gleson score 9 with cancer with right seminal vessicle positive

hello all,

my dad was diagnosed with prostate cancer back in june 2014 psa 62 bone scan negetive gleson 3+4..he went robotic prostatectomy in aug 14 and gleson score elevated to 4+5 with right seminal vesicle showing bit of cancer.Psa after 3 months came down to undetectable but soon after another 3 months it went to 0.2 and started increasing.Our urologist then suggested ADT for next 6 months and psa came down to 0.1 then he went to 44 rounds of imrt psa after 3 months of imrt to pelvic area was .1 and after 6 months it was.16.Now he is again back of imrt but has severe pain in his legs..Please suggest any treatment as we dont want to lose him.Please help

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  • Nad, I think your Dad will be ok for a long time, I wonder what is causing the leg pain? Perhaps that may not be the cancer and something else. The numbers you achieved with whatever adt you are doing is very good, I have often heard of a small psa flare like that after radiation, keep an eye on it. What meds for cancer is he now on? How old is he? and what is His general health. It is very important to have a medical Oncologist that specializes in Prostate Cancer, These can be found at major researchTeaching hospitals. In my experience with some labs psa can jump around a bit due to noise in the test. It is great news that he had a clear bone scan. There have been so many advances in PC in the past decade, and more to come in the next decade, I wish you the best, keep the faith, Spend time with your Dad

    Dan dx 2006 stage 4 Gleason 10 ,bpsa 148, extensive mets to distant sites in skeleton and Lymph, still fighting , feeling good pain free. Never made it to undetectable, but I did make it to 3.0 psa 10 years ago, current psa 66.

    Dan

  • What treatment have you had Dan?

  • I have had Lupron , zolodex,casodex, nilandron, estradiol patches, Avodart/dutasteride, Ketoconazole/HC, zytiga, xtandi and q21 docetaxol chemo

  • What meds for cancer is he taking, now.

    Rich

  • he is 61 and overall health is good but now he feels tired all day and he is becoming incontinence also after the harmone treatment..He had pamorelim just after 3 months of surgery twice and after radiation imrt our doctor changed it to zoladex 10.8 mg along with some calcium and multivitamin tablets.By the way he had undergone bone scan before 2 years at the time of surgery and not after that thats why i doubt his pain only localised to legs.Is this a symptom of cancer metastasis.He has become diabetic also after starting pamorelin.

  • It is hard to tell Nad, but with such a low psa , makes me think it is something else, Many of us have done other drugs with zolodex to bring the cancer into remissission.If he is diebetic, is he on metformin, which has been shown recently to have anticancer properties. keep us posted

    Dan

  • What was your fathers starting PSA and did they say he had a rare form? Some prostate cancers do not produce much PSA. I have Ductal and the only way they can follow it is by scans.

  • I agree, I would have bone and ct scans repeated to investigate pain. And also at this time a Medical Oncologist should be the primary cancer Dr. Not a urologist, hopefully one specializing in Prostate Cancer

  • no sir they didnt mention any such thing.Starting psa was 62

  • With a PSA that high at diagnoses you should be able to use PSA to monitor your cancer. Good luck!

  • thanks a lot..

    Tomorrow we are planning for a bone scan.What if the results comes out positive the what all options we'll have and also what can be the avg. life expectancy after positive bone scans.I know its very illogical question but its just a son very concerned about his father..

    thanks again brother.It means a lot.May god bless you

  • Nad, I have never in 11 plus years had a negative or clear bone scan , I only asked one time , 11 plus years ago what my survival statistic was, they told me a year, I never asked again. Cancer statistic can be very misleading and often not even true. There are many new drugs now that your Father has in his back pocket ie Zytiga, xtandi , docetaxol, cabitaxol ,provenge , he has not tried any of these yet, nor can I see where he even had casodex/bicalutamide which is very first line. many of us have gotten lots of extra years with these drugs. Me as a prime example. There currently are working on many new things as well. Lately Genetic testing for targeted meds has shown to be very useful. Your Dad is my age, I was diagnosed at 49, and never even achieved a psa below 3

    Keep us posted on the results of the scans, I am glad he is getting them.

    Dan

  • I took Zoladex 10.8mg ( similar to Lupron ) continuously for 2 years after my prostatectomy followed by 40 sessions of IMRT for my GS 9 PCa dignosed in March 2015 at PSA 9.7ng/ml. For more than 2 years up to now my PSA has remained at 0.008ng/ml. Presently I am not taking any treatment. I also have joint pains here and there. Still I think I am not out of the woods because my PCa is GS9. Learn more about various treatment options available for advanced prostate cancer and also about the important Trials concluded recently regarding the upfront use of combined therapies for long term survival benefits. Trials : STAMPEDE, CHAARTED and LATITUDE. I think you should read out loudly to your dad the classic case of brother Dan59 which in no uncertain terms should tell your dad that he can live at least for another two decades from now onward.

    My best wishes!

    Sisira

  • now what options you are considering

  • Every three months I check my PSA from the same lab. The potential risk i am facing is sooner or later the possibility of the recurrence of my PCa due to micrometastasis in the past, may be even before my diagnosis and the surgery. This probability is high when the GS is high. Recurrence will be indicated by a biochemical failure when the PSA exceeds the undetectable level 0.2ng/ml ( mine is still 0.008 ). In such an event I don't want to waste time. I want to hit the cancer as hard as possible with a treatment that can kill all types of PCa cells when the cancer burden/volume is at its lowest. The treatment regimen would be Docetaxel ( chemo ) combined with ADT ( Zoladex ) which I stopped after using for 2 years. One can buy time with different hormone therapies but they can deal only with hormone sensitive cancer cells. Chemo drugs are cytotoxic ( killing cells ) but many have an unwanted fear in using chemotherapy because of severe side effects. With proper understanding and preparations such side effects can be mitigated to a great extent. Some individuals go through the chemo cycles without any difficulty. I am very hopeful if I knock down the recurrence ( may or may not happen ) at the first instance with this strong protocol, it should give me a long lease of life and also I will have several more new swards to fight this battle. I am already 70 and yes, I am very confident.

    As a brave daughter take the lead and fight the battle for your dad. We are with you. Good luck!

    Sisira

  • I don't agree with the other posters. The fact that ADT only brought PSA down to .1 is real bad news and points to a cancer that will soon become crMPCa. Good chance that the cancer has metastasized to the spine which would explain the pain in the legs. Needs aggressive treatment

  • Aggressive as in..can you please elaborate

  • I agree with nal. Be on the safe side and closely monitor psa even in the slightest since gleason 9. put out less psa for metastatic growth and if necessary discuss with mo doc early chemo and scan for spine. Were not docs. here and don't always get it right and on 2nd thought other posters might agree. Only our opinions and hoping you the best. Rocco

  • Sorry I meant gusgold

  • I agree with you, one must always be vigilent, and educated when fighting cancer. Have a great day

  • Gus, I was under the impression Nal stated <.1 was considered undetectable a few days ago. All we have is our hope. My psa nadir on adt3 was 3.0 , 11 years ago. But yes one must always be vigilent with any, and all cancers.

  • we are not docs....get a good oncologist

  • Xofigo for bone mets (am currently on Xofigo and it is helping with the pain and reduction of lesions within bones). PSA will not drop while on the six month treatment plan, but it should kill the tumors that are causing him pain. May be an issue due to current radiation treatments. There are also a couple of treatments that are generally used for women with ovarian cancer (non-hormone related) that are immuno based that are currently being used for men with met cas resistant pros cancer. Chemo? Docetaxel combined with carboplatin. I was given four rounds over the course of 3 to 4 months and it helped. Did Onco try or suggest all of the ADT meds...Xtandi, bicalutamide, Zytiga (there is another that I cannot think of at the moment)?

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