Surgical Castration recommended

User

Posted 07 Nov 2018 at 14:38

Hi wonderful members of this community,

At the outset, let me thank everyone here for being so helpful, patient and supportive with questions from newcomers :) It's a great community. Let me also state that my dad lives in India and we really don't have any good forums to discuss these things.

He (59 yo) was initially diagnosed with a Gleason score 6 (3+3, PSA = 16-17, free PSA= 1.266) and it was diagnosed as an early stage prostate cancer. We were kinda relieved but the PMSA PET scan revealed that the cancer had spread to the femur and some lower vertebra (both low grade). This didn't correlate with the biopsy and hence the biopsy slides were re-analysed by another pathologist and it was deemed to be a Gleason 7/8. So the planned surgery was cancelled and an immediate shot of hormonal therapy was given. However, the doctor now advises surgical castration/orchiectomy. The chemotherapy will be started soon.

He also has a pretty shitty insurance which refuses to pay for regular HT shots but will pay for any surgical procedure (you guys with NHS are blessed!). So financially too, it's a sensible decision for him. He doesn't mind going through with the procedure. We are going to get another oncologist's opinion tomorrow.

What do you guys think about this? For me it seems like they are skipping some other treatment options like ultrasound or radiation.

Once again, thank you so much for this really informative forum.

User

Posted 07 Nov 2018 at 17:15

Hi, orchiectomy (also called orchidectomy) is much more common in India than in the UK - as you have noted, hormone treatment is very expensive there which rules it out for many men. There are still men in the UK who have it, sometimes because they cannot tolerate the hormones or cannot have injections. The side effects are very similar to HT but without the man boobs.

There is no ultrasound treatment for prostate cancer, and radiotherapy is not appropriate for a man with bone mets so eliminating testosterone (surgically or with chemicals) is the sensible route.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 07 Nov 2018 at 17:51

Thanks LynEyre. Seems like the best course of action given the circumstances. What is your opinion on the gleason score? It's pretty weird to me that the first pathologist made a score 6 diagnosis versus an 8 by another one (the score 8 matched the PSMA PET scan though).

Best,

User

Posted 07 Nov 2018 at 19:27

It's hard to say, Ringo - things might be very different in India.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 07 Nov 2018 at 23:51

A two point Gleason upgrade on the same specimen is very unusual, re-evaluations usually argue about a single point change in the major or minor component not an upgrade across the board.

Might be worth checking they have it (and the PSMA scan) right before lopping anything off.

Orchidectomy is pretty common in the US too, If there is no hope of a HT holiday it's probably a sensible and effective option.

User

Posted 08 Nov 2018 at 02:03

Might be beyond the scope of radiation and certainly HIFU (High Intensity Focal Ultrasound) if that is what you meant and PSMA interpretation is correct.

Barry

User

Posted 08 Nov 2018 at 09:19

@francij1 - thanks for your reply, it does seem unusual that the Gleason score interpretation went up 2 pts! He's getting another opinion today from another oncologist. I'll ask him to discuss this.

@old barry - Yeah that's what I meant (HIFU). Like LynEyre mentioned, maybe lowering testosterone is the only option available now. Chemo will be started soon too.

Thank you guys for the replies. I'll let you'll know if anything changes :)

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