This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
Although the understandable fear of death is what drives us to choose what we feel is the best path for us when we are diagnosed with prostate cancer, it is a subject that is rarely discussed on any of the Forums or Mailing Lists.
I came across a well written piece by Dr Michael Glode on his BLOG - this was published in October 2007:
Prostate cancer tends to spread to lymph nodes or bones. There are some studies that begin to show us why this is different in different patients (that is, why some patients have almost exclusively bone metastases, while in others, it is predominantly lymph nodes that get the brunt of the disease. The molecular differences are interesting, but have yet to lead to more practical management decisions. We treat all metastases first with androgen deprivation.
In those patients with nodes, we often have to use tubes (stents) to keep the ureters open as they may be compressed by the enlarging nodes. Radiation therapy can be useful to keep the ureters open as well. Without these interventions, the kidneys can stop working and lead to death from accumulation of toxins normally excreted in the urine.
For those patients in whom bone metastases dominate, the main issue is often pain management. Radiation to bones that have tumor deposits can be extremely helpful along with appropriate pain medications. It is highly unusual to have a patient in whom pain cannot be well controlled with radiation, opiates, NSAIDs and attentive care.
The thing that leads to death in most patients, however, is not direct involvement of an organ like the liver, lungs or brain. Instead, most patients seem to have a "wasting syndrome" not unlike AIDS. Loss of appetite, loss of energy and general debilitation lead to weight loss and patients don't feel like getting out of bed. Hospice care can be extremely helpful for this stage of illness and is usually available either at home or in an inpatient facility. I always refer my patients to these wonderful care providers to assist in terminal management, and I try to stay involved as appropriate.
The man posting as The Stranger made some strong points regarding pain control in his post on the Suicide thread, but I think it is important to draw a distinction between the awful position his wife finds herself in and the somewhat shorter period that the few men who are unfortunate enough to have painful bone metastasis have to deal with this issue.
I agree with your comments about my wife's condition and what a terminal prostate cancer patient would go though. My wife started taking heavy pain medication right after her head on car accident in 1964 and has been on it ever since. It's been our experience that in the short term, a few years, pain management works pretty well. But if your condition is severe you do have to take quite a bit of strong medication to keep the pain under control.
The problem I see talking about pain management is, there are so many variables in the patients that need it. Some are in mild to medium pain and pain management works very well for them. But some are in severe pain and it takes a lot of pain medicine to control it and the medication makes you tired and sleepy so you sleep more than normal.
My sister had a back ache which got really bad so she went to the Doctor. They found out she had cancer that had spread from her lungs and she died in 6 weeks. Yes, that's 6 weeks from the time they found it till the time she died. She was in severe pain and used hospice care along with her older sister that gave her strong pain medicine in suppository form. The pain medication definitely helped her but we had to keep on top of it, which means you need to take it the instant you start needing it. Don't wait till the pain gets fairly strong or the pain over powers the pain medication.
My wife has been on pain management for many years so we have a great deal of experience with it, and what Doctor's say and do for it. And it's just like any other health care, you need to find a good Doctor and ASK for what you need. Don't be shy. If you're in pain don't worry about the effects of taking opiates, just use them.
I can't tell you the number of people that resist taking the very medication that can help them through what they're dealing with. But I've seen it over and over again. They hear narcotic pain medication and refuse to be a drug addict. The simple truth is, drug addicts take narcotics to feel high, a person in pain takes it to relieve pain.
I'm sorry to be so direct about this, but I must share the experience we have. Both in chronic pain from my wife's car accident and the death of several family members due to cancer. It's not pleasant to think about but my Father (62), Middle Sister (36), Younger Sister (45) all died of Lung Cancer. Yes they were all heavy smokers. I have never smoked so I pray to God that I'm spared from it.
Thank you for having the courage to post this topic. It is indeed a topic that is not discussed as much as it should be. We have all lost friends to this disease and not a week goes by that someone doesn't post to one of the groups that another one has passed away.
For me and perhaps a number of other men this is a terminal disease. My disease was at diagnosis not curable and of grave concern to my urologist. But I am [or perhaps was] an eternal optimist. I would find some way to beat this monster. I would cure my cancer. That attitude gradually was replaced with a more realistic attitude. My goal is to live for another year.
I failed ADT shortly compared to most men. Took about a year. All my oncologist could do is watch my PSA go up. He really was not that effective in treating my disease. In December of 2008 he wanted me to go on to chemo [Taxotere]. I gave it some serious thought. But I eventually decided the odds were not good enough for me. So I discontinued all Lupron and all other androgen treatments and struck out on my own.
Most men will die when their PSA gets to very high numbers. However, I know a few men with PSA in the 5000 range who are alive and in actually good shape. I think that once you go on chemo your chances are not good. Chemo will mess with your bone marrow and your blood counts. For men with bone metastasize our bone marrow is compromised already. Adding Taxotere just makes it worse. For men with bone mets we will likely die when our bone marrow is too damaged.
For the men who have a less serious disease G <7 your prognosis is probably good. you will have to do whatever you can to keep your PSA very low for the rest of your life. If you keep the tumor burden low you will probably not develop mets.
In the light of some of the responses I have received to this post, i have expanded it somewhat to include some of the issues that might be considered in trying to answer the question "How long have I got?"
