Re: Father t3c need advice
What a shock that must have been for your father and you, and unlike many men with lower risk PC, he has to proceed quickly to treat and hopefully cure his locally advanced disease. It's great that you have gotten so many opinions so quickly. Florida has several great cancer centers.
I presume he's started the hormone therapy already, which should stop the progress of the disease for now, and give you a few months time before you have to take the next step. Usually hormone therapy begins with Casodex first to prevent a testosterone flare and then adds Lupron. Alternatively they give Firmagon (degarelix) which doesn't cause a flare. On top of that, some add Proscar or Avodart.
Unfortunately, it sounds almost certain that the cancer has escaped the prostate and infiltrated the prostate bed and possibly the lymph nodes. Surgery can't remove the entire prostate bed, so what would be the point of surgery? Hormone therapy started before radiation improves its chances of success. You might want to look into getting him an HDR brachytherapy boost along with the IMRT. The combination of all three have an improved success rate. NCCN guidelines indicate ongoing hormone therapy and radiation with or without a brachy boost. The Moffitt Center in Tampa is an example of an NCCN hospital.
Radiation typically begins 2-3 months after the start of hormone therapy, with the hormone therapy continuing through the radiation therapy and for 4-6 months after if there is a brachy boost, or for 2-3 years after if there is no brachy boost.
Docetaxel is indicated for known metastatic PC, but there are doctors who think it may be useful earlier in the game, especially before radiation.
I too am confused by the latter two options. I've never heard of docetaxel before surgery. I guess option #3 supposes that the surgery will not work and radiation will be required, but then why do the surgery? NCCN guidelines allow for surgery followed by radiation, but only if it is not known before but it is found in the surgery that there are adverse features like seminal vesicle invasion. However, in your father's case, you already know that. Did the doctors who proposed #2 and #3 give a rationale for those plans? Possibly there may be a clinical trial they are involved with.