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PCa for five years - biopsy suggested at 87!

User
Posted 14 Aug 2019 at 12:54

A friend of mine, aged 87, has had prostate cancer for five years (funny how so many friends come out of the woodwork with PCa, once they hear you have it!).

He must be the luckiest man in Britain as he has had no symptoms except a sore hip - which may be down to arthritis - and has had no side-effects whatever from various HT therapies.

We have just been to see his urologist who has referred him to oncology for a blast of RT to the possibly metastatic hip, but she said the oncologist might insist on a biopsy (the dreaded TRUS variety) before considering any ‘advanced’ treatments, i.e. Enzalutamide and Abiraterone.

I wonder what the point of a biopsy at this stage would prove? If he was G5+5=10 he would be most likely be dead by now after five years. I must ask the oncologist if there was a PIRADS score following a recent MRI.

His PSA is down from 300 five years ago, down to 3, and now hovering around 18 with quarterly injections and daily Stilbesterol.

Any thoughts?

Cheers, John.

User
Posted 14 Aug 2019 at 18:33
Is it possible that the urologist doesn't know much about oncology? No self-respecting onco is going to give RT to a hip without confirmation that it is indeed bone mets so has your friend got all the relevant information from the recent scan?

The only reason I can think of for an onco to ask for a biopsy at this point would be a) if he never had a biopsy 5 years ago or b) if his cancer wasn't responding normally and they needed to check for small cell, squamous, etc.

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

User
Posted 14 Aug 2019 at 19:13
Very strange, Matron, as he has never had a biopsy, and following a recent consultation and MRI and bone scans he was referred to a named oncology specialist by the MDT, but that guy read the notes and said he didn’t want to see him and passed him back to urology.

They keep saying to him things like: ‘In three years you’ll be ninety’, Chris is youthful and is anxious to point out that he’s only 87 1/2!

Anyway, he’s been referred back to the oncologist, and that will be his first visit to that department. I told the urologist they will only tell him the same as she would - we get on very well with her - but she said she cannot prescribe ‘enhanced treatments’ such as Abiraterone and Enzalutamide except in partnership with the oncologist.

Anyway, we are happy with his treatment, and we’ll see how it pans out. Last time she said: ‘One blast of RT into the pelvis might relieve some hip pain’, but when I asked her today if it was one blast or umpteen fractions, she was not clear. She calls me ‘The patient expert’ - I said I’m impatient!

Cheers, John.

 
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