Hi,
Just returned from first oncology appointment with husband. PSA was 167, Gleason 9, spread to local lymph nodes.
Treatment plan they are proposing (he's plan on HT injection for 2.5 month's) is 6 rounds of radiotherapy and followed by 7 weeks of radiotherapy. I mentioned Brachytherapy but he said more dose would go to the prostate which would mean less to lymph nodes and Abiraterone has same results as chemo but would have to be paid for out of pocket.
What do you think?
If it has only spread to local lymph nodes, it still may be curable. What you have to ask for is not brachytherapy, it is brachy BOOST therapy. They are different, and you would have to see a radiation oncologist who specializes in that. It consists of external beam radiation to the whole pelvis and a boost of brachytherapy to the prostate itself. For men with cancerous lymph nodes, 2-3 years of ADT are given with it.
Neither abiraterone nor chemotherapy have any proven benefit with it. However, I don't understand why chemo would be approved but not abiraterone.
Thanks, sorry I did mean Brachy boost. I did ask about this and he does specialise in radiology but he told us they would give it without lymph node involvement but with lymph nodes the Brachy boost would mean less dose could be given to the nodes.
Abi isn't approved as a first line treatment in the UK but chemo is, apparently given an extra year of life
Radiation oncology is not enough of a specialty - you have to speak to someone who specifically knows about brachy boost therapy. If you can, see Peter Hoskin, Mount Vernon Hospital, Cancer Centre, Northwood, UK.
Chemo does not seem to have any survival benefit except for men with multiple DISTANT metastases.
I think pelvic area and the spine is not considered "DISTANT metastases"?
They are regional, but ALL bone mets are stage M1b and are, so far, incurable.
EDITED Post between *
"If it has only spread to local lymph nodes, it still may be curable."
Isn't this "metastasis", any tumor findings outside of the prostate? Are you saying only local lymph nodes, that is, no * "other" tumors around the pelvic area and/or extending from the prostate*?
We were told lymph nodes within the pelvis are N1, M0. Distant lymph nodes are M1
I agree with Fdccs - pelvic LN mets (N1) may be curable, whereas distant LN mets (M1a), bone mets (M1b), and visceral mets (M1c) are not.
Hi TA,
Well, you know I'm a software guy, so for me, Metastasis is a boolean expression, 0 or 1, or Yes or No.
Diagnostics cannot definitively determine T, N and M categories, or if you're into the blue colors.
Biology is not computers. We have to go with what we can know. it's better than guessing.
Aren’t we talking here about the difference between Stage IVa PCa, which might be a long shot but is still curable, and IVb, which is outside the bed and local nodes and not?
Look at my response to TA, the classification of what "DISTANT metastases" means varies in my research.
How about bladder neck?
Bladder neck is not even a metastasis
Thanks for replies
By the way my name is Gemma, I need to change my profile name
Really ? That’s great , except it causes lots of other problems . I think my husband is considering a urostomy.
I think his problems stem from his salvage surgery.
Unfortunately I think your right. We are getting a couple of additional opinions before he rushes getting a urostemey as his current urologist that did his salvage is suggesting. The people that I know that has success usually have their bladder removed as well but he didn’t mention that.
There are exceptions to the rule that M1b is not curable under the right scenarios. As one of nine “guinea pigs” with a complete response almost fourteen years ago, I can attest. One day, the rule will change.
Gourd Dancer
Has there been any genetic testing done or considered? I had a simple saliva test with Color Genomics, as recommended by a MO. Turns out I have BRCA2 mutation, which will now help in determining my future course of treatment. This has also answered me the question as to why I now have aggressive PC. In addition, now that I know I have BRCA2 mutation, I have followed up with my children (2 daughters). One of which has now been tested and also has the mutation.
My husband needs to get this done. Is it costly? What will they do for your daughter? We have three. My husbands father and uncle on his mom’s side passed from APC or PCA not for sure of my acronyms yet.
Genetic testing may be partially or fully covered by your health insurance. The Color test retails for $249 at color.com. My daughter has signed up for a preventative program offered at Sloan Kettering called RISE, and will be closely monitored.
Hi Gemma
If you haven't seen the prostatecanceruk site its worth taking a look at. Also they have a helpline you can contact that might help for queries.
Re abiraterone this link might help as it explains at what point in the UK its prescribed.
prostatecanceruk.org/prosta....
Best wishes to you both
Mike
Well Gemma you've come to the right place for valuable information. Tall_Allen knows his stuff. I just know humor.
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 01/23/2019 6:49 PM EST
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