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Chadhas 05-11-2010 11:47 AM

Another worried daughter needs help...Dad has Stage 4 PC.

My Dad was diagnosed with stage 4 PC in March 2010. Initially the doctors suggested a biopsy but after getting bone scan and MRI results, it was discovered that the cancer was already spread to his bones (pelvic, spine and almost all major skeletal bones). So his urologist said that biopsy is no longer required and we should start the treatment asap. PSA at the time of diagnosis was > 500.
He had his Orchiectomy done in end of March 2010. He is now getting Zometa infusions once every 3 weeks and also taking Bicalutamide 50mg.
I have a few questions and would appreiate any help:

1) Is this the correct line of treatment for him?
2) Can we find out his Gleason score now? I have heard that biopsy is the only way it can be discovered.
3) Is PSA related to the level of metastasis? Does extensively spread metastasis imply a high PSA?
4) His spine is effected by the PC cells and his hemoglobin before the treatment was 9 which went further down to 6.7 within 14 days of Orchiectomy. Is this normal?
His first PSA test is scheduled in July 2010, that is, after 3 months of surgery. How low shall we expect it to go? Also, he will complete 6 Zometa infusions by then.


kcon 05-14-2010 02:36 PM

Re: Another worried daughter needs help...Dad has Stage 4 PC.
Hello Chadhas family,

I do not have personal experience in this area of the disease treatment, so I cannot answer all your questions...

1) sorry, I am not equiped to answer
2) The biopsy is the only way to obtain a Gleason score. The tissue samples are examined under a microscope, and the pattern of the cancer cells are "graded" based on various definitions. I would agree, however, with your doctor that the biopsy doesn not matter at this point due to the advanced stage of metastasis. Gleason score tells how aggressive PC is, and can be used to estimate prognosis of metastatic cancer...which your dad already has.
3) My understanding is that once metastasis occurs, the actual PSA number is probably not as important as whether it changes. The PSA number does not predict whether or not a person will have symptoms or how long he will live. Many people have very high PSA values and feel just fine. Other people have low values and have symptoms. With advanced disease, it may be more important to look at the way the PSA level is changing rather than the actual number.
4) sorry, I am not equiped to answer

Sorry I could only be a partial help.

I have question for you, if you don't mind. To be diagnosed with a PSA result over 500 seems unusual to me, unless he went for years without having any PSA screening. PSA screening is relatively common in the US, but perhaps this is not true in India. Can you help clarify your father's background? Did he have prior PSA tests? Not trying to be nosey with this question, but trying to better understand the big picture. thanks, and good luck

Chadhas 05-15-2010 12:31 AM

Re: Another worried daughter needs help...Dad has Stage 4 PC.
Hello kcon,

Thanks a lot for your reply.
Well we never had his PSA checked earlier as PC used to be quite uncommon in India few years back. Although the number of cases are growing now. Also, he had no symptoms other than bone pain that we though is because of arthritis, as he has a family history of the same.
We did take him to a GP for his bone pain last year who said it is arthritis and gave my dad some pain killers. But more or less, I, as a daughter blame myself for letting his PC grow.
Doctors say his PC is chronic, so does that mean we have some hope?

Thanks and regards
Chadha family

greggeva 05-15-2010 05:13 AM

Re: Another worried daughter needs help...Dad has Stage 4 PC.
Hi Chadha Family,

You might want to check out your father's situation with Dr. Steven Tucker in Singapore. He's an American oncologist whose specialty is treatment of advanced prostate cancer. (Well-respected in the field of hormonal therapy.) I think it's against the board rules for me to post his contact information here, but you can find it easily enough by googling "Pacific Cancer Centre." You can add "Dr. Steven Tucker" to your search parameter if the first is not enough. (Though I'm quite sure it is.) I live in Taiwan and went to consult with Dr. Tucker last year in regards to my advanced prostate cancer. Wonderful man! I have much more confidence in his knowledge and experience than the local doctor who was treating me here.

Bless you guys!


If, for some reason, you can't find Dr. Tucker's contact info, please feel free to get hold of me via private message.

vinudev 05-17-2010 09:37 AM

Re: Another worried daughter needs help...Dad has Stage 4 PC.
Hi! I am sorry you are going through this stressful time.
As for your first q, yes, it seems to be standard mode of treatment in India. Jim and others here have had success in adding another class of drugs, the 5-AR inhibitors(Fincar is the finaseteride generic, Proscar is the duasteride generic) to the regimen. But, I have not yet been able to find a doc in india who thinks it will help. You should check whether his urologist recommends it. It is great that they are giving him Zometa infusions right away. It is supposed to help a lot to stabilize and also lower the spread of bone mets.
From what I have read(in my layman's opinion) it is how low the PSA goes after intervention(PSA nadir) that decides how soon the cancer will be back or how aggressive the disease is. A PSA nadir of <0.05 is what is considered true remission here(Check PCRI website for more info on PSA nadir). His Calutide dosage can be increased to upto 150mg daily to help bring down the PSA some more. Ofcourse, PSA levels might not be truly indicative of his disease kcon suggested before, some people have very high PSA but are still doing fine.

Apart from the medications, daily exercise to maintain strength is very important. He should be having calcium/vit D supplements along with his Zometa infusions. Pomegranate juice is also thought to be beneficial. Following a mediterranean diet is also thought to be better for prognosis.

MY FIL is also in the same situation. Delayed diagnosis, back pain dismissed as complications from a slipped disk. Esp considering his family history, he or his docs should have thought of it a yr or two earlier. I truly understand the need for maintaining a detailed family history now..unfortunately, it was a costly lesson.

To answer Kcon's q from another indian perspective. Preventive diagnosis is not very well practiced in india..esp for tumor marker diagnosis etc. Most people have preventive diagnostics for heart/diabetes related ailments. So, PSA tests are not done unless some doc makes the connection between urinary difficulty or bone pain and PC. Its truly a shame.

Good luck to your dad and your family.
From what I have read here and all the books and website regularly reccommended by the people here, it is definetely possible to find a treatment plan that works for your dad. So don't lose hope!


kcon 05-17-2010 08:50 PM

Re: Another worried daughter needs help...Dad has Stage 4 PC.
Hello Chadha family,

The doctor's comment that his PC is "chronic" basically means that it can be treated, but not cured. Early-stage PC may be cured if it is confined to the prostate, but once metastasis occurs then treatment shifts to an effort to control the spread and manage the effects...hormone therapy (HT) is the common approach, but unfortunately it is not an area I am very familiar with and cannot, therefore, give much advice. Vinudev and Gregg seem to have dealt more directly with this, and hopefully you can gain from their experiences.

Vinudev, thank you for your insight/perspective. The PSA test is not perfect, but even with it's faults it seems tragic to me that it is not more widely available.


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