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Looking at dramatic decline in PSA, it is clear that your Dad is responding very well to current therapy. I would wait and not go for surgery with this kind of super response unless there is evidence in future about increase in PSA
Add some other supportive measures such as vegetarian diet, lot of home made yogurt, cauliflower, cabbage, radishes tomatoes ,spices and herbs , Vit D caps, and walking 4 to 5 miles a day with some weight bearing excercise to minimize side effects of AD and slow cancer progression.
Note that average PSA for a healthy Indian Man is 1.5. As long as his PSA stays below 1.5 after treatment and he is asymptomatic with normal blood count...there is no need to worry too much. I would like to monitor PSA at least once every month and keep record.
Yes, the response to Hormone Therapy has been fantastic.
Furthermore, Its nice to know that vegetarian diet would help fight the prostate cancer, as our whole family is vegetarian. As advised by you, will try to incorporate and focus more on the veggies in the diet.
Have started Tab. Shelcal CT for Vitamin D, Tab. Neurobion Forte for Vitamin B-Complex and Tab. Folvite 5 mg - for Folic Acid.
Would need to look into the exercise aspect as well.
Thank you very much for your valuable input and time. GoodLuck !
Not a true vegetarian but do eat lots of fruit and vegs and very little red meat but still do chicken,turkey and seafood.soynfs like he is doing well , keep up the good reports.
Do you plan for the combination of the external beam radiation with brachytherapy boost together with the hormones? Would give the best chance for cure. Good luck!
Our Doctor had told only radiation and hormone therapy. Will consult with him again regarding Brachytherapy boost. Thank you very much for your input. Highly appreciate it.
I don't know what is available in India, but if you can get a mixture of external beam radiation, HDR brachytherapy boost to prostate and seminal vesicles, and 2-3 years of hormone therapy, that would give him the best chance of a cure. This would involve:
(1) 25 treatments of external beam radiation (at 1.8 Gy per treatment) to the whole pelvic area, with a simultaneous integrated boost to the left internal iliac and left common iliac lymph nodes.
(2) High Dose Rate Brachytherapy boost to the prostate is preferred because it can reach to the seminal vesicles
As you have mentioned, whole pelvic area for the radiation, our Doctor is of the opinion of radiating only the prostate and seminal vesicle part and controlling the cancer in lymph nodes by ADT. He said that radiating the lymph nodes would cause problem to good organs nearby. But, I personally feel radiating the full pelvic area would be better in order to cure or control the disease.
Thank you very much for the specifics and direction regarding to the treatment that should be given. I would discuss this with our Doctor at the earliest. The information that you have provided means a lot to us. Highly appreciate it.
My case is a little more extreme. I had PSA of 258 and Gleason 5+5 on biopsy with seminal vesicle invasion and one ECE seen on the MRI. PSMA Pet Scan did not show any nodes or any other lesions anywhere in the body. I started Firmagon (ADT) immediately and after 4 months the PSA was 1.47. I was advised IMRT 39 sessions @ 78 Gy covering pelvic bed, pelvic lymph nodes, seminal vesicles and prostrate. I have completed this from Nov to Dec. The ADT continues and doctor wants me on it for at least 24 months total or more. I am 74 years old without any comorbidities and was advised against RP to avoid side effects. Thankfully, there have been very minimal side effects with the IMRT for about a month and I am almost back to normal now. I have no urinary urgency at all during the day. At night I get up once mostly. There is a checkup 3 months after RT completed with PSA and blood tests and at 6 months with PSMA Pet Scan and some other tests. I have had a Dexa scan in 7 months after starting ADT which shows normal bone density. Let me advise you that your Dad must exercise daily with walking at least 5-6 km and preferably take up weight training under a good trainer. This is to prevent loss of muscle and not necessarily to become a body builder. He should also keep his weight under control with a Body Mass Index of less than 23.5. Ideally should not put on weight on the waist. Blood sugar should be checked as it tends to go up with ADT. I am from a diabetic family so was mildly pre-diabetic but so far with exercise and food control seems to be still only borderline. Best of luck to your Dad.
We are advised to be on ADT for 2 years. Further continuation will depend on the reports at that time. Have finished the 6th Fraction of VMAT Radiation Therapy today. No side effects of radiation seen so far. But the Doctor has said they might come as the treatment progresses.
Will focus on the exercise after completing the radiation. My Dad's age is 62 years, Height- 178 cm and weight is 85 kg. The body mass index is higher than 23.50 will need to work on that as well.
Good thing is that he has no diabetes and blood pressure. I suppose this will help him to recover quickly from the side effects of radiation.
Thank you for the guidance and time. Will be in touch.
If done accurately with great discipline the radiation can be effective and minimum of side effects. I chose the best radiation oncologist in Delhi just for this reason. My brother in law whose wife is a Professor at MDA(Houston) was keen that I should go to MDA but I demurred owing to major logistics issues and of course cost. It costs about 8 to 10 times of Indian cost. I also consulted with a top radiation oncologist in Mayo who is a friend. The advice was to go with standard of care for high risk PCa and that is what I did. My RO says that she wants me to be on ADT for at least 3 years if not more. Let us see how I weather the first year!!. Best of luck for your father's treatment. I hope it is successful and he goes into a long, long remission.
As you said, Asking the right questions is of prime importance. There is a lot of literature available to study. But making the final decision when our life is on the line becomes little difficult.
Considering the Quality of Life, We avoided Radical Prostectomy (Risk of Incontinence) We have started with ADT and Radiation, but the question still keeps haunting me about skipping the surgery. Only time will tell....!
Thank you very much for help and guidance. All the Best
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Newly Diagnosed - Advanced Stg Prostrate Cancer.
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Next step. Some advise please
