My father was recently diagnosed with prostate cancer. About 3 weeks ago he was having trouble with urinating and asked to see a dr. Dr performed a dre and said it was hard and bumpy. He then took a psa which came back at 32. Since then he has had a ct scan which came back totally unremarkable. An MRI which showed a carcinoma covering most of the prostate and extending into the seminal vesicles. Rectum clean. There is one lymph node that was .8 cm which the dr said we should monitor but was under the standard 1 cm for true suspicion. Biopsy 4+5=9 Gleason with all 12. Cores positive. Bone scan clean no bone mets.
We have had a lot of different medical opinions and are really confused. We know his cancer is very serious and drs have all have classified it as locally advanced but have all given us different treatment options.
1. Hormone therapy followed by radiation
2. Hormone therapy and doxataxal for 20 weeks followed by surgery
3. Hormone therapy followed by surgery and then radiation
Father is 68 and in perfect health otherwise
Need advice and hopefully experiences with other people that have had this stage of prostate cancer.
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.
I am sorry to hear about your dad's diagnosis. It sounds like you are doing your homework and a degree of confusion is understandable. It can be hard to stay positive in the beginning especially with when you start reading things on Gleason 9 tumor's that have escaped the capsule. I know because I was there seven and a half years ago.
The advice to go on hormone therapy while you decide your next step is sound. I had surgery, followed by radiation, and have been on intermittent triple hormone blockade since then. My PSA has been lowered to >,01 while on Lupron, Casodex and Avodart but rises when I am off Lupron and Casodex indicating cancer is still present. However on a scale of 1 to 10, I would classify the daily affect on our lives as minimal, a 1 for most of the time. I would suggest reading Dr Charles "Snuffy" Myers book Beating Prostate Cancer through Hormone Therapy and Diet. He has a practice that concentrates on high risk advanced prostate cancer patients. There are some uplifting stories about patients that continue to beat the odds. I was impressed enough to switch to him as my primary oncologist a few years back and make an annual trip to consult with him in VA.
I am not sure where you are in Florida but in Orlando, Sand lake Imaging Is doing an MRI with Fereheme as the contrast agent which is identifying prostate cancer in the lymph nodes at much smaller sizes. When coupled with F18 bone scans these two may have the ability to identify if the desease is oglimetastatic in nature. I just came back from there where Dr Bravo determined that I have two sets of affected lymph nodes, After discussions with him and Dr Myers, we decided to proceed with radiation to eradicate the cancer in these locations. i am back on triple blockade and return to the mainland to have Dr Dattoli in Sarasota fl do the radiation.
The reason I mention this is that while I was in Orlando I met a man from NH who was using the scanning to make his decission on which way to proceed. It was able to identify a location not seen on the other scans.
This type of thing may not be of interest to your dad. I was 56 when diagnosed and given the agressive nature I decided to be agressive in treating it. The fereheme scan is new for prostate cancer, few know about it yet and so there is likely some contreversey about it. You can search the board and find some posts on it. At one time Sand Lake was only taking patients for the ferehme scan from Dr Myers and Dr Dattoli. I am not sure if this is still the case since they are ready to publish their results and have just sent out abstracts on the trial they have been doing to some of the medical journals.
The main thing for your dad is to stay positive. Whatever route he takes he will have a number of good years ahead and new things are coming down the tubes that may change the prognosis and treatment of patients like us.