

My father in law was diagnosed with prostate cancer in July 2011 with a PSA of approx 320.

He went for bone scans and apparently lit up like a christmas tree! (his words). He told me that his 'bone levels' were over 3000. I have no idea what this is but he says it should be MUCH lower.

He's been having hormone injections but feels pretty rough most days. You can't hug him properly anymore because it's too painful for him.

Anyway, he's had another set of tests done and his 'bone level' has come down to 2500 but his PSA went up by 1 point.

I assumed that this was good news but doesn't sound like it when they say life expectancy is only 6 months to 2 years.

Does anyone have any suggestions to how I can help him improve his chances of a longer (& healthier) life. I can't bear to see his family being torn apart.

 
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slenderella (10-20-2011)
Old 10-20-2011, 10:58 AM   #2
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Re: Psa 300+

Hi bartonhouse, and welcome to the Board! I'm sorry that your father-in-law is having such a hard time with the cancer. There are treatments that have helped men in similar circumstances, but I'm concerned that some of them may not be available under the UK health system. I'll insert in green some facts and thoughts in excerpts from your post.

Quote:
Originally Posted by bartonhouse View Post
Hi,

My father in law was diagnosed with prostate cancer in July 2011 with a PSA of approx 320.
As you probably know by now, that is a very high PSA, a level that is often associated with detectable metastases.

Quote:
He went for bone scans and apparently lit up like a christmas tree! (his words). He told me that his 'bone levels' were over 3000. I have no idea what this is but he says it should be MUCH lower.
I don't know what that bone level is either. Could you find out? As for the bone scan, it appears your dad has widespread bone metastases.

Quote:
He's been having hormone injections but feels pretty rough most days. You can't hug him properly anymore because it's too painful for him.

Anyway, he's had another set of tests done and his 'bone level' has come down to 2500 but his PSA went up by 1 point.
The fact that his PSA went up rather than declining sharply indicates that the injection is not sufficient on its own. That is consistent with his discomfort even with a hug. His testosterone and DHT levels (at least) should be tested (simple blood test, usually in the same blood draw as the PSA and other blood monitoring tests). It could be that his DHT is still high, and DHT is much more potent in fueling prostate cancer than testosterone, which is the direct target of the injection. A second drug, an "antiandrogen" in pill form, is often used to help block androgens from docking with the cancer cells fueling ports, which are known as androgen receptors. A third drug is often used by leading medical oncologists in the US with practices dedicated to prostate cancer, either Avodart or finasteride. The third drug is not strong on its own, but it does greatly reduce the conversion of any remaining testosterone to DHT, and that effectively prevents DHT from crowding out the antiandrogen from the fueling port, thereby greatly increasing the effectiveness of the therapy. The Prostate Cancer Research Institute, a non-profit organization, has published information about this. Other sources include books entitled "Beating Prostate Cancer: Hormonal Therapy & Diet," (Dr. Charles Myers), "Invasion of the Prostate Snatchers", (Dr. Mark Scholz, and Ralph Blum), and "A Primer on Prostate Cancer," (Dr. Stephen Strum and Donna Pogliano).

However, it is possible that your father-in-law's cancer is no longer dependent on an ample supply of androgen but rather can get along on a minimal supply, including androgen manufactured by the cancer cell itself.

In the US, docetaxel chemotherapy might be used in conjunction with hormonal therapy. Other approaches, such as second line hormonal therapy, perhaps involving ketoconazole (carefully managed) or transdermal estrogen patches, might also be used. So might Leukine, an immune system drug.

As a layman with no enrolled medical education, based on what I've learned, I also think it very likely that a powerful bisphosphonate drug would be prescribed, probably Zometa. Zometa helps protect bone density, and it also has some effectiveness against metastases.


Quote:
I assumed that this was good news but doesn't sound like it when they say life expectancy is only 6 months to 2 years.
That sounds like a typical forecast for a doctor using single-drug hormonal blockade for a patient with cancer as far advanced as it is with your father. My view is that he needs to be under the care of a medical oncologist who understands the role of two drug, and, better yet, triple androgen deprivation therapy, as well as other options. (Is your f-i-l's doctor a surgeon? That's not the kind of doctor who should be managing his care at this point.) I'm hoping that is possible. From what you have posted, I get the impression that you father-in-law's doctor does not understand advanced androgen deprivation therapy and is simply accepting the prospect that your father-in-law will decline in the near future. (By the way, I was told by two respected surgeons that I likely had three good years and two declining years ahead of me in early 2000.)

Quote:
Does anyone have any suggestions to how I can help him improve his chances of a longer (& healthier) life. I can't bear to see his family being torn apart.
With effective treatment, he has the chance of feeling and doing much better. Moreover, there are some really exciting treatments for far advanced patients that are well-along in the research pipeline. While they are not available yet, if we can gain time by wise treatment now, we have a good chance of being able to take advantage of them in the not distant future.

Lifestyle tactics can also be important. These cover nutrition/diet/supplements, exercise, and stress reduction (and I'll include prayer under the latter). The Myers book is outstanding on these tactics. They can involve major changes in the what we eat, such as eliminating red meat and pork from the diet. I am convinced they have helped me do well.

Best of luck to you, your family, and especially your father-in-law.

Take care,

Jim

 
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Old 02-13-2012, 06:22 AM   #3
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bartonse HB Userbartonse HB User
Smile Re: Psa 300+

Just a quick update . ..

Father-In-Law was given 6 months to live back in Oct 2011 and we have seen him start to deteriorate over the last few months.

He's still having estrogen injestions every 3 months which help but he's been told there's nothing else he can try as it's too late. So he's living on a combination of strong painkillers, haribo sweets and Gin!

He's such a positive person that none of it seems to phase him. He started taking oral morphine a couple of weeks ago but it was messing with his head so he's stopped it for the time being. He'd rather be alert and in a bit of pain than pain free but vegetable-like.

My fiance and I decided to get married sooner rather than later so that his dad could be there. So our big day is this Friday, 17th Feb! We're both hoping that his dad is well enough to last through the ceremony before he needs to have a rest. Fingers crossed he'll be having a good day!

People keep asking how the family is managing to cope so well in such horrible times. . .the answer is simple . . because we have to!

 
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IADT3since2000 (02-25-2012)
Old 02-13-2012, 11:32 PM   #4
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Re: Psa 300+

How wonderful of you to give your father-in-law such a lovely gift. I'm sure he rests easier knowing that his son is being taken care of by such a kind, compassionate woman.

Bayer has recently made their new, soon to be approved drug, Alpharadin available for compassionate use to those who meet certain criteria. It is not a cure, but it may help with the pain of bone mets.

Wishing you a joyful wedding,
Allen

Last edited by Tall Allen; 02-14-2012 at 12:12 AM.

 
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