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Alan, glad you raised the question. In my mind, and perhaps that of many others, palliative care was confused with hospice care. Good old...er...new Wikipedia has a very good explanation.
http://en.wikipedia.org/wiki/Palliative_care
I like the summation in the comparison between Palliative and Hospice Care:
"Non-hospice palliative care is appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression."
The goals: "While palliative care may seem to offer an incredibly broad range of services, the goals of palliative treatment are extremely concrete: relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, a support system to help the individual live as actively as possible, and a support system to sustain and rehabilitate the individual's family."
Alan,
How old are you? With T3B you can get a prostatectomy and radiation with the ADT and it just might kill off the prostate cancer. At a minimum it should keep you alive for another 10 years. By that time there should be many new treatments available.
On the other hand, the treatment you are getting now should keep you going for another 5 years or more and will have very few long term side effects and there should be a few new treatments available over the next five years.
I have been told by my oncologist and urologist that removal of the prostate and radiotherapy is not an option as they said they cant be sure that with such a high psa they could get it all and also because of the possibility of microscopic spread.Also the high gleason and psa signifies that it is in the seminal vesicles and penetrated the capsule so why go through the distress of an operation that won't be succesful.
Usually the docs will try for a "Cure" first with radiation, surgery or other treatment.
After you have played the "cure" card and it did not work, then the next thing is to treat it as an ongoing disease with the idea of controlling it rather than curing it.
"Pallitive" is a scary word because it connotes the idea that nothing can be done and the patient is going to die.
The truth is that many men live for a LONG time on pallitive care with the cancer controlled and it is considered a "chronic" disease.
Alan,
You didn't say how old you are. Also, are you going to a prostate cancer center?
See the paper:
Radical Prostatectomy for Clinically Advanced cT3 prostate cancer since the advent of prostate-specific antigen testing: 15 year outcomes. John F. Ward, Jeffrey M. Slezak, etal. 2005 BJU 95, 751-756.
The authors concluded that radical prostatectomy as part of multimodal treatment for patients with clinical T3 disease offers cancer control and good survival rates.
Thankyou for your replies. please see the below article. Doesn't look good for my 90% of positive cores, psa count and gleason 9. I think RP would be waste of time. was 65 when diagnosed
Down-staging of clinical T3 (cT3) prostate cancer after radical prostatectomy (RP) is not uncommon due to the inaccuracy of the currently available staging modalities, although selected down-staged cT3 patients can be a candidate for definitive RP. We identified the significant predictors for down-staging of cT3 after RP.
Materials and Methods
We included 67 patients with cT3 stage prostate cancer treated with radical perineal prostatectomy (RPP) between 1998 and 2006 and reviewed their medical records retrospectively. The clinical stage was obtained according to the DRE, the prostate biopsy findings, and the prostate MRI.
Results
Fifty three (79%) patients with cT3 prostate cancer were down-staged to pT2 after RP. The percent of positive cores had the strongest association with down-staging of cT3 [p = 0.01, odds ratio (OR) = 6.3], followed by baseline prostate specific antigen (PSA) (p = 0.03, OR = 5.0), the biopsy Gleason sum (GS) (p = 0.03, OR = 4.7), and the maximum tumor volume of the positive cores (p = 0.05, OR = 4.0). When the cut-off points of significant parameters which were a PSA < 10 ng/mL, a percent of positive cores ≤ 30%, a maximum tumor volume of the positive cores ≤ 75% and GS ≤ 7 were combined, the sensitivity, specificity, and positive predictive value were 0.25%, 1.00%, and 100%, respectively.
Conclusion
The percent of positive cores ≤ 30%, serum PSA < 10 ng/mL, the biopsy GS ≤ 7, and the maximum tumor volume of the positive cores ≤ 75% were the significant predictors of down-staging cT3 disease after RP.
I don't know whom your doc is but look elsewhere is a suggestion. Hey I was looking at a checkout counter scenario back in 2002, with total urinary blockage (from PCa) added to high stats. Just to show control is happening and can be done, how long???? That varies alot, Dr. Fred Lee should be gone as he failed primary therapy, that was 25 yrs. ago, and 27 yrs. since his diagnosis, age 80 and living now. Here is my yananow biography thingy:
www.yananow.net/Mentors/RobP.htm
Dr. Lee's story: Find on this board forum, posted not that long ago below on this forum.
Alan,
You seem to be able to understand the research papers so you should look at the one I referenced. The upgrading/downgrading issue doesn't really effect your treatment decision here.
I changed from my urologist to a prostate center for treatment because my original urologist was just going to give me hormone treatment and made it sound like I didn't have long to live. If you are not at a PC center then you relly need to meet with some experts in the field of PC for a second opinion. The treatment you are receiving may be the best for you but it is always good to know if more can be done.
I was cT3b, GS 4 & 3, PSA 12.7 and I got a prostatectomy with adjuvant radiation/LHRH treatment. My oncologist thinks that I should be able to live for another 10 years with just intermittent ADT before I might need further treatment.
THANKS FOR YOUR COMMENTS. I APPRECIATE WHAT YOU ARE SAYING BUT MY PSA IS VERY MUCH HIGER THAN YOURS AND GLEASON TOO. I AM JUST AFRAID OF ENDING UP INCONTINENT ETC AND HAVING TO GO ON FOLLOW UP ADT ANYWAY. ED ISN'T A PROBLEM AS MY WIFE AND I SADLY CANNOT HAVE A SEX LIFE ANY MORE AS I HAVE ABSOLUTELY NO LIBIDO. PCA STINKS.
There are various ways to fight PCa, so look at all possiblities and make your own decision, as the docs don't fight your battle, you do. There is some evidence on the Bolla Studies as to longer survival and other studies now using surgery and ADT with similar findings. You would have to decide if you believe it is worth it to you. There are various drug protocols, especially if you see the things that Dr.'s Myers, Lam, Leibowitz, Scholz, Strum, Sartor and others have done with patients. So you have choices, I am not trying to sway you but only let you know there is alot to consider in this fight. I got alot of opinions and it is almost like the wild west in some respects. Best to you going forward.
Alan,
You might want to go to your local PC information/support group. I always find these meetings to be informative, uplifting & enjoyable.
You are alive 28 months after starting out from a not great prognosis and getting good response from the ADT. With aggresive treatment there is a reasonable chance you'll die of heart failure when you are 85 and not from PC. A fellow in our group started out at T4 14 years ago and is still alive.
You might think of trying an antidepressant. I know the lack of sex and having cancer does seem to be depressing after a while.
I am in the same position and wish i could say more to help. When i was diagnosed at age 58, i was told that i should look into hospice! I was never informed about the different med's, chemo etc. I have been on chemo and it has failed. I will be starting a new line of chemo in the coming weeks. Anti depressants have helped me so much. i feel great, but know that my body will only take so much. I really pushed for surgery and was told it was a waste of time and too expensive, now i wonder what if...... follow your instincts, they will guide you.
Thankyou everyone for your replies. To be honest I am not depressed at all. I certainly don't miss sex because I never think about it ever now. My wife greatly misses the passionate closeness. It's a terrible blow on a relationship that has always been so passionate. But like my wife says I am alive. I play golf, excercise daily, enjoy life etc. I was just going over in my head like Amador said if my treatment fails, and lets face it more times than not it does and like Amador I may say what if I had have tried radiation or something else............
