Prostate Cancer Cases for Our Discussion

[Darryl]

History: 60 year old man. Rising PSA 11.5 years ago, two biopsies to finally find prostate cancer. Presurgery PSA was 11.8, gleason score was 3+4 (7). Prostatechtemoy fall of 1998. Post surgery complication has been primarily incontinence. Open bladder neck, two Contingen injections to try to close it up. Male bladder sling 2001 that was not successful as soon as I returned to exercise walking. About 2003 resorted to using a penile clamp along with half pads. This is not completely successful.

PSA remained at <.1 for a few years. Rose to .2 in 2004 and up one tenth per year until .5 Dec. 2008. April 2009 hit .7 That is when primary care referred me to urologist. Did not know was in chemical recurrence until then. Had bone scan, MRI for suspect places was negative. Pelvic/abdomen CT didn't turn up anything. Was referred to local cancer center. Saw the chemical specialist first. Referred me to his radiology partner. The thought is (no concrete test) that the cancer is in the prostate bed. It was recommended to treat with 37 lower dose radiation treatments.

What do you think....is this fellow following a good course of treatment?

[JoelT]

For this man radiation is an option, however it would have been better to have had it earlier. The big question around radiation is the man's incontinence. Radiation could cause additional damage and create additional problems with urine control. The decision to have the radiation should be made by the patient after he has been informed and understands the risks he might face. He also needs to know that there is no guarantee that radiation will resolve his cancer. Another option is to simply wait and monitor his PSA as the doubling time is slow. Along with the doctor he should decide how high he will allow the PSA to rise and then at his trigger point he could start hormone therapy (ADT).