First injection of Elegard

[Redmonder]

My father, who is 78 and has prostate cancer (Gleason 9/10, potential spread outside the prostate), is going to receive his first injection of Elegard tomorrow. Is there anything we should discuss with his urologist during the office visit and what should he expect in the coming days?

[Tall_Allen]

He should be talking to a radiation oncologist. Before he has his Eligard injection, he should consider this:

healthunlocked.com/prostate...

[Redmonder in reply to Tall_Allen]

The info could be interesting, but we’re in Florida. If it were a trial treatment, then maybe it’s worth it, but even if we get chosen, I don’t think it makes sense to delay treatment and consider flying across the country for a scan.

[Tall_Allen in reply to Redmonder]

They just opened the trial, so I don't think there's a waiting list. At any rate, you have nothing to lose by calling - if they can take him within a week or so, the delay in treatment is minimal. In central Florida, I can recommend he see Matthew Biagioli in Orlando. He specializes in a kind of brachytherapy called "high dose rate", which when combined with external beam therapy to a wider area, gives the best chance of a cure for men with high risk prostate cancer. He should not be treated by a urologist.

[Redmonder in reply to Tall_Allen]

Thanks for the tips. Why should he be treated by a urologist?

Our appointment for the Eligard injection is scheduled for tomorrow. What about getting the injection and then talking to an oncologist? Our understanding is that hormone therapy just slows down the growth of the cancer and it doesn't preclude other treatments. We area also getting a second opinion from the Mayo Clinic in Jacksonville, Florida, but wanted to start hormone therapy to halt the growth of the cancer.

[Tall_Allen in reply to Redmonder]

No, I said he should NOT be treated by a urologist. Urologists are not expert in curative therapies for a 79 yo man with PCa. He should be seeing a radiation oncologist- not a urologist or a medical oncologist. A medical oncologist is an expert in non-curative therapies. They know less than I do about curative radiation. Talk to Biagioli. If you don't want to get the free PSMA PET scan before the Eligard injection, they can plan his therapy without it. They will probably want to treat his pelvic lymph nodes anyway.

[Redmonder in reply to Tall_Allen]

Is there any benefit to him for participating in the study? Sure, it's nice to contribute to science, but it would potentially delay his treatment and incur the cost of flying to UCLA. Would the trial organizers put him in touch with treatment options back here in Florida or somehow improve his chances? I'd think that would bias the study.

[Tall_Allen in reply to Redmonder]

The benefit is that it can potentially:

(1) Find sites of cancer, e.g., in the pelvic lymph nodes, that may benefit from a boost dose of radiation, or

(2) Find sites of cancer in remote locations, e.g., bone, which might obviate the need for radiation (depending on how many).

No, they don't refer patients to doctors. I recommended Biagioli to you.

[Redmonder in reply to Tall_Allen]

So a PSMA PET scan is more accurate and concise than the CT and bone scans that he's already had? We're also scheduling an MRI, which is complicated by the fact that he has a pacemaker (though it's an MRI-compatible pacemaker).

So if his cancer has spread to bone, then radiation isn't an option anymore?

[Tall_Allen in reply to Redmonder]

"So a PSMA PET scan is more accurate and concise than the CT and bone scans that he's already had? "

Yes, the PSMA PET scan is the most sensitive scan available anywhere in the US. This may help you understand the various kinds of scans:

prostatecancer.news/2016/12...

"So if his cancer has spread to bone, then radiation isn't an option anymore?"

Well, it may or may not be an option, but it will not be a curative option. It's called "debulking." If there are very few bone metastases, radiation of the prostate can still delay progression. It may also prevent prostate problems later on.

prostatecancer.news/2018/09...

[depotdoug in reply to Redmonder]

Agree totally my 68G-PSMA-11 PET/CT scan 08/01/2019 was the best test i could have ever had. My onc/ urologist assistant professor doctor is part of the head of that PSMA PET i had done.

Yes. Redmother my IMRT 42 radiation zaps got rid of PCa or so i thought back in late 2005. Wrong i should have opted for brachytherapy 1st.

Tall_Allen is absolutely correct RO doc is your best choice for killing locally ID’d PCa if that is what you have.

Please consider getting an 68Ga-PSMA-11 PET Scan 1st. It Florida, i got my PSMA in Indianapolis IU Neurosciences Reaearch center...

[CSHobie]

The first few months on Eligard is not very eventful. I am much younger than him, at 52, but apart from the loss of sex drive not much happens.

The thing is, how much testosterone does he still have at 78? My guess is that he won't feel much of an impact.