Radiation or Chemotherapy on Prostate?

[Here4Dad]

Hi All,

I wish I was back with better news but we met with my Dad’s oncologist for our 3 month checkup after completing chemo and found that although the cancer has stopped growing in my Dad’s bones and lymph nodes, it continues to grow in the prostate gland in specific. My father actually suspected this, as 2 weeks ago he abruptly stopped being able to urinate on his own. Luckily, he has no issue self catheterizing but says he would rather die than have a catheter bag again 😢

Since the cancer seems to have stabilized elsewhere in his body but continues to grow in his prostate the oncologist referred me to a radiation oncologist to discuss further treatment options. I’m not sure if we should try chemotherapy again as he did respond to it or try radiation on his prostate? Also it is important to note, my Dad has never done any radiation therapy. At the time of diagnosis his cancer had already spread to three different bones and lymph nodes. We immediately started Lupron and did chemotherapy.

My Dad is pretty checked out which leaves me with the decisions. He even left his appointment early today before the results were given to not miss a work appointment. I stayed behind to not only get the results but discuss next steps. Trying to not get overwhelmed and continue to be proactive on my Dad’s behalf.

Any advice would be helpful and appreciated!!!

Also including pic of my Dad and all his grandkids as my daughter was just born February 17th and he is just smitten by her. Makes me happy that his grandkids love him so very much ❤️

[GP24]

I would recommend prostate surgery, this will debulk a lot of tumor mass and remove the obstruction of the urethra.

[Here4Dad in reply to GP24]

Is this shaving of the prostate or complete removal?

[GP24 in reply to Here4Dad]

I would remove it. You do not need a prostate full of cancer.

[judg69]

Here4Dad, from my perspective I would go full- bore with maximum radiation to the whole greater prostate, and prostate bed. As you are now discovering, you will get all kinds of differing advice here and from Doctors from different specialties. Undoubtedly, Tall_Allen and Nalkarats will shortly give you their advice/ recommendations. Pay close attention to their counsel as it is normally spot on. Best Wishes to you and your Dad! judg69

[Here4Dad in reply to judg69]

Appreciate your input! Thank you 😊

[Tall_Allen]

Consider a TURP (or similar) rather than radiation or surgery. Two recent trials proved that men with multiple metastases did not benefit from total prostate removal or radiation. However, a TURP, HoLEP, REZUM, or prostate artery embolization may provide sufficient urinary relief.

[Here4Dad in reply to Tall_Allen]

Thank you for your input! Any ideas as to why only the cancer in his prostate would grow and not the cancer that has spread in surrounding areas??

[Tall_Allen in reply to Here4Dad]

Everyone's cancer is different like that.

[Shooter1]

Had three bone mets and 2 lymph nodes and still had prostatectomy. Bag for a week as splice healed. Diapers for a week then pads for a while. Nothing after 6 weeks. No more prostate pain. Right decision for me but we are all different..

[Here4Dad in reply to Shooter1]

Thank you for sharing your personal experience with prostate removal!

[whatsinaname in reply to Shooter1]

There are at least a couple of people on this board alone who have been completely incontinent ever since they had surgery. They had the courage to admit it. I wonder how many others are incontinent after surgery but do not admit to it openly.

Incontinence is a very real problem that surgery creates. One should be aware of this.

[407ca]

I would consult with a radiologist who does SBRT.

When I went to MD Anderson my oncologist was of the opiniin that even with mets, there was benefit to treating local recurrance. I took his advice and had treatment to known mets and prostate. He described me as oligometastatic. Even though other cancer cells are likely circulating, the known tumors were dealt with. Why let it grow around the prostate and spread there if at least that area can be improved? Also, my urinary function improved.

All the best.

[Here4Dad in reply to 407ca]

Your personal experience gives me hope! Thank you for sharing!!

[Jimdoud1]

I did radiation first, PSA dropped to .02, then did chemo. PSA 0.1 since. Taking Lupron and Xgeva shots quarterly and Zytiga and Prednisone daily. 23 months since diagnosis PSA 0.1. One bone Mets and two lymph nodes. Radiation is area specific so I would recommend it for sure. Drink Aloe Vera heart juice to ease the burn which is relatively minor.

[Here4Dad in reply to Jimdoud1]

Thank you!! I’ve heard great things about Aloe Vera juice 👍🏻

[whatsinaname in reply to Here4Dad]

Aloe Vera juice (as with all things Aloe Vera) is excellent.

[j-o-h-n]

I hate to comment because it's your Dad's call. (looking around ok I can whisper now, do what I did - get that frigging thing out asap).

So any of those kids for sale?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/30/2019 7:39 PM DST

[Here4Dad in reply to j-o-h-n]

Thank you for your input! I spoke with him about removing it but he wants to use that as a last resort as he is fearful of incontinence.

[j-o-h-n in reply to Here4Dad]

He's right!

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/30/2019 9:36 PM DST

[whatsinaname in reply to Here4Dad]

He is 100% right about fearing incontinence.

[RonnyBaby]

I believe that in this case, a TURP and radiation to the whole area (pelvic) might be the best approach. The TURP will enable the restoration of urine flow (will need about 1 week of catheterization) and the radiation treatment will be able to work on a larger target area I am assuming that that scanning / testing would confirm node involvement.)

It is clear that the cancer has spread, so I'm assuming evidence will indicate that.

The possible incontinence (that many suffer from after RP) could be avoided.

I personally had both proceedures done and came out the other end in much better shape.

I'm sure we are all hoping for the best outcome.

take care .....