Hi all, I am from India and my father (75 years) was recently diagnosed with metastatic prostrate cancer with distant metastasis to bones (avid during PET scan). He has had an enlarged prostrate for a long time and a recent blood test showed a PSA of close to 500! That is when a biopsy was done which showed 60% tumor involvement and a Gleason Score of 8. His MSI (High) test ruled out any targeted therapy relating to that. He has been advised BRCA 1&2 to consider the possibility of adding a PARP inhibitor to the treatment. He doesn’t have any bone pain.
He was put on 3monthly leuprolide acetate injection and given bicalutamide for the first two weeks. As he is anemic we got him some iron infused intravenously so that his hemoglobin is at an acceptable level. All other blood parameters are fine and a recent 2D Echo showed all well with the heart as well. He will now start Abiraterone Acetate (and steroid). PSA has gone down from 500 to 42 after a month of the injection.
The doctor has said the treatment will progress as follows - ADT along with Zytiga followed by possible chemotherapy/radiology if and after ADT fails. I have not yet asked if PARP inhibitor will play a role prior to ADT. Does it?
I will be grateful if someone could advise if there is an additional line of treatment which can be added? I stay in the same city where Dr Ishita provides Lu 177 treatment and where APCEDEN therapy is administered. My medical oncologist isn’t too supportive of immunotherapy because as per him they don’t work well in PC. But I might take a second opinion if others have benefitted from it. Or am I thinking too far ahead and should wait to see how ADT progresses?
Also, does the ADT shrink the prostrate? Father has been on a catheter for 1.5 months as the nearby hospital has converted into a dedicated COVID hospital so TURP can’t be done for another month at least and we don’t want to risk him catching COVID by moving him to a different hospital.
Thanks a lot! Apologies if I am asking too many questions but I really want the best treatment for my father.
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Rodeoz15
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Dear Good Son...Rodeoz15. Reviewed your father's data above. Good news is that his PSA is coming down beautifully with initial treatment. This is a good beginning. You dont have to fear that his starting PSA was 500..because high PSA secreting cancer cells are in fact less dangerous than low PSA secreting cancer cells.His Oncologist is on right track. He should be on Lupron plus Abiraterone (Zytiga) in order to block all 3 sources of testosterone(androgens)....This regimen is going to knock down his PSA to less than 1...which will be a fantastic good news. It will mean most of his cancer cells are DEAD. So..wait and watch his falling PSA for next 9to 10 months and see how low PSA reaches finally.
Yes..Treatment does shrink prostate gland and that will enable him to get rid of catheter..hopefully in next few weeks.
As for BRCA 1 and BRCA 2, Have he been tested for these germline mutations ? Is he BRCA2 positive? Even if he is BRCA positive, the current line of treatment still remains the same.
BRCA+ mutations only indicate that his prostate cancer is more aggressive than usual prostate cancer. and may require aggressive treatments.
At this point, there is no need for immunotherapy. Let the current treatment do its magic and get PSA below 1.0. Leave immunotherapy for a later time. Good wishes to you and your father.
BTW, its lockdown in New Delhi. But do not forget to sneak out of home (or order online)
for him ...cancer killing foods like Cauliflower, Cabbage, Radishes, Munakka, , Giloy, Guava, Pomegranade etc. Make sure to tell your mother to put extra spoonful of Turmeric powder, Ginger powder, Garlic and Onion in his moong lentil soup and vegetable curry.
Its Mango season..its OK for him to enjoy some Langada or Dashahari sweet Mangoes as they have good amount of Carotenoids and Vit A.
Yes, ADT will shrink the prostate, but it may take some months.
In the US, he could not get Provenge (an immunotherapy, similar to APCEDEN) until after he is castration resistant. A PARP inhibitor and another radiopharmaceutical, Radium 223 bichloride, are also only available if one is castration resistant.
A recent clinical trial proved that chemo+Zytiga works better than either alone.
WelcomeRodeoz15! I’m sorry about your father . Mine had it also. If you’re the daughter welcome and if you’re the son , please get a PSA starting at 40. I don’t have medical advise . Love is important now more than ever between you two. He will be depleted in many ways . Keep his spirit up and cheer himAnyway possible. I’m glad he has you advocating for him. This us the highest form of love . I salute you and him. Together you’ll do the best for him . 🙏🙏❤️
All good advice. Be sure and add exercise to combat fatigue. It will be difficult but necessary. Tell him he likely has a LOT of quality time left with the family. Enjoy your lives all possible. If he tests positive for the BRCA gene mutation get yourself tested immediately and regularly. Educate yourselves, build a good team of oncologists, follow their SOC recommendations.2Dee
hello My dad went into remission using natural progesterone creme!!! He had a radical prostatectomy went he was 75. At 85 his doctor ran a psa it was 20. He was given l upron shots for 6 months which lowered his PSA below 1. He felt horrible and looked horrible.He started progesterone....8 to 10 mg topically and stayed on remission for 7 years. Very important dosage and the application of progesterone must be moved every time it is used.
One day on the left arm, one day on the right arm, one day on the back etc.
The molecular science is in JAMA. Progesterone upregulates a gene p53 responsible for Apotosis and down regulates p13, this gene turn on the cancer. Also too little progesterone it will not work.....too much progesterone makes the cancer grow......8 to 10 mg!!!! Forgot he stopped Lupron! At one point after 3 years he stopped following direction and put the progesterone on the same spot. His PSA doubled in 6 months and he undergone a round of lupron shots. After that he never used lupron again!
I had it around is buried in one of my computer disks. I told you all you need to know. There are only 2 studies done and they are small. One in Italy which I could not read because its in Italian. The other was done in the 50's in Texas. 2 American doctors used progesterone in their practices for prostate cancer and breast cancers and wrote books.Johnathan Lee MD (havard trained) and Johnathan Wright MD. The JAMA study is a molecular study............you may be able to google it.
My father was also diagnosed with prostate cancer. His Gleason is 9. He was initially presented with the option of chemotherapy or Zytiga of course along with ADT. He chose to do the chemo first and it has really worked well for him! It beat the cancer back for more than a year and he has not had to go to anything further yet. I would recommend the chemo first before the Zytiga.
Thank you, Karyn. That is very good to know. The doctor advised against chemo for my father looking at his age and general fitness. But I will take a second opinion as well.
I understand. My father is 72 and he is very fit and athletic. Over time the ADT has put weight on him and he has a belly now. He still stays very active walking and golfing and that has helped. The chemo was not pleasant for him. It started out ok, but with each incremental session got more bothersome. He completed the six sessions and really feels it was worth the discomfort. Also my father has made it a point to eat non processed foods and that has really made a difference as well. I wish you and your father good luck and success with this journey! There are tons of tools to keep him going strong for a long time so have much hope and strength🥰
all those things are good for the overall health of your body and are a big plus but concerns are for medicines that make cancer growth impossible.Research each one and find out what its designed to do.Check the studies done and see what good it can do.Dont be overwhelmed with med terms.They are just different words.
i know that avodart shrinks the prostate and so does finasteride. LUPRON may help your Dad if all else fails. A friend psa 300 with a rock hard prostate at 81 years went on monthly injections of lupron and live to be 96 years and went to work everyday til he died of something else.
Greetings Rodeoz15,You obviously know your stuff regarding Pca. You've come to the right place for information. Keep posting. (btw are you in the medical field?) Give your Father my regards and tell him he has a good son watching out for him. Make him laugh....
Yep stress will do you in.... we all went through it and still do every time we wait for doctor's appointment regarding MRI's, Cat Scan's and PSA test results and etc. I know it's difficult but try laughing with your Dad. My way of beating the tiny bastards is to laugh. So if you see my silliness here it's to make members laugh, see when they laugh I do too. I am a born and bred American who loves various cultures and languages. I can speak a little Hindi but write it phonetically. If you speak Hindi here is my favorite Hindi word (Like the sound of it and it may not be true Hindi) "Mehabooba"... Anyway regards to you, your Dad and the rest of the family...
Yes I realised soon after I started reading about this. English is not my native language and everyone around was pronouncing it as 'prostrate' and I thought that is how it must be spelt! Haha
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