Hello all. My 68 year old husband had a routine physical about six months ago that showed a PSA of 77. His PSA had not been tested for seven years prior (which infuriates me). He then had a biopsy that showed Gleason 9 (4+5) prostate cancer. Twelve samples were taken; only one sample was benign. Two samples showed Gleason grade group 4 (4+4) and the remainder grade group 5 (all of which are 4+5, however 9 samples show 5-10% ‘pattern 5’). Two samples stated that ‘Perineural invasion is present’. Two samples showed ‘Intraductal carcinoma with tumor necrosis’. A subsequent CT scan showed four enlarged lymph nodes in the vicinity of the prostate. His bone scan showed three areas of bone metastasis (“Findings suspicious for osseous metastatic disease involving the medial aspect the left iliac bone adjacent to the SI joint, posterior lateral aspect of the right fourth rib and T7 vertebral body.”) He has had genetic testing; nothing found, despite a long family history of cancer.
My husband was put on Casodex immediately and then on Eligard. He has been fortunate to have no side effects. His current PSA is .19 and his testosterone is ‘< 10’, so the ADT has been effective. We have been advised by the medical oncologist that the next step is either Docetaxel chemotherapy or Zytiga.
Meanwhile, my husband went to a PC conference out of town recently. One session was given by a well-known radiation oncologist at Medstar Georgetown University Hospital on the use of radiation in oligometastatic PC. I gather this is somewhat controversial. My husband then met with the radiologist in his office, and he felt confident that either Cyberknife (probably not covered by insurance) or IMRT radiation to the prostate and the mets is an appropriate next step.
Does anyone have any thoughts/insight on this?