Need helpful advice...Dad has cancer

kho2317 · New User Joined: 16 Oct 2008 Posts: 2

Hi, my name is Keith and this is my first posting to this forum. I find the information shared in this forum is very useful and read with hope that some of your loved ones actually survived this cancer. I hope to get some advice through this forum. My dad has just been diagnosed with Prostate cancer - PSA 43.5, Gleason score (4+3). Both right trus biopsy and left trus prostate biopsy alrady shows evidence of malignancy. Basically the cancer has penetrated the entire prostate. Whole body bone scan shows that pelvic bones already contained small trace of cancerous cells.

All above suggests that there is little hope for my dad. Doctor is not even suggesting RP, radiotherapy or chemo. Only going to start him on Hormone therapy as palliative measures to shrink the prostate tumor and stop the spread of cancer in the bones. He told us that since cancer has spread to bones, there is little relevance of having RP to remove whole prostate. And he said that unless hormone therapy fails then he will move on to more drastic measures like chemo or op. I am doubtful that this is the best option for my dad in the meantime. Am seeking second opinion from another govt hospital (private hospitals are very expensive in Sgp). Anyone of you has similar experience and is hormone therapy the best option now? My dad is only 63 this year.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 273

I'm sorry to hear about your dad. It sounds to me like his doctor is acting prudently and in accordance with standard medical practice.

If his cancer has spread to bone, it is metastatic. A local cure through radiation or surgery is no longer possible, and at this time there is no cure for advanced prostate cancer. However, some men have such long remissions via hormone therapy (androgen deprivation therapy, or ADT) that it's just as good as a cure. In other words, some men can live and not be bothered by cancer until they die at a ripe old age of something else. This is not USUALLY the case, but I do personally know men who have lived for more than a decade after initiating ADT and at this point are not really bothered by the cancer, although being deprived of teststerone for so long does have its side effects.

So--there is hope that your dad can live for a long, long time with PCa, and be relatively symptom free.

Like I said, once the cancer is systemic, RP or RT will not cure it. Starting ADT is the standard protocol. Sometimes doctors will try early chemo, or a combo of chemo and ADT, but that's not the norm as far as I know.

Radiation is used on a spot basis in advanced PCa to reduce tumors in bone and relieve the associated pain.

ADT, as far as we know, does not cure prostate cancer either. Once ADT no longer keeps prostate cancer in check, the patient is hormone refractory. It's at this point that chemotherapy is often employed. Chemo is not as effective against prostate cancer as it is against other types of cancer, and up until a few years ago, the use of chemo in prostate cancer was considered experimental. Chemo can also buy time, but not as much time as a person can get from effective ADT.

Bear in mind that at this time, research is proceeding on multiple fronts to find more effective treatments (or even a cure) for advanced prostate cancer. Your father's fight strategy is now to stall, stall, stall--keeping PCa at bay until new treatments come online. When one treatment fails, move to the next.

Johnw100 has more experience in this area, and hopefully he will spot any errors I may have made in the statements above and add any useful information I have omitted.

Standard disclaimer applies--I'm not in any way qualified to give medical advice, and anything I write should not be taken as such.

I wish you and your father the best.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

johnw100

"Anyone of you has similar experience and is hormone therapy the best option now? "

Yes it is: as Replicant suggested hormone treatment is the usual approach in this situation, and it can be effective for an extended time.

Everyone is different, so if someone finds that one particular medication is not effective, or becomes less effective over time, one of the other similar products will often work for them.

Two friends currently on hormone therapy are both doing well, and both continue to lead active lifestyles. In both instances their PSA reduced to under 1 after a few months.

It's very important to improve lifestyle, exercise and diet wherever possible.

I strongly suggest that you read the book by Dr Myers, "Beating Prostate Cancer: Hormonal Therapy & Diet" which to my knowledge is the most informative publication on this subject.
Dr Myers is a Medical oncologist and nutrition expert who has extensive practical experience with hormonal treatment.

Best wishes.

kho2317 · New User Joined: 16 Oct 2008 Posts: 2

Thank you for your great advice! johnw100 and Replicant. It is comforting to know that what the Doctor has done is indeed a prudent and possibly effective measure to keep the cancer at bay.

I am feeling hopeful that my dad will react well to the ADT and live for at least a number of years before the symptoms starts coming in or when he becomes hormone refractory. I already learning so much from the posts that i have seen in this forum. At least I now know that there is still hope despite the seemingly insurmountable gloom.

Once again, thank you for your advice.

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