Started treatment

[JNunes]

Hi,

My name is Isabel.

I am Portuguese and I live in Portugal.

My message is related to a diagnosis of prostate adenocarcinoma, Gleason (3 + 4), initially staged with a T2b N0 M0, to my father, last year, at the age of 60.

On May 1, 2019 he underwent radical radiotherapy without hormone therapy. Completed treatment on May 22, 2019. 5 intense sessions. PSA after treatment dropped from 9.3 to 7.6.

However, starting in March, he had biochemical recurrence criteria, underwent examinations and presented bone and ganglionic metastasis with a PSA of 47.5.

It was suggested by his doctor to do hormone therapy with an LHRH analogue and evaluation in Medical Oncology to perform concomitant chemotherapy (docetaxel).

He also started with the treatment (just one session), but had mucositis. The treatment will continue in the next week.

I know what I ask of you is ungrateful, but do you have any guidance you can give us?

Any recommendations from an expert in Europe/Portugal? Any clinical trial?

Is there a very bad prognosis?

Best,

[GP24]

Mucositis is a common side effect of a chemo therapy. You should discuss this with the oncologist, maybe he can reduce the dose of the chemo infusion or give you a drug against that.

In general the treatment with hormone therapy plus Chemo is correct in your father's situation. He will live for a number of years after the treatment.

The initial treatment was suboptimal. The Gleason score is probably wrong and you should send the slides to a different clinic for a second opinion.

I do not know what type of radiation was done in five sessions. This is unusual. A drop from 9.3 to 7.6 indicates a failure of the radiation. A bone scan before the radiation would have shown the bone mets probably and then hormone therapy would have been added to the radiation.

[JNunes in reply to GP24]

Thanks. I appreciate your response.

Do you recommend any uro-oncologist in Europe / Portugal?

Best,

[GP24 in reply to JNunes]

Your current oncologist is performing the right treatment, no need to go anywhere else.

Ignacio Duran is a good doctor: researchgate.net/profile/Ig...

[Tall_Allen]

I also had radiotherapy in 5 sessions, which is usually a good plan for GS 3+4. Unfortunately, his cancer had already escaped the prostate. Probably, the biopsy missed some higher grade cancer, as often happens. It may be beneficial that he had this, as it may extend survival and reduce later urinary side effects.

That sounds like a good plan going forward. The LHRH analogue+docetaxel is a very good therapy if used early enough. If the mucositis continues to cause problems, some oncologists reduce the docetaxel dose. After docetaxel, he can try abiraterone, a powerful hormonal therapy.

His prognosis will be determined by how well he reacts to these therapies.

[JNunes in reply to Tall_Allen]

Thanks. I appreciate your response too.

[vivamais7]

I also am Portuguese 84 who for the last 24 years have been fighting PC; have not accepted RP and for 17+years on wait and see; have had a good quality of life and hope will go on with "dreams". I suggest Fundação Champallimaud (where I am in treatment), Dr. Jaime Santos (an oppen minded doctor). Do not let your father give up: he has to fight to live.

[JNunes in reply to vivamais7]

Thank you. I wish that you continue as well as until now.

My father is being accompanied at the IPO, he says he trusts the doctors and will do the treatments suggested to him, and that he will control the disease. Maintain his routine, without drama or neurosis.

Apparently, he believes that he will be able to spend many years receiving treatment and following his life.

He is a patient that all doctors would like to have. I am sorry that things were not controlled at first.

I will see the Foundation's suggestion that you recommends. Thank you.

The best for you.

[Hidden in reply to JNunes]

Your dad sounds like he is calmly trust in his treatments- that’s wonderful. Take it one day at a time and don’t let the sweetness of life be missed. Look for things to be grateful for and it will change your outlook.

[j-o-h-n]

Greetings JNunes, You've come to the right place for excellent information. Keep posting here and let us know what is happening with your dear Father.

Saudações JNunes, Você veio ao lugar certo para obter informações excelentes. Continue postando aqui e deixe-nos saber o que está acontecendo com seu querido pai.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 07/04/2020 12:04 PM DST ** Good Bless America **

[Hidden]

I did androgen deprivation therapy (Hormone Therapy) plus chemotherapy. The good thing about doing chemotherapy upfront is that in 18 weeks it's done and you can add an anti-androgen such as Abiraterone (Zytiga) or Enzaluatmide (Xtandi).

In my case, my doctor prescribed Zytiga after my PSA starting rising a bit over a year after diagnosis. Zytiga has been working for 2 years now and my PSA is still undetectable. So there is hope for years of successful treatment. Sounds like he is getting good care.