Treatment opinions for my father in India

[meowlicious99]

Hi,

I am posting this on behalf of my father. We are currently located in south india. I wanted to see if current treatment option suggested is the right one

Timeline:

* My father ( 69 yrs ) saw a urologist about 10 weeks ago urinary blockage, pelvic and rectum pain.

* Urologist did a psa test and PSA: 100 , the test was repeated the next day and PSA: 114

* Catheter was put in to relive pressure on kidneys and relive pain.

* Biposy of the prostrate:

Gleason 4 + 3 on all 6 cores , greatest % of core involvement of 61-70%

* PSMA Pet Scan :

GA-68psma : avid irregular mass legion in prostate involving base of the bladder and anterior wall of rectum

Avid multiple enlarged pelvic lymph node metastasis

No other evidence in the rest of the body

* Put on 3 month lupron depot injection 2 weeks ago.

* IMRT radiation to follow in 3 months time

I have been researching this disease a lot and haven't been able to get clear answers form oncologist here in India. Doctors here don't expect questions from patients and don't feel the need to give clear explanations. Drs in usa sound so knowlegble and patient.

*. I am wondering if current treatment is aggressive enough. I am worried that we'd miss a chance to use chemo/docetaxel on currently castrate sensitive cancer.

* One oncologist suggested that we might add xytiga 4-6 months down the line . Not sure what that is about.

* I don't trust radiologists here to do SBRT so we are ok with IMRT. We do have an option to do proton therapy here but its very expensive and I am not entirely clear if its actually better than IMRT.

I am so glad i found this forum and i am hoping to talk to other ppl here and post our journey here for others benefit.

[Tall_Allen]

May I suggest you get a consult with Vedang Murthy at Tata Memorial Hospital in Mumbai? He is an excellent radiation oncologist. A lot depends on exactly where those lymph nodes are, the degree of penetration into the rectal wall, and your father's personal anatomy.

[meowlicious99 in reply to Tall_Allen]

Hello thank you for your response. I contacted Tata memorial to get a consult with dr murthy but was told that he is currently not ‘active’ so can not do consults atm

[Tall_Allen in reply to meowlicious99]

I sent him an email - maybe he went elsewhere since we last communicated. I'll get back to you.

[meowlicious99 in reply to Tall_Allen]

oh wow. Thank you so much !!! Tall_Allen

[Tall_Allen in reply to meowlicious99]

BTW- I can answer your question about docetaxel. It's been found to not add very much when there are no distant metastases.

prostatecancer.news/2019/02...

[binati]

I am in India. I got my radiation treatment from Dr Tejinder Kataria at Medanta, Gurgaon. She too is a top class radiation oncologist. I had Gleason 5/5 and PSA of 250. However, no lymph nodes, one ECE and seminal vesicles involvement. Her team is very meticulous and she is a stickler for proper procedure. Tata Memorial should also be top class. You could consider SBRT to prostrate and IMRT to prostrate bed and lymph nodes.

[meowlicious99 in reply to binati]

We are in Hyderabad but i am trying to get an online consultation at Tata.

Intersting suggestion about sbrt plus imrt. Drs here seem to be unanimous about their preference for just imrt.

[binati in reply to meowlicious99]

There is now lots of data collection about cases treated with SBRT instead of HD Brachy. The main reason is minimum side effects. Data so far shows that the efficacy is almost as good. Most people still consider IMRT as the SOC but I think this might change as more data is collected. I was offered this mix of SBRT and IMRT but two years ago there was still doubt on SBRT efficacy. I think the opinion might change now once data proves it is effective. Your choice really.

[meowlicious99 in reply to binati]

Binati a quick question, why didn’t you get chemo in the beginning if micromets were suspected

[binati in reply to meowlicious99]

There was nothing in the PSMA PetScan so the advice was to just go for RT. Who knows if it will turn out right or wrong. I got lots of advice but no one suggested or recommended chemo.

[Rodeoz15]

I don't have a suggestion for a radiologist but if you want to consult a medical oncologist, Dr Joshi at Tata Memorial does teleconsultation and is one of the few doctors in India who patiently takes questions from patients and their attendants.

[meowlicious99 in reply to Rodeoz15]

Thank you they want me to get a second opinion with the board for 10k rs. I will request a teleconsult with dr joshi instead.

Qq if you don’t mind me asking, what was the rationale by your dr to add abiraterone to Lupron for your dad.

I keep getting told that abi is not needed for me father. I want to be sure if i press for this or not.

[Rodeoz15 in reply to meowlicious99]

My father had Stage 4 cancer which had spread all over his bones. If he was any younger they would have gone with chemo too. Abi plus lupron was recommended by all medical oncologists and I believe is the standard when you have PCa which has spread to the bones.