In Oct 2023, My dad's MRI revealed that cancer had spread to few vertebral bones and has reached a rib bone. He got a PET scan and then underwent ~20 days of radiotherapy in Nov 2023.
But his doctor has not asked him to do any follow-up tests after the radiotherapy ended. Is this the norm? Should he be doing additional tests to determine if the radiotherapy had it's intended effects and if additional therapy is needed? I am very worried that the cancer had reached his rib bone. I want to be proactive in monitoring this and prevent further spread.
I have provided additional information on his history in the comments below.
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Additional details: My dad (74 years) lives in a small town in India with my mom. I live in a different country. The doctors he has been seeing for the last five years have not been proactive in monitoring his cancer.
2019: Urinary issues. Underwent minor surgery for BPH. Doctors didn't tell him to monitor PSA levels. Didn't ask him to come for follow-ups. And then Covid happened
2021: Sharp pain in upper leg. Thought it was bone issue and was told by orthopaedic that it was old age issue and was prescribed pain medication
2022/May: Leg pain and weakness woresened. MRI revealed a bulge in a vertebral bone. Prostate cancer had spread to vertebrae and was pressing against a nerve which caused the pain. PSA 78. Stage 4. Gleason score 8
2022/June: Two surgeries: 1. Orchiectomy 2. Removed portion of the prostate. Since then he has been doing monthly PSA tests and visits oncologist once very two months. PSA dropped to normal levels and doctor told him that he is in remission. Has been continuing bicalutamide, calcium and vit d. But his leg pain didn't subside but the doctor kept saying it's normal
2023/Oct: Leg pain got severe. MRI revealed bone spurs in additional vertebrae. PET PSMA scan revealed cancer in multiple spinal bones and had reached one of his rib bones
2023/Nov: 20 sessions of radiotherapy. But in the follow-up with the doctor he hasn't asked him to do any additional imaging tests.
Grrrr so sorry to hear but he is lacking some serious health care. Having visited Indiana many times over the years everything is close to Indianapolis and within driving distance to a decent hospital. Heck I drove from there to the Cleveland Clinic. PCa is curable or at least manageable with the right help and facilities.
Just my two cents but why fook around with one of the most important person in your life.
Radiation doesn't prevent spread, it only prevents pain and fracturing of the bone metastases it is aimed at. To prevent spread, he needs a systemic therapy like hormonal, chemo, or radiopharmaceuticals.
I don't know about Chennai but there are excellent hospitals specialising in cancer in Delhi and Mumbai. I have been treated at Rajiv Gandhi Cancer Institute and also had consultation with Tata Memorial Hospital in Mumbai. My RT was done at Medanta Hospital in Gurgaon. All very competent doctors.
Small town, Small treatment. Large town, Large treatment....
Note: I wish to offer my apologies if I offended anyone regarding my so-called humor about "race" or "misogyny". To me, humor is boundless and since we entered this word crying, I thought it would be a good idea to exit laughing.
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Next steps on the journey
PSA 6 months after RT
How long should I continue with bicalutamide after radiotherapy?
