Right treatment path?

[Drandma]

My husband had RRP in 7/19. Post op path report upgraded from Gleason 7 to 9. Lupron administered and radiation to prostate bed and pelvic lymph node 12/19-2/20. No ADT after that. 10/21 PSA .29. 1/22 PSA 1.23. Lupron shot. PSMA showed cancer in hilar lymph node which was biopsied and diagnosed as prostate cancer. Consulted with specialist who said it could not be radiated due to possible lung/heart damage. Lupron shot was given in January and doctor doesn’t want him to get another one so maybe he can see where else it’s hiding. PSA/Testosterone check every two months. Thoughts?

[Magnus1964]

The cancer has spread beyond the prostate. What else does he need to know. I would think a milder ADT drug would be a good choice, i.e casodex.

[Drandma in reply to Magnus1964]

Given in addition to Lupron or instead of?

[Magnus1964 in reply to Drandma]

I would say in addition to, unless the Lupron side effects are too much.

[Justfor_]

You wrote: "Thoughts?"

Thoughts, I have aplenty, sad and practically worthless.

Advise, just one, but not applicable to your husband's case any more.

healthunlocked.com/prostate...

[Tall_Allen]

The PSMA scan does not tell you "where it is hiding." It is everywhere, even if too small to be seen on a PSMA PET/CT. The purpose of the scan is to see if the Lupron alone is working. If not, the doctor may want to add additional medicines.

[Drandma in reply to Tall_Allen]

Thank you

[Shooter1]

PSA up X4 in 3 mo. No way I would want to stop ADT. It's growing fast enough you don't need to let it grow even faster... JMHO.

[Drandma in reply to Shooter1]

Thank you

[CAMPSOUPS]

Dr. wants to see where its hiding.Its hiding alright. Its hiding while it festers and mutates. Time to treat it. Dont wait.

[Drandma in reply to CAMPSOUPS]

Do you believe Lupron is sufficient?

[CAMPSOUPS in reply to Drandma]

I'm not a Dr. of course but definitely needs the Lupron.Considering that and the bit of info. from you.

There are trials that show the benefit and scientific consensus of adding other hormone therapy drugs to the Lupron. (Zytiga is one for example).

Some Medical Oncologists might even suggest a course of chemo treatment.

Re-reading I notice you spoke of his Radiation Oncologists. Is this who is overseeing his cancer care and the Lupron recommendation?

If so please make an appointment with a Medical Oncologist. At the very least you will have a second opinion but pretty sure an MO would agree with the comments in this thread for systemic treatment. Continuous Lupron/hormone therapy at a minimum.

[Drandma in reply to CAMPSOUPS]

He is under the care of Dr. Oliver Sartor at Tulane

[CAMPSOUPS in reply to Drandma]

Dr. Sator and Tulane. Interesting. I hear his name mentioned often here by those on the eastern U.S. if I'm not mistaken. I think he is respected by many maybe.Well now I am hoping you misunderstood him lol.

[Drandma in reply to CAMPSOUPS]

Maybe so 🤷‍♀️ We don’t see him until October unless my husband’s PSA or Testosterone is up before then

[j-o-h-n in reply to Drandma]

October? of what year?

His age?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 05/24/ 2022 10:44 PM DST

[Drandma in reply to j-o-h-n]

October of 22. My husband is 62. Thank you

[MSPCF2021 in reply to Drandma]

Dr. Sartor and others at Tulane are well known for newer treatments. Seems you are in the best place. Is he eligible for Lu-177 which I have seen associated with Tulane? Best wishes always.

[Drandma in reply to MSPCF2021]

I’m not sure if he is eligible or not

[Drandma]

Thank you

[Mare28]

My husband has PCa in hilar lymph node along with a few cancerous nodes in the pelvis. The radiation oncologist is planning on RT for all of the lymph nodes including hilar.

[Drandma in reply to Mare28]

The medical oncologist we saw (different person from the radiation oncologist my husband had used in 2020) along with another specialist he consulted both agreed that it might damage the heart and lung function to radiate the hilar lymph node. Have your husband ask about this or seek a second opinion.

[Mare28 in reply to Drandma]

Your post prompted me to question both of his doctors. Initially the RO said he couldn’t radiate the hilar LN then changed his mind after talking to our medical oncologist!?! I’m going to give him a call and question this. I’m thinking a second opinion is warranted. Thank you for responding. Prayers for you and your husband.

[SteveTheJ]

"My husband had RRP in 7/19. Post op path report upgraded from Gleason 7 to 9." Once again I wish people would spell out their acronyms. If RRP means prostate removal, I don't see how it's possible to have a Gleason score at all. Enlighten me?

[Burk in reply to SteveTheJ]

After surgery the removed prostate is sent to a lab for a more comprehensive analysis. In some cases, this results in a change in the Gleason scoring. Gleason score refers to the aggressiveness of the cancer. You may be confusing Gleason score with PSA.

[Drandma in reply to Burk]

Thank you for replying for me. I thought I had replied and explained that but apparently I did it incorrectly. Can’t seem to find my reply 🤷‍♀️I’m new to this site.