my dad was diagnosed with prostate cancer back in june 2015 psa 62 bone scan negetive gleson 3+4..he went robotic prostatectomy in aug 15 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.Then the oncologist suggested adt again.We were not expecting adt though.After 9 months of imrt with 1 adt psa came as 0.02.Then we wanted to do a bone scan but instead they did a bone density test and that also came fine.Just wanted to know what will be the next treatments and what we can expect from such history.
Thanks in advance
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nad95
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Welcoming to our forum. Looks like your dad has had extensive treatment and is doing very well.
None of us are doctors, just PCa patients trying to help and support each other. This forum is an amazing place to get information. I’m sure many will weigh in soon.
My guess is that as your dad’s PSA rises he will start ADT on an ongoing basis and also add Zytiga and prednisone to the treatment plan. Or possibly add ADT plus early chemo (perhaps taxotere). These are the latest approaches, supported by the Stampede Study and the Lattitude Study. A great source of information is the Prostate Cancer Foundation website.
We wish you and your dad much success with his journey.
The problem is he'll become castrate resistant after a year or so and he is self employed in India so obviously no medical insurance.Zytiga and xtandi cost s a lot and still not available here.So the only option left will be chemo which i know he'll say no.So whats next?
Your dad is doing well at present with undetectable PSA. James has given excellent advice in view of long term survival. I would like to add few more points for you to bear in mind. GS 4 + 5 PCa is very aggressive and in the event of any progression with a significant PSA hike you should hit the cancer as hard as possible without wasting time. Combination of drugs are now considered as more effective in treatment. Proper diet, some accepted supplements and vitamins and without fail regular exercises too will enhance the effectiveness of all treatments and the quality of life. More than anything else you must have a smart oncologist who is specializing in treating PCa for your dad. Thanks for seeking help from our group and I appreciate you being a very caring daughter for your dad.
Wish you both Good Luck, Merry Christmas and Happy New Year!
The problem is he'll become castrate resistant after a year or so and he is self employed in India so obviously no medical insurance.Zytiga and xtandi cost s a lot and still not available here.So the only option left will be chemo which i know he'll say no.So whats next
Zytiga and xtandi cost quite a lot of money is alright. But what do you mean ' they are still not available here" ? Where do you live ? In India ? May be since your dad is self employed in India. Zytiga ( Arbiraterone ) is available in India, much cheaper, under different trade names but Extandi ( Enzalutamide ) is not manufactured in India.
It is pretty obvious that when the first line of ADT stops working the second line should be tried ( Arbiraterone and Enzalutamide ). It will definitely work. How long ? depends on the pathological and genetic condition of the individual. We can't just come to a conclusion and say your dad's PCa will become castrate resistant within a year or so. IMO the best next move for treatment is to use Arbiraterone ( whatever cheaper brand available in India ) in combination with the ongoing ADT before the cancer become castrate resistant. According to the recently concluded Trials STAMPEDE, CHAARTED and LATITUDE such combinations will yield significant long term survival benefits. Even chemotherapy is more synergistic with a combination drug such as first line or second line ADT. One can easily face chemo with early preparation to avoid the known toxic side effects. Fear is all due to ignorance.
Due to unavoidable constraints, especially financial if you are unable to move on to the second line ADT, the only treatment option I can suggest is the Estrogen Therapy : Trans-dermal Estradiol with Dexametosone which is very much cheaper to all other PCa treatments. But it may be difficult to find an Onco who is willing to go for this treatment. It is a pity that majority likes expensive cancer drugs and mainly big pharma simply ignores them.
Be proactive and get ready for the battle with courage and confidence. Knowledge is always power. Motivate your father and learn how to manage advanced prostate cancer. You have enough resources on a daily basis in this blog alone. Don't forget the following favourable aspects of your dad's PCa.
- He has debulked his cancer by the prostatectomy. Thus the residual balance is a manageable burden
- IMRT would have killed all or nearly all residual cancer cells in the pelvic reagion.
- ADT is a systemic ( whole body ) treatment would have killed a good number of floating PCa cells and keeping the others starved suppressing growth.
- At present only micrometastasis can be possible and apparently further progression is being arrested. But don't forget GS 9 can move very fast.
Capitalize on these strong plus points and work hard.
If there is a will, I am sure you will find a way.
We will not leave either your dad or his beloved daughter ... to fight alone.
Bone density scan is needed ahead of most treatments to get a base analysis so changes from treatments can be noted and supplements can be added to diet to prevent osteoporosis and bone fractures. Bone scans are usually only show mets with higher PSA #'s. Some of the newest scans that are available only a few places around the country do show minor mets sooner, you might research them in other posts on this sight...sounds like your dad is actually doing pretty well in our Gleason 9/10 club.
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