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Looking for advanced prostate cancer advice

Posted 22 Feb 2019 at 21:53

My brother who is 55 was diagnosed with advanced prostate cancer in may of last year. He had a psa of 450. He underwent hormone therapy and it reduced to 12 in 6 weeks. Since then he has been thru chemo and radiotherapy. It has spread to his spine and pelvis. His psa fluctuates between 45 and 150. It is not stable.

I live in the USA and travel to see him and take care of him. 

Does anyone have experience with private UK health insurance? He is currently under NHS and on universal care but they have him on palliative care and i want to know if there are other options here in England. 

I have heard that if he goes to private insurance then NHS will not treat him anymore. Is this true?

Thank you

Posted 22 Feb 2019 at 23:55
The main consideration is that private health is unlikely to get him access to the things that the NHS can offer.

It would be useful to clarify some things to be able to understand why nothing else is being offered. The normal plan of attack with advanced PCa is:-

- bicalutimide tablets for one month to prevent tumour flare when the injections start

- hormone injections (usually Prostap or Zoladex)

- chemo (although this is quite a new addition at this point - traditionally it was only used in the end stages)

- when the hormone injections fail, Abiraterone or Enzalutimide

- if there are bone mets, possibly 6 rounds of Radium 223

- palliative care / pain relief

- sometimes, oestrogen or steroids are tried

For many men, it can take 10-15 years from start to end but it seems that your brother’s cancer has been hormone independent (sometimes called castrate resistant) almost from the start. It would be useful to know whether he was diagnosed with a normal adenocarcinoma or one of the rarer types that do not respond to hormone treatment (such as small cell prostate cancer but there are also others).

If you could fund privately you may be able to pay for Abiraterone or Enzalutimide but need to understand that if he has had one and it failed, the other will almost certainly fail very quickly (2 - 3 months, according to the research). Set that against the fact that if he has a rare hormone independent cancer then Abi and Enza are hormone based.

Some treatments cannot be given to men with underlying health conditions such as heart, circulation or liver problems.

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

Posted 23 Feb 2019 at 00:01

If you can tell us the following, it will help:-
- did he have between 20 - 37 radiotherapy to the prostate bed or was it one or two zaps to bone mets to reduce pain?
- which hormones has he had
- is he still on any kind of hormone treatment

You can’t usually mix private and NHS care.


considering his age, do you know whether he has applied for PIP, a financial benefit for terminal patients to help pay for equipment, carers, etc. It is usually only available when someone has less than 6 months but some consultants will sign the application as soon as active treatment is stopped. 

Edited by member 23 Feb 2019 at 00:08  | Reason: Not specified

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

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