Advice on bloodwork after radiation treatment?

Hello all,

I have been coming back to this forum since finding it a few weeks back, and am looking for some advice and thoughts on my father's case. He was diagnosed with prostate cancer (a very low PSA) back in 2016, underwent a radical prostatectomy that year, and then radiation a year or two later to his pelvic area after a rise in PSA. Last summer, his cancer metastasized to his bones (small spots on ribs, two spots on spine, and one spot on shoulder). He did 5 of 6 rounds of docetaxel chemo, then 4 of 6 lutetium treatments (last one in April of 23). We were under the impression from his oncologist that the lutetium would work quite well from his PSMA scan. However, his PSA continued to rise during the lutetium treatments and, therefore, was stopped after 4 treatments. His bloodwork was very good throughout and he was feeling fine except for leg numbness that began back during the docetaxel. Even though he mentioned the numbness to his oncologist, he was told it was an unusual thing that couldn't be explained. Around the third lutetium treatment, he began experiencing pain in that same leg that migrated toward his lower back and his new oncologist ordered an MRI of his spine. The MRI showed a met on L2 with nerve involvement. It was decided to radiate the spinal met and shoulder with SBRT. Two days after the radiation course was completed, he met with his oncologist who informed us that his bloodwork that day was suddenly quite poor. He ordered another blood draw for this week, and seemed to imply that, if the results were still poor, that there wasn't much hope for improvement. Overall, the visit felt very fatalistic. I am looking to see if anyone could advise on whether or not the bloodwork could simply be due to the radiation treatment (not to mention the overall gauntlet of back to back treatments the past year). My father is very important to me, and I want to know what other treatment options we can ask of the oncologist, or where we should seek a 2nd, 3rd, and even 4th opinion.

[Tall_Allen]

The poor bloodwork is not from the radiation spot treatment; it is from some combination of the Pluvicto, chemo, and the cancer itself.

[Okay4now]

I'm sorry to hear about your father's blood work. My only experience with chemo was a clinical trial in 2002. One of the chemicals was taxotere, now called docetaxel. I had the usual hair loss, and lost all 20 of my nails. I'm glad for your father's sake that his chemo is behind him.

[Don_1213]

A question - your father's age?

And a comment: I strongly recommend getting a 2nd opinion. I've been known to go for 3rds when I can't get a clear answer.

As to where - I'd suggest - while there are certainly excellent local urologists (and radiation oncologists and medical oncologists) - that it's much easier to find an excellent one if you stick with a major university medical school affiliated hospital or doctors service. That seeks especially true if you can find a doctor who is also on staff at the medical school. That's been my experience.

I have been the patient of a number of local urologists and found their interest in my case never seemed to extend past the 15 minutes of time Medicare pays for. The doctors I found in NYC at Columbia/Presbyterian/Weill/Cornell (aka Columbia Doctors) not only will spend as much time as I want talking things out, but they also shared their email addresses with me just in case anything came up, leaving me with the admonition to make sure to contact them if ANYTHING came up. Its a bit of a pain to get to the hospital when I have to do an in-person visit (about every 6 months for a bladder scan), but well worth it, and televisits have been quite satisfactory for discussions of test results and such. And when I do make an in-person visit, there is no rushing of the appointment and I just feel I've been treated well.. all the staff seems top-notch.

[Hidden in reply to Don_1213]

Thanks for the replies (and thanks to the two replies above as well). My dad is 70. He's been getting treated at MSK in NY, but I would like to get opinions at other centers as well. I am a bit disappointed that he mentioned the numbness in the leg back during the chemo when it started, and an MRI wasn't ordered until months later.

[Don_1213 in reply to Hidden]

If he's already going to MSK in the city, Columbia Presbyterian is on the Columbia campus uptown (on 168 St) - nyp.org/ - check the Columbia Doctors out.

[Hidden in reply to Don_1213]

Thank you!