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Old 07-08-2012, 01:24 AM   #1
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prognosis for my father aged 85

My father has just been diagnosed with prostate cancer, Gleason score 9. He has just had a TURP operation and is supposed to go onto hormone therapy. The hospital said that an MRI scan is not necessary as his PSA level is "normal". He had 12 biopsies taken. Can`t seem to get much information from medical staff at all.

He has been losing weight since last December, and feels cold all the time. He also has high blood pressure and a hiatus hernia.

The hospital staff said that the hormone therapy should let him live out the rest of his "natural life" (whatever that means). There is still no sign of hormone therapy starting, despite being diagnosed a month ago.

I should be grateful for any help anyone can give. Thanks

 
Old 07-09-2012, 05:25 AM   #2
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Re: prognosis for my father aged 85

Quote:
Originally Posted by Inti447 View Post
My father has just been diagnosed with prostate cancer, Gleason score 9. He has just had a TURP operation and is supposed to go onto hormone therapy. The hospital said that an MRI scan is not necessary as his PSA level is "normal". He had 12 biopsies taken. Can`t seem to get much information from medical staff at all.

He has been losing weight since last December, and feels cold all the time. He also has high blood pressure and a hiatus hernia.

The hospital staff said that the hormone therapy should let him live out the rest of his "natural life" (whatever that means). There is still no sign of hormone therapy starting, despite being diagnosed a month ago.

I should be grateful for any help anyone can give. Thanks
Inti
Welcome to the board.

I wonder about other diagnosis of your father status. Any symptoms? What was the reason that made him to have a biopsy? Is there any chronology of PSA tests? What are the levels?
What is the clinical stage attributed to your father?

A “normal” level of PSA differs with the age of a patient and with the type of prostate cancer. Some tumours produce low levels of PSA serum so that small amounts are critical in judging the condition of such patient. In any case, Gleason score 9 is for high risk and aggressive cancerous cells, but the spread of the cancer becomes important when accessing the advance of the disease. Your dad could be Gs9 but contained.

In these cases, radical treatment may provide cure but such is usually recommended in younger patients. The doctor may have considered the hormonal treatment approach due to the age or other health condition of your father, or if any image study provided apparent metastases.


Hormonal treatment is excellent to control the advancement of the cancer. Many guys do well in periods over 15 years. The important factor will be if your father’s cancer responds well to hormonal manipulations. That you can find only by experience so that he should start the treatment now.
Hormonal therapies got their own side effects which you should be aware of. Heart health is important so that your dad should get a full check up of lipids, bone health (osteoporosis), etc. Drugs also interact/react so that some may be proibitive in the presence of other illnesses.

Just type in a net search engine; “side effects of hormonal therapy for prostate cancer”.

You may also find in this forum many threads regarding hormonal treatment (HT). Another consideration you should take is on clinical trials. There are many involving newer HT drugs known to be perfected “time-bombs” to kill cancer.
Discuss the matter with his doctor and make sure that he does not fall into the placebo group.
See this link;
http://clinicaltrials.gov/ct2/results?term=hormonal+treatment

I would recommend you for getting second opinions from oncologists specialized in prostate cancer.

Hope for the best.

Baptista

Last edited by Baptista; 07-09-2012 at 05:31 AM.

 
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Old 07-10-2012, 06:47 AM   #3
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Smile Re: prognosis for my father aged 85

Many thanks Baptista for the advice. My father had been having prostate trouble (enlargement) for a few years and the doctor had given him tablets for this, but he had urination problems from December, when he started to lose weight.

He had to go to the hospital today and has collected Zoladex injections for his doctor to give him either weekly or three weekly, and Bicalutamide tablets to take for the next 14 days.

We were baffled when he went into hospital for the TURP operation, as according to the notes he had beforehand, he could be in hospital for 5-7 days and have a catheter bag for four weeks. He was also told only to exercise around the house. We were most surprised, therefore, when they discharged him from hospital the following day, took out the catheter two days later, and expected him to walk and catch the bus the following day (today) to go to outpatients. Totally at odds with the information given.

He should start hormone injections next week. I`ll see if I can learn anything from his doctor, but the hospital didn`t even inform him that my father was having the operation. Total lack of communication.

Many thanks once again for kindly replying to my plea for help, but all this is totally new to us.

 
Old 07-10-2012, 09:57 AM   #4
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Re: prognosis for my father aged 85

Inti

The hospital and the staff caring for your father’s case are totally in disarray. Nobody seems to really care about his condition. You need to find someone that you feel trust and comfort. An oncologist will be a better choice.

I do understand the reason for the TRUP for his prostate enlargement that was troubling him to urinate. Probably the tablets were not proper or in fact they did nothing to stop the enlargement. In any case, the cathedra should be in place until complete healing/recovery of urethra.

You should inquire about the hormonal protocol too. Usually bicalutamide tablets (50 mg daily or x 2) are started firstly, taken for two weeks before starting Zoladex, and the Zoladex is administered in shots of doses for one month, 3-months or 6-months. The bicalutamide then is stopped or continued. Get the prescription from the doctor and read the instructions in the box that also explains on how to administer the shots. Some GPs do not have a clue on matters of prostate cancer. Nurses also are not used to handle this type of shots that require a mixing.

Use a net search engine to find more about Zoladex.

Hope for the best.

Baptista

 
Old 07-11-2012, 01:19 AM   #5
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Re: prognosis for my father aged 85

Many thanks Baptista - you are so right, the hospital tell you one thing and do another. It`s not fear of bad news, it`s the fact you just don`t know what`s going on.

My father has started taking the tablets, has to see doctor next week, followed by nurse giving him injection. It said 1x50g Bicalutamide (Casodex) tablet every day for 14 days. The Zoladex (goserelin) is 3.6 mg every 3 weeks as far as we can make out from labels. I checked out the side effects, as you suggested, and didn`t like the fact they are giving him this when he already has high blood pressure. Before he had the TURP op the doctor had to quadruple the dose of BP tablets to get his BP down. Not good. If only they`d tell you what was going on. I hope to speak to doctor later today. Every time my mother visited the hospital there was no one around to answer her questions. He was told it was localised prostate cancer by the hospital. It was left to the doctor to tell him it was Gleason 9.
According to some articles I`ve seen on net, PSA is not reliable (his was always normal just prior to discovering the cancer). Don`t know why they won`t do MRI just so we know one way or another. I did ask, but they just won`t do it.

 
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Old 07-11-2012, 04:21 AM   #6
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Re: prognosis for my father aged 85

Inti

Can you share more info on the diagnosis of your father? What has been his PSA levels?

You have commented about “being normal” but some aggressive cancers produce low levels of PSA. Gleason 9 is quite aggressive which requires constant vigilance. In any case, the hormonal treatment will hopefully control any advancement and your father will enjoy life to the fullest.

I would advise you to get a second opinion from an oncologist. You are in the UK and I know how sometimes NHS treatments are done carelessly. Doctors also tend to avoid answering questions. Your dad could inquire with his GP to secure an appointment with other doctor. (My mother-in-law an English national had a sour case at Chester hospital with an unnecessary kidney operation. They removed one thinking it with cancer and found later to be benign)

Regarding Zoladex for males (Pca), the 3.6 mg is usually administered monthly or every 28 days. The formulation of 10.8 mg is given every three months. The later may be better because it avoids the discomfort/pain associated with the injection. You can request for the 10.8mg after verifying how responsive the cancer is to this initial 3.6mg dose.
The effectiveness can only be checked with a testosterone test so that it would help to get one test now for comparing latter. Urologists do not usually request for testosterone tests. Oncologist do. You can also do the test at a laboratory (about 30 pounds) with a blood sample.

I am also a HT patient but much younger (62) than your father. I took 6-month Eligard shots which are similar to Zoladex. The drug did not interfere with other typical medications I take daily (Aspirin 100mg, Adalat 35mg, Diovan 40mg and Sinvastatine 20mg), for blood pressure and cholesterol.
The side effects were many but mild. Fatigue was the one most pronounced. Physical exercises helped me in countering the effects.
Inform the doctor and the nurse about your dad’s other health conditions, and you may request for a CT that is usually accepted by NHS.

Wishing a complete recovery.

Baptista

Last edited by Baptista; 07-11-2012 at 04:24 AM.

 
Old 07-12-2012, 04:55 AM   #7
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Re: prognosis for my father aged 85

The doctor confirmed his blood PSA last February was 7.5. He has no recent results for same from the hospital. Got to wait until next week when he starts Zoladex injections, given every three months.

 
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Old 07-13-2012, 06:41 AM   #8
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Smile Re: prognosis for my father aged 85

Hi Baptista. Thank you so much for all the information. I was so sorry to read about the hospital blunder regarding your mother-in-law. Some hospitals treat patients like sausages - wheel them in, then out asap, without thinking. The doctor said he thought my father should have been in hospital a bit longer. I had a word with him about my concerns regarding my father`s blood pressure and he said it shouldn`t be a problem as long as he kept taking the tablets. Trouble is, we think he stopped doing so about a week ago. My father said the hospital told him to, and also said he can now do what he likes, eat what he likes etc. He keeps forgetting things and gets confused, so we have to check everything. He`s also very stubborn. The doctor said he shouldn`t do much exercise (just indoors or a short stroll around the block until this coming weekend), but he ignored us when we suggested it, and was doing the garden and carrying heavy things just five days after being discharged from hospital. We despair! The doctor is aware of this and said ultimately he`s responsible for his own health, and we`ve done our best. He stopped taking Proscar (for prostate), which sounds OK to us and is still taking his medication for hiatus hernia, as well as Casodex, but we don`t know if he is taking the blood pressure tablets or not. He stopped taking Aspirin prior to the operation. He said the doctor will tell him what to take, so it`s fingers crossed that he doesn`t overdo things before Tuesday.

I`m so sorry you`ve been through all this too, especially as you`re so much younger. My friend`s husband, also a lot younger, has just been through it too as his father had prostate cancer and lived well into his 90s. My friend`s husband had keyhole prostatectomy at Bournemouth hospital, but couldn`t go out for three weeks. He`s only just had catheter removed (4 weeks), so I just couldn`t make sense of how quickly my father was deemed to be back to normal, when he`s 20 years older.

Thanks once again for replying. I wish you all the good health in the world.

Best wishes

 
Old 07-13-2012, 09:57 AM   #9
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Re: prognosis for my father aged 85

Inti

I do understand the worries your dad is causing you. Probably his earlier release from the hospital was at his own intent. It seems that his doctor’s instructions was for him to stay longer (surely with the cathedra in place), but old man do not like to be “told” of what to do. In any case if he doesn’t have pain and passes urine normally then one should think that the healing process is OK. However, he may be experiencing incontinence and uses pads.

In a worse case urine could cause an infection and such could cause a stricture at the urethra sphincter and he would be agonizing with pain or even stop voiding. If such happens your dad should be rushed to the hospital (emergency) because he could get kidney failure due to an overflowing bladder. Stubborn 85th do not express pain so that you may need to keep an eye on him to check if he urinates.

Physical exercises such as gardening should be fine if it is mild. He must avoid contracting any infection. I do not know his fitness with regards to his age but exercising is good to counter the effects from hormonal treatment (walking and golfing has helped me). Fatigue will be a nasty one and so it is forgetting things and hot flashes (menopause like symptoms).

Proscar (finasteride) is used to treat benign prostatic hyperplasia which was part of the problem that took your dad for the TRUP, but it also is used in the hormonal treatment protocol to lower dihydrotestosterone. He can continue Proscar as it will help in the treatment. Just follow his doctor's recommendation.

Hormonal therapy resolves in killing the cancer by starvation. To that intent patients take drugs to lower the levels of androgens circulating in the body that are the “food” in which responsive cancer survives. Zoladex agonist will “close down” the factory of testosterone (the testes) causing chemical castration. The Casodex antiandrogen will try to stop the feeding of androgens at the cells receptors (closing their mouths) and Proscar will stop the produce of dihydrotestosterone which is a variant of testosterone but tenfold more powerful (small quantities but very potent).
This combination is called total androgen blockade.

Nevertheless, not all the protocols use the three drugs. Some cases do well with only a single blockade at the testes (Zoladex, Eligard, Lupron, etc.). In some a double blockade with Zoladex and Casodex works better. That will be figured by experience along the treatment.

Your dad needs to take periodical PSA tests (every three months) to check for any cancer progression. A testosterone test will indicate if the drugs are effective in maintaining your dad on castration. This can be done every six to twelve months.
The medication for blood pressure I take has not interacted with the hormonal drugs. You need to convince your dad of taking the medicines as instructed by his doctor and doing the annual health check-ups of the lipids.

After three months on Zoladex, the PSA will drop to zero levels indicating a hit on the cancer and the start of the control in its advancement.

I hope the above gives you some insight on what to expect.

Your dad is fortunate for having a lovely caring daughter.

Wishing you peace of mind.
Baptista

 
Old 07-14-2012, 06:15 AM   #10
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Lightbulb Re: prognosis for my father aged 85

Many thanks for words of wisdom. My father has always been difficult and he never listens to advice - always does his own thing. The trouble is that he`s been forgetting things and getting confused for some years now, and we never know if the advice from the hospital has actually come from there or not. The doctor says he can help with this but only if my father is agreeable to it (which he never will be), so this makes it doubly difficult for my mother and myself. If we try to advise him quietly he flies off into a rage (always been like it). Therefore, it`s like hitting your head against a brick wall. I only hope the doctor checks his medication on Tuesday (my father`s even had a row with him in the past over his medication, so he knows what he`s like). He said he`d see what the doctor says, but won`t take any advice from us.

You are so knowledgeable and it`s been a great help to us, but what can we do in the circumstances? We just feel our hands are tied. We`re very grateful for your help, and hope that after he`s seen the doctor, he sees sense and is back on the appropriate medication.

This morning he had an itchy red rash on his chest, which I assume is a side effect of the Casodex tablets. All we can do is watch him carefully, as you say, without it being apparent. The trouble is, I don`t live there, so have to rely on my mother to tell me what is going on, although I visit every day.

Many thanks once again.

 
Old 07-19-2012, 09:35 AM   #11
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Wink Re: prognosis for my father aged 85

The doctor said that my father`s blood pressure had gone down, so he has halved the doseage of his Ramipril to 5 mg. Don`t know how that happened as he hasn`t been taking it for nearly two weeks, and I understand that the Casodex he has been taking for the last week raises the blood pressure. So that`s good news.

The nurse gave him his first Zoladex injection, which was for one month. He then has to go back for a three month injection. It wasn`t very nice as it caused a slight bleed. Must be very painful.

The doctor said he doesn`t have to take Proscar or Alfuzosin (for prostate enlargement), or the Aspirin for the time being, but he may have to take that again later.

 
Old 07-19-2012, 12:47 PM   #12
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Re: prognosis for my father aged 85

Inti

Congratulations. The hormonal treatment will hit the cancer hard.

Zoladex injections causes swallowing at the area of administration and pain but it will gradually gets better in three to four days. The injection is thick which requires special care when injected. Your dad will do fine.

Keep the whole data and copies of tests, pills and drugs administration schedule, etc. in a file to check for treatment progress.
Has the doctor established the timing for the next PSA?
I recommend you to get a PSA every three months.

Regards.
Baptista

 
Old 07-20-2012, 06:24 AM   #13
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Cool Re: prognosis for my father aged 85

Many thanks Baptista. He`s got to go back to the doctor in four weeks time. He said he usually takes his blood pressure. He`s then got to see the nurse for next injection, so I don`t know if she`ll take more blood then.

He had a letter from the hospital last week, telling him to go to outpatients here at the end of October, rather than Dorchester, and to see his doctor 1-2 weeks before attending the hospital. I haven`t seen the letter so can`t confirm what the appointment`s for. He also had another letter from the hospital yesterday, but again, I don`t know why. It`s like the Secret Service (ha, ha - joke).

I think he`s getting frustrated as it feels like he`s losing control of his life with so many things going on. Can`t blame him, really. Trouble is, the hospital have made mistakes with appointments in the past, so we should really check it before my father goes. The doctor also forgot to add the Ramipril to the repeat prescription next time - good job the pharmacist and my mother noticed, and added it.

Best Wishes

 
Old 07-20-2012, 12:46 PM   #14
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Re: prognosis for my father aged 85

Inti

You are right, the system is so complicate and intrigue. The GP has the power to send us to a specialist (hospital) who has the power to send us for a treatment, which will be decided after a series of tests done by other specialist, so one could die easily before the problem is addressed or contained.
With so many physicians looking upon our cancer case we should be relaxed, but such is possible in a world of efficacy with no human errors. This is not what one may expect to happen at the European NHS model.

We patients must be on the driver’s seat and “roll” the matters all the way through. Constantly look for faults in the process and try to recover. Your dad needs you the most.
You may understand now why we PCa patients need to be “doctors” of our cases and consequently, become experts in the disease.

I recall (2000) my first consultation one week after being diagnosed, where the doctor (a professor of urology) looked at me and asked; “Have you decided on a treatment?”
I become a stunt.
Well……….., it took me two months to get an internet “doctorate” on what was cancer and how it is treated and visited 4 different specialists before making a decision. This happened in Japan where I was living of a different culture and different NHS standards.

I hope that the GP at your location is friendly and will accept your requests in good faint for preventive care. Mine does maybe because he knows that I am aware of the facts in my problem.

You could accompany your dad (with his permission) in his next visit and try request the GP to apply for blood tests such as; PSA tests every 3-month, Testosterone every 6-month, lipids count (liver, etc), bone density scan (dexa) and BCG every year. These are all related to his treatment for cancer and the side effects. However, his doctor at the hospital will probably not follow the request. They tend to minimize the costs.

In any case, hormonal treatment (HT) may cause osteoporosis so he may need to start taking a bisphosphonate (fosamax) and that can be checked only with a bone density scan. Prostate cancer “likes” to spread in weaker bone.
HT also may impose risks to heart health and diabetes. Hypogonadism will cause menopause-like symptoms and your dad should care for any anemia because of the so many drugs effects.

Do not expect the hospital to care for the matters in a preventive intent. They look at each case when the problem is advanced and causes symptoms.

Wishing your dad good results from Zoladex and peace of mind to all of you.

Baptista

Last edited by Baptista; 07-20-2012 at 12:49 PM.

 
Old 07-21-2012, 06:34 AM   #15
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Wink Re: prognosis for my father aged 85

Many thanks Baptista. You are so right about everything. I think that`s why the hospital won`t give him an MRI, because of the cost and his age. The doctor told my father that the Zoladex injection (one month) costs £100.
How do they work that one out? The pharmaceutrical companies must be making vast profits, yet are always asking for charitable donations, but don`t seem to remember that when they achieve the desired result.

The doctor is a nice man (a very, very nice man - joke) and is easy to talk to. He told my father to tell my mother and myself, that if we needed anything, to let him know. My father doesn`t really want to know much about what`s been happening regarding his health. When he had the ultrasound test, and the nurses told him to look at the screen, he didn`t. I suppose we`ve all been there - if we can`t see it, it doesn`t exist. At the moment he`s carrying on as usual.

I`d be willing to go to the doctor with him, but don`t think he`d agree at the moment, preferring to go on his own, as he always has.

I know what you mean about managing everything yourself. I suppose it gets complicated for medical staff with so many people attending the hospital every day, and there does seem to be a marked increase in cancer cases, with some people so young. It`s alarming, and questions should be asked as to why.

I`ve had some experience of medical incompetence in the past myself - with a vet. My dog, some years ago, had seizures. My previous dog had been doing exactly the same thing just before he died, and he had an irregular heartbeat, so I linked the two. The vet said epilepsy was one end of the scale and heart conditions at the other. He said my dog had an irregular heartbeat too, but that it was epilepsy. I joined a group that helped people with the condition, known as Reflex Anoxic Seizures - a heart condition, not epilepsy, and the two were totally different. The vet would not accept this from me (a lay person knowing more than him) and told me if I didn`t shut up he`d give my dog epilepsy medication. Charming! So, needless to say, we wouldn`t see him again - only two lovely lady vets at the same practice, who listened to what I had to say, read the leaflets, and when my dog had a bad bout of seizures, due to diarrhoea, which lowered his blood pressure and slowed down his heart, gave him atropine, and not Diazepam, as you do to epileptics. The seizures got less intense and further apart, proving that he had RAS, not epilepsy - the first dog to be diagnosed with it.

The group sent me an article from a Vet`s magazine, which said that whilst they thought animals could have it, the same as humans, there was insufficient proof. So I wrote to the author, and the Veterinary College, to let them know what had happened, with the vets` names to back me up. Never heard a thing from them.

I thought if I couldn`t prove what it was, I`d prove it wasn`t epilepsy, and studied everything I could lay my hands on, so I could quote chapter and verse to the vets in their own language. It worked. They were more understanding, but I`d never go to the fool with the mad ideas again. He could have killed our dogs, as my dog`s brother got RAS shortly after (it`s genetic).

So I`ve had my share of fighting, as I expect you, and many others on this board have too. In the words of Churchill, "Never surrender". I certainly won`t.

Thanks once again for your wise words. My best wishes to you.

Last edited by Inti447; 07-21-2012 at 06:38 AM. Reason: spelling mistake

 
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