My Dad just had his first oncology visit. In April he had trouble passing urine, prostate was very large and referred to urologist. MRI revealed Grade 5, PSA of 14.2 and biopsy was done came back at 4+3=7. Prostate was removed on 8/9/18, pathology results showed spread to 3 lymph nodes, Gleason score 10. His primary sent from for bone scan and it is in his hips, ribs, spine (right hip shows severe metastasis). Lymph nodes in throat are now enlarged as well. And psa at 5.33. Luckily he is not in any pain. His oncologist wants to start hormone therapy now and chemo in three months. His urologist is against both options and wanted to do radiation and pills. One would hope that the oncologist knows more about treatment than the urologist and the urologist also did not find this four months ago. Urologist also urged him against going to Karmanos since it is a teaching and research hospital. Just trying to find out what is best for him...
Stage IV Treatment Advice Please - Advanced Prostate...
Stage IV Treatment Advice Please
I can't imagine why this urologist would recommend AGAINST a teaching and research hospital. Karmaros is excellent - so is U Mich. If the urologist had done the bone scan BEFORE the surgery (which is standard for unfavorable risk PC) your father might have been spared a prostatectomy. Too late for that, but this urologist does not sound very good to me.
Thank you!
Listen to the oncologist.
Radiation doen't make sense for multiple skeletal metastases. The urologist doesn't seem well informed at all.
Thank you so much. Very much appreciate the referral!
Hi Jane, how old is your father? Any further illnesses or important medical history? I was first seen at a teaching hospital by the Urologist lead for 7 London hospitals. He sent me biopsy, MRI of the lower abdomen and hips and whole body bone scans. My GP had already told me my prostate was recorded as 3x larger than normal and my PSA 200. I am 72. He told me I was Stage 4 and too advanced for surgery, radiotherapy etc. He passed me to the lead Oncologist nearly 5 years ago and she is still my wonderful saviour. PSA 0.07 having been 0.03 to 0.04 for four years. Just started rising. 5 years ADT, 10 cycles chemo, now Zytiga (2 years) .
He is 65. No other illnesses. One sister who passed away from Ovarian cancer.
Thank you for sharing!
Go with oncologist and start ADT NOW. Chemo stopped my bone mets. and soft tissue mets disappeared. Stage 4 Gleason 9/10.
Do what I did in 2003; fire the Urologist. You need a pro deals deals with and understands metastatic prostate cancer. Question. How long has he been a patient of his Urologist? I asked, because my longtime Urologist failed me. I found that the person who helped me and cared about me was in academia. Yes, a Professor and Researcher at a major facility. I got there through recommendation by two Radiation Oncologists.
In 2004, my PSA was 32.4 on a Gleason 7(4+3) biopsy with metastatic lesions on L2 and T3 of my spine. I was 57 years of age and Stage 4. Don’t jack around. Find the best Medical Oncologist available that specializes in metastatic prostate cancer; not one who treats other cancers. You want a pro. I enrolled in a six month hormone-chemotherapy trial and haven’t looked back since. I was most fortunate and had atypical results. I believe in my heart that the reason was that we attacked systemically the cancer while my body was still strong and the tumor burden minimal; before it ravished my body. Consequently, I am biased toward early and aggressive treatment of this bastard, while no walk in the park, all side effects were overcome and at age 71, I enjoy a great life with my family.
Gourd Dancer
He has been with the urologist since May, so not too long.
Thank you for sharing your experience. I’ll be sure to share with my Dad!
I, also, got dx'd because of difficulty passing urine a year ago. I was scheduled for surgery but the urologist did a bone scan first and found the mets. Surgery canceled and put on lupron, the theory was the lupron would shrink the prostate enough to relief the urination problem. Well, it didn't; I'm castrate-resistent and it took a TURP to cure the urination problem - after 160 days with the Foley catheter. Not fun!
So while I would concur with the advice given by others on this group, I would (1) get a TURP as soon as possible to take care of the urination. Your dad will feel SO much better! I guarantee it!! (2) start chemo concurrently with the ADT right after TURP surgery recovery.
In this order because I don't think it's a good idea to have sedation for something non-critical while on chemo. But that sequence worked for me. I also cannot emphasize enough having trust in your oncologists/urologists. Your father is putting his life in their hands and needs to have full trust in them.
Let us know how things work for your Dad. We are with you and him all the way. Attitude is everything. Give him your full support also.
(Parenthetically I had a colonoscopy yesterday which came out clear. The surgeon told me they had been "iffy about doing the procedure given your condition." DON'T allow yourself to be "written off"! I had insisted and will spend the next several years without colorectal concerns.)
You are all wonderful! Such a supportive and helpful resource. Feel much better hearing these stories.
I will surely give him my full support along with the rest of my family! Thanks!!
The uro seems out of touch. Mine was also. Glad that I did not follow his original plan for me. I had pc specialist take over and overshadow the uro ‘s original call for six months of chemo. Instead I did imrt and adt to date with the best results so far. It’s rough to see him suffer. I’m sorry for the misery and anxiety of it all.. , we ‘ ll be praying for dad.. comfort support and love is all you can do. These are the most important... Take care Jane...Scott 🙏
He was not served well by his urologist. Fire the urologist and maybe the primary care physician too. Between those two, he was not adequately screened for prostate cancer, which is a slow moving disease. He's probably had prostate cancer, that could have been detected, for years. That assumes that he got his annual physicals and screening.
to jane $88.89, Ditto to all of the above...
Good Luck and Good Health.
j-o-h-n Wednesday 10/03/2018 6:53 PM EDT
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