Next steps after radiotherapy

[QuestionsAbtMyDad]

Hi,

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.

[QuestionsAbtMyDad]

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.

[Murk in reply to QuestionsAbtMyDad]

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.

[CAMPSOUPS in reply to Murk]

Actually its India not Indiana.

[Murk in reply to CAMPSOUPS]

WOW sorry i missed that grrr...

[CAMPSOUPS in reply to Murk]

No biggie. Seems like something I would do.

[Tall_Allen]

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.

[QuestionsAbtMyDad in reply to Tall_Allen]

Thank you. I didn't know that. I assumed that Radiotherapy kills off the cancer cells and thus stopped further spread.

[Tall_Allen in reply to QuestionsAbtMyDad]

I wish that were true.

[witantric]

which is the closest big city in India he can go to? He needs to go to one of the big hospitals in India

[QuestionsAbtMyDad in reply to witantric]

He is planning to go to Chennai which is the closest city.

[witantric in reply to QuestionsAbtMyDad]

I would go to the top hospital on the following list: impactguru.com/info/cancer-...

Also, I have been impressed with Dr. Ishita Sen on this website. See if you can contact her.

I would also see if you can get a "tele consult" with one of the top centers in the USA.

[binati]

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.

[QuestionsAbtMyDad in reply to binati]

Thank you sharing. I will look into these options.

[j-o-h-n]

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.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 12/18/2023 6:32 PM EST

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

We are lost if we cannot laugh. Go with the flow and the groove. Enjoy the ride.

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

You said it best.....Thank you....

Good Luck, Good Health and Good Humor.

j-o-h-n