Hello. I recently found about this site and this is my first post here, so I want to wish everyone here good luck and health. My father (64 years old) started to feel numbness in legs 2 weeks ago, shortly after that he needed someone's help or forearm crutch to walk and now he uses crutch while walking, although he tries to spend most of the day lying down in bed (as we read that bed rest is recommended for metastatic spinal cord compression). prior to this he had back pain for 3-4 months. No problems related to urinating which made it hard to get to the cause early. We did PSA test last Sunday and it came 1560. Also, did spine MRI and it showed TH8 pathologic fracture with compression on the spinal cord (ibb.co/tBGdr0c). The result of biopsy will be known on Tuesday.
So, most probably, this is stage iv metastatic disease. He had been healthy and active person and as you can imagine we were devastated to hear the news. I'd highly appreciate your advice if any of you or your family member went through something like this (especially vertebra fracture caused by metastases). I know that spinal cord compression can be treated with surgery, radiation therapy or combination of both but I don't know which one we should choose and how rapidly to preserve his walking ability and quality of life.
I would listen to any advice, suggestions or past experience.
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gio2x
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Gio2x. There is hope for a decent outcome. I am far from an expert, but have learned much from the people on this forum. Men here have undergone surgery (like a micro cage) to repair and stabilize the spine.
3 - 20 minute treatments, over 3 days, of SABR/SBRT (Stereotactic Ablation Radiation-painless) may eliminate the cancer in the TH8.
ADT (Adno Deprivation Therapy) which lowers testosterone levels, PCa’s main diet in early stages, which usually lowers PSA back down under 4.0, or hopefully lower. So have faith. PCa is usually one of the slower Cancers. So you have time.
Finally, there are many Men here with 10 years since Dx, and a handful w 20 years. No time for tears. Use your energy to make good decisions, and get him to a major Cancer Center for best care. Use a combination of Western and Eastern Medicine, but move to get this under control. My best to you and yours, Mike
Hi Gio2x! Was amazing to read your Dad's story. A year ago I also had a backache and no other symptoms. My story is almost the same as your Dad's including the extremely high PSA (see profile). The only exception though is I have had no spinal fractures (yet!), I do have three compromised vertebrae and had pain from nerve compression.
I can't comment on spinal repair but my therapy has been very successful so far from a cancer perspective. (It doesn't help a spinal fracture but the meds start to work immediately and quickly to shrink metastases and in a matter of days my back pain was reduced. I still had gait problems for 6 months though.)
My therapy model has been the rather new "triplet therapy" (apparently allowed for de novo only) - start with ADT, ARAT and chemo all at once (and then ADT and ARAT forever as long as they still work). All these things are well known; the difference is in the sequencing - all at once versus one after the other.
As for physical activity, and once your Dad is back on his feet, safe exercise is extremely important for quality of life and apparently even PC suppression. I am enrolled in a safe exercise program targetting daily resistance work and also cardio. (Because of the fracture, after treatment your Dad will need special guidance on safe exercise. Apparently this is often difficult to come by.)
After the initial shock of the late diagnosis (doctor didn't like to do PSA tests!) We eventually realized I have three risks to avoid for living longer and better: (1) prostate metastatic cancer risk, (2) skeletal, esp. spinal, fracture risk and (3) cardiovascular risk! (ADT etc. apparently drives CVD risk, along with any existing blood sugar issues.)
So far so good. Ten months ago at night I was lying on the hard floor at night with lots of pain (that's the pleasant version) and a lot of codeine - but no understanding (my doctor thought I had "pulled a muscle" or something). Completely different now! Still pretty tired but less so. And a little more of a future than when originally diagnosed 🙄🙂😃
A big success to your dad in dealing with the immediate spinal issue! And then with everything else! As you say he was active and that's a good foundation I think. The whole thing is overwhelming and it's wonderful that he has you helping.
Thank you very much for taking time to write. Hearing other people's stories gives me hope. I hope your treatment will stay successful for very very long time
The first step should have been a bone scan/CT. A consult with a neurologist will determine the best next steps on his spine. Triplet therapy (chemo+ intensified hormone therapy) will slow things down and provide a lot of relief.
Thank you very much for the answer. We live in an eastern European country and the oncologist gave us a plan of Zoladex, Casodex, Docetaxel and radiation therapy. I guess that's the standard of care here. I guess triplet therapy isn't currently available. Any advice?
I unfortunately have a similar situation to yours. My family called me back home in August because my father was not looking well, but refused to go to a doctor (as he has his whole life). I had the first 10 days of August off so I flew home and used my birthday as a way to get my father to see a doctor. Which, even then, best I could do was get him into a chiropractor. But long story short- with a lot of scheming with the chiropractor we were able to get my father to where he needed to be, as spinal Mets and compression fractures were visible on the chiros X-ray. In ten days, my father went from complaining of extreme back pain (4 months or so worth) and kind of being able to walk, to having to crawl around the house, to being unable to pick himself up off the floor or move, for that matter. It was only then that he allowed us to take him to the hospital where scans showed 3 different fractures in the spine and cancer from his femurs to his skull. His kidneys were failing from obstructed ureters, etc. etc. etc. in the hospital, he underwent spinal decompression surgery (laminectomy of l3,l4,l5) and partial resection of tumor. He was sent home with the understanding that due to his condition, cancer treatment probably wasn’t an option because it was just too late…..
Anyway, he’s worked hard at PT and I stand in the kitchen ALL day and make him healthy meals and… he is walking again. Mostly with a walker but is walking without one around the house again. And he’s gotten so much better that he is able to do chemo! Something that was not an option just 2 months ago…. He just did his first round last week.
Most important: Without doing the spinal decompression surgery, there’s no way we could have gotten him back and forth to radiation, etc due to his pain level just with simple movements. and while it did delay his start date for radiation and chemo (we had to wait 6 weeks to let the surgical site heal) we used that time to beef him up. His fractures have remained stable and he is in so much less pain post surgery. So much less pain- for him, it was almost instantly, too. I’d definitely get a neurosurgeon on team to take a look. And don’t lose hope. People told me that when all this was going on, when my dads first oncologist told him he was too weak for treatment . The first picture is him on the day we were told that. The other picture is him on his first day of chemo just 3.5 months later.
it can and will. Get your dad a great care team and don’t be afraid to get second opinions elsewhere if what his care team isn’t working for him. That was the best advice given to me and we took it and Dan with it.
Hope you and your father are well. I am interested whether surgery interfered with ADT or not. I see that it delayed radio and chemo, but was he on hormone therapy before, during and after the surgery?
Lower back pain is what sent me to the doctor to begin with, three and a half years ago. Turns out I had a compression fracture in L4, plus lesions in many of my other vertebrae. No spinal cord compression, however.
ADT started bringing my PSA down quickly and dramatically. Meanwhile, meloxicam worked very well at controlling my back pain. Chemo brought the PSA down even further.
It's good to read that your father is getting treatment and doing PT and seeing results. I hope he continues to improve.
I had a similar situation almost four years ago with PSA at 3500. Two surgeries, orchiectomy and spine, target radiation for hip pain, Abiraterone, predisone, diet changes, exercise and strong family and friend support.Now age 74 with good results, PSA less than point one, some mobility limits but living well. There is hope in the fight.
Thank you for sharing info. I wonder what the spine surgery was like? was there spinal cord compression? Did it interfere with your treatment plan? (did it delay chemo?)
not sure of the details because it was emergency and done quickly. What I was told: a fracture nesr spinal and bone metastasis from prostate cancer required the surgery to mend the fracture to protect spinal cord and if the cancer got to the spinal cord it was lights out. I said ok lol.It all went well so I can laugh about now but it was a close call. I was referred to an oncologist and cancer treatment began asap from surgery recovery about three weeks
I had a T-12 compression fracture right before my official diagnosis of stage 4 metastatic prostate cancer. Suffered for weeks without going to dr. Thought it was just a sprained back. It pretty much almost healed itself. Slipped and had really bad issue with L4 and L5 a few years later. Offered surgery or Ultracet (Tramadol with Acetaminophen). I believe Tramadol has a bad name. Believe it is a synthetic opiate. Don't quote me. Not really addictive at the dose I take. (According to MO.) It was like a miracle drug for me. I could suddenly bend over again and do things I couldn't do before. That is just my story. Extensive and innumerable bone mets. Official diagnosis March, 2017.
Thank you for sharing. I am interested - how did you exactly manage T-12 compression fracture? was there spinal cord compression? Wish you all the best.
The fracture was discovered during my first bone scan about 2 months later. It occurred Friday, Jan. 13th, 2017. A date to remember. All I did was get up off my couch! By the time the neurosurgeon saw it, it had almost healed itself. Put me in a $1000 back brace for a month. Next bone scan called it a 50% compression fracture. Nobody seems to be too worried about it, but I don't lift anything over 12 oz.
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