[QUOTE=LabMom;3400447]Hello everyone,
My father was diagnosed w/ PC back at the end of Oct. He will be 69 next week. It was kind of a shock as he had been getting yearly PSA and DRE tests for about the last 10-15 years. His PSA had risen slightly over the last couple of years (it was 2.0 - good for a man his age, from everything I read) when he went in early Oct, his Urologist debated whether to even send him for a biopsy, I guess during the DRE, he felt something suspicious.
... His doctor recommended the seed treatment, which is currently scheduled for 2/28 (if the infection has cleared up by then).
...
I've been reading the boards since Oct, and decided it was time to post. My questions are:
1) With a PSA of only 2.0 (68 almost 69 year old man), does the Gleason score of 6 surpise anyone?
2) Has anyone had to deal with this lengthy (3 months now) of an infection? If so, how did you deal with it?
3) In your opinion, is the seed therapy the way to go for him? I know I said that it had already been decided, probably should have posted right after diagnosis. I know it's an individual decision, I guess I'm looking for people that have had it done, the good, the bad, and the ugly. What can he expect? If it doesn't work, what else can be done? ... QUOTE]
Hello Labmom,
Daff has already provided many good comments. Here are some more thoughts responding to your questions.
You asked: 1) With a PSA of only 2.0 (68 almost 69 year old man), does the Gleason score of 6 surpise anyone?
No, that PSA is outstanding for a man of his age - usually the PSA is several points higher because of BPH (noncancerous enlargement of the prostate associated with aging, and his unusually low PSA in itself is a clue that his cancer is low risk, but of course the PSA level by itself is not the complete picture. A Gleason of 6 is in the low-risk range, though other case characteristics can indicate a higher overall risk. I just checked the book "A Primer on Prostate Cancer -- The Empowered Patient's Guide," page 48, which states "The most common Gleason score is (3,3)." This means the total score is 6, 3 for the most common pattern in the biopsy,from 51% to 95% of the the total, and 3 for the second most common, ranging from 5% to 49% of the total. In the (3,3) case, the whole biopsy is very likely 3, though there might be a small percentage of some other grade."
You asked: 2) Has anyone had to deal with this lengthy (3 months now) of an infection? If so, how did you deal with it?
I hope you get more responses, but I have not heard that a long infection like that (or any infection at all) is due to prostate cancer, though the stress of the cancer might indirectly be affecting the course of the infection. I caught a cold within weeks of being diagnosed, and I'm sure the stress of diagnosis was partly to blame.
You asked: 3) In your opinion, is the seed therapy the way to go for him?... I guess I'm looking for people that have had it done, the good, the bad, and the ugly. What can he expect? If it doesn't work, what else can be done?
Seed therapy is a common approach in circumstances like your dad's, especially his age and what appears to be a mild case based on the few details you know. Seed therapy now has a long track record, and success rates are very similar to other therapies when matched for level of seriousness. Daff made good comments on whether it is best. Your dad definitely has other options based on the limited detail you have. If his PSA was 2.0 at diagnosis, which I think you meant, then his PSA did not rise more than 2.0 in the year prior to diagnosis. In fact, it probably rose quite a bit less since he probably had a PSA of at least several tenths before this year. If other case characteristics are low risk - like stage 1 or 2 (from the DRE - Digital Rectal Exam, mainly), number and percent of biopsy cores positive, percent of cores that are positive, absence of perineural invasion, to name some of the main characteristics, then that low rise in PSA indicates a case that is probably even milder than otherwise indicated.
If seed therapy does not work, a recurrence could be so mild that no further treatment would be necessary. Or, the use of diet, etc. low-key tactics might be all that would be necessary. Failing that, a few experts in radiation therapy would probably be willing to do salvage radiation, though that is not typical. Salvage cryo therapy is an established option. Hormonal blockade therapy - either a single course of it or intermittently, would almost certainly be highly successful and would probably be all he would need to control the cancer for the rest of his life.
There are couple of approaches that are low in intrusiveness.
Active surveillance, especially at age 69, is probably a viable option, though it appears that he might feel too much stress for that approach. Another viable option could be a fairly mild version of hormonal blockade, using a combination of drugs known as an antiandrogen (typically Casodex) plus either the generic Proscar known as finasteride or
Avodart, or the antiandrogen could be used alone. One leading doctor in hormonal blockade comments that with that approach you get 80% of the benefit and only 20% of the side effects. Your dad could even try a very low key approach to see if the PSA indicates that's all he needs: diet, nutrition, supplements, exercise, stress reduction, and a mild drug, either finasteride or
Avodart. I am just a fellow survivor with no enrolled medical education, but I have heard experienced doctors advocate this approach as a reasonable option for low risk patients. Of course, it requires continued monitoring, but that is usually done just with PSA tests every few months with occasional scans. There are a couple of books that do a good job laying out some of these options, the Primer being one of them.
The MRI scan is not as common as the CT scan, though the latter rarely turns up anything for low-risk cases, and some doctors consider it worthless in such cases. There are other imaging tests that can be done, as well as some blood tests, that can help nail down the low-risk nature of a case, if a patient wants to do that. A simple MRI scan is usually not very helpful, but the less comfortable endo-rectal MRI, especially with spectroscopy, is quite useful, at least accoring to the Primer.
You did not mention your dad's overall health. That is a significant consideration, especially with a man who is 69. I'm guessing he's in good health since he's been getting regular check ups. If so, that might make more aggressive options more attractive. If he is not in good health, then less intrusive options would be especially attractive. For example, your dad's PSA doubling time with a followup test in a few months, or, even better, a couple of spaced out followups, would be an important clue about when he would probably run into trouble because of the PC. If he has serious heart disease or diabetes and a PSA doubling time of a hundred years, then it would make lots of sense to do nothing about the prostate cancer. If he is in super health except for the cancer but has a PSA doubling time of six months, then it makes sense to vigorously fight the cancer. I'm guessing your dad is somewhere in between, much closer to the good end of both the health and PSA doubling time dimensions.
Please stay in touch.
Good luck and take care,
Jim
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