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Almost Diagnosed?

Hi,

I am from India and my father (65 yrs) has almost been diagnosed with PrCa. Almost because the biopsy is scheduled for later this week.

My dad first approached a GP because of continuing problems with urinary hesitation and frequent trips to urinate at night. He had been diagnosed with BPH earlier so the symptoms did not seem unusual. In any case, the GP advised a PSA and a Transabdominal US. The ultrasound was okay but the PSA came in at 200 !! Meanwhile, my dad's symptoms actually got better since the day he approached the GP.

The next step was to call up another doctor who's been advising us since a very long time. He suggested a recheck of PSA. The recheck confirmed the original findings. Next, the family doc called up a urologist who first asked us to get a radionuclide bone scan done. Then, liver and kidney function test and a urine test. Everything came in normal including the ALP test and the bone scan!

So, with all reports in hand we went to the urologist who performed a DRE and found a suspicious lesion. He asked us to get a pelvic/prostate MRI done which was performed yesterday and then the biopsy later this week.

It's been about 21 days since we first approached the GP.

This is how the things stand today. Any advice would be much appreciated.

Re: Almost Diagnosed?

Alltime,

Let us know about the test results. Your Dad may have PCa but advice depends very much on the grade and whether the thing has escaped the prostate. With such a large PSA number (if it is PCa) it probably has, but don't worry until you have all the necessary facts. Then take comfort from the large number of men on this site with higher PSA numbers of a similar age to your Dad who are still going strong after many years of treatment.

Your Dad will be going through a worrying time but I'm sure you will give him all the emotional support you can - that will be invaluable.

Good Luck

OC in England

Re: Almost Diagnosed?

OC,

Thank you for the reply.

Once I saw the PSA number, I researched a bit. Then, when the urine test came in normal (no bacteria, no leukocytes) I was pretty sure what it was. I was only hoping it was contained.

So, I have the MRI reports and I assume the urologist has it too. Will meet him tomorrow.

The conclusion from the MRI report in part reads;
"abnormal T2 hypointense signal"
"Prostatics capsule and neurovascular bundle intact"
"Lymph node involvement"

So I am assuming as of now the staging reads T2C, N+

Re: Almost Diagnosed?

AllTime,
Perhaps it is not helpful to quibble over staging at this point, but I don't believe you can have a T2 stage once the lymph nodes are involved. Because the cancer is no longer entirely confined to the prostate gland, even though the capsule is still intact, apparently.

My understanding is that physically the cancer can push through the capsule in an anatomical sort of fashion. But it can also leave the prostate gland via the blood stream or the lymphatic system.

You'll know more after the biopsy, from which the Gleason score will be important. We all wish you and your dad well, and in the upcoming months and years you'll find plenty of support from many good people on this site.

Re: Almost Diagnosed?

Some more information:

Gleason Score 8 - 9

Dad will begin Complete Androgen Blockade next week with 45 Eligard (6-month) combined with Casodex (Bicalutamide). Doctor's also prescribed diet changes, Lycopene and calcium supplements.

Pinning my hopes on an article I found and other similar papers on patients with non-regional lymph nodes but no bone mets.

http://www.prostateforum.com/article-02-16-09.html

Please let me know if you have any suggestions.

Thanks.

Re: Almost Diagnosed?

Status after 6 weeks on ADT;

PSA: Down to 19 from 220
Testosterone: Down to 32 from 400 (not quite 20 yet)

All observations are welcome.

Re: Almost Diagnosed?

Alltime,

Can you mention his doctors name. I'm guessing Dr. Meyers.

Fred

Re: Almost Diagnosed?

Fred,

I wish. Virginia's a long way from India :)

I had emailed Dr.Myers (through the website) but I believe he does not offer telephonic consultations yet. I'd be more than happy to visit his clinic. But I am unsure whether he would be willing to follow-up with our doctor here and how feasible that would be.

AllTime

Re: Almost Diagnosed?

Update:

PSA trajectory
220 (15 days prior to biopsy and 25 days before start of ADT)
20 (6 weeks into ADT)
5 (a little less than 12 weeks into ADT)

Testosterone seems to have stabilized at 29 ng/dl with Trelstar and I think it's as low as it's ever going to be with LHRH analogues. What are my options?

1. Increase Casodex (bicalutamide) dose to 150 mg/day
2. Add Avodart to the mix
3. Surgical castration to try and bring it down below 20 ng/dl
4. Something more aggressive







Re: Almost Diagnosed?

Update after 5 months of ADT:
PSA is 0.4, T is 32

For the last 2 months, have added dutasteride. So, in effect, on ADT3 for the last 2 months. Still worried about higher levels of T. The doctor does not seem overly concerned.

Is surgical castration an option or just let the T be?

We will meet a radonc next week to decide if and how to administer radiotherapy.

Re: Almost Diagnosed?

Another update.

After a PSA nadir of 0.1 7 months post HT PSA slowly inched up. 0.21 at 9 months and then 0.52 at 13 months and 0.67 at 14 months with an approx DT of 3 months.

When PSA hit 0.67 bicalutamide dose was escalated to 150 mg and also started with metformin XR 500 mg to begin with.

PSA at 15 months in March 2016 dropped slightly to 0.58.

The plan is to continue with Eligard + 150 mg bicalutamide + Dutasteride + metformin until PSA starts to rise again. If PSA crosses ~1.5 the plan is to stop the bicalutamide and add Ketoconazole.

Any suggestions are welcome

AllTime

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