Advice on PC cancer

[OB23]

Hi, I have joined here on behalf of my dad.

He had CABG surgery in 2022 and on Nov 2024 he was diagnosed with high PSA. After MRI and Biopsy it was confirmed that he has prostrate cancer, Gleason score 4+3. He is undergoing PET CT scan to confirm the staging. Doctors have advised him immediately robotic prostatectomy. Age: 71 years

PETCT scan shows the following indication :

Psma avid left mesorectal lymph node - metastasis.

3.6 * 3.2 * 3.9 cm ill defined PSMA avid enhancing mass in the left transitional and peripheral zone extending from base to apex to contralateral extension and infiltrations of the seminal vesicles as described above - carcinoma prostrate

Also His PSA level is 38

I am very concerned at the moment. Please can someone advise what are the likely treatments going to be suggested ?

Does this look treatable? Thanks

[Don717]

With his age and spread I would advise against RP at this point. He should find a PC specific MO\RO and get a consult going. Good luck to you and make sure YOU are tracking your PSA. Thanks for taking care of Dad.

[OB23 in reply to Don717]

Thank you for responding.

[Tall_Allen]

Brachy boost therapy or SBRT. He should talk to a radiation oncologist to see if it's safe to irradiate the mesorectal lymph node during whole-pelvic radiation.

[Murk]

IMO, surgery, besides being invasive, will proabbaly not solve the complete problem since it has expanded to the Lymph Nodes. If so, he would later proabbaly need salvage radiation anyway. I would consider Tall_Allen's comments above.

[minnowman]

Proton Therapy. I got mine at Hampton University Proton Therapy Institue. They have treated THOUSANDS of Prostate Cancer patients (As well as other cancers).

There are centers all around the U.S. especially near the major cities.

Best of luck to you.

[WisdomSeeking]

Hello,

first of all, don't let him be pushed into anything.

Apart from the CABG surgery - is he active, healthy? Does he have any symptoms (pain, blood in urine, ...)?

I will assume that he is quite healthy and has no symptoms.

I will assume that your father is on ADT (Firmagon/Orgovyx/Zoladex/Casodex/...)

As per NCCN guidelines:

1.) RP (=surgery) is not a preffered option when a lymph node is positive: "There is limited evidence that RP + PLND is beneficial in the setting of node-positive disease. Use of this approach should be limited to patients with >10-year life expectancy and resectable disease and should be used in the context of a clinical trial or planned multimodality approach."

2.) Preffered is: RT+ADT(2 years)+abiraterone or RT+ADT(3 years)

You should ask if abiraterone is ok, I think it increases blood pressure. It's taken with prednisone. Maybe Xtandi (enzalutamide) would be better instead.

NCCN guidelines are accessible after creating a free account: nccn.org/professionals/phys...

Radiation should be more effective with ADT which "sentisize" prostate cancer cells to radiation, making them more susceptible to radiation-induced damage, which improves the overall effectiveness of the treatment. It means that RT may start approx. 3-6 months after starting ADT.

You may look at these posts of jpburns (healthunlocked.com/user/jpb..., even though your father's PSA is higher, I think he was in a similar situation as your father: Was on ADT, then went to whole-pelvis EBRT and then started abiraterone (but was offered Xtandi or Erleada).

Check for example these posts:

1.) healthunlocked.com/advanced...

2.) healthunlocked.com/advanced....

3.) healthunlocked.com/advanced...

And check his comic: healthunlocked.com/advanced...

Don't hesitate to ask anything.

[OB23 in reply to WisdomSeeking]

Hi my dad is just diagnosed and is not on any medication yet. He has no symptoms apart from CABG and arthritis pains he is okay. Thank you so much for this info. I am going for second opinion tomorrow.

[OB23]

Hi  WisdomSeeking ,  minnowman ,  Tall_Allen : I went for second opinion today and they advised my dad to take firmagon for 3 months, post that they will do an MRI and plan RP. I am so confused at the moment.

Also they mentioned if they feel RP is not an option post MRI then they will do radiation therapy