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Is this Advanced Prostate Cancer

User
Posted 13 Sep 2019 at 12:31

Hello,

Thank you for letting me join this community first of all.

My Dad was diagnosed with prostate cancer about 5 years ago and then 4 years ago had his prostate removed. After the recovery he saw his consultant for check ups to monitor his PSA etc etc. This was all done under private health care. His PSA went up slightly but he was told it was nothing to worry about. He was then referred back to the NHS to continue his monitoring as his consultant was retiring. For some reason the appointments got messed up and he didn't get seen for a long time and within that period his PSA went from 0.5 to 9. 

They called him in for an urgent appointment and told him he needs to have 6.5 weeks of radiotherapy, as most people start radiotherapy after removal if their level gets to 3. 

My questions is: If he no longer has a prostate gland does this mean the cancer cells have metastasised (spread) into other areas of his body e.g. Bones, lymph nodes, prostate bed. ?

Thank you for reading.

S x

User
Posted 13 Sep 2019 at 21:38
Not necessarily; if his PSA had never really gone low after the op, and / or it rose very quickly that would suggest that there were already mets before he had the operation and these hadn't been noticed. If he had been having his regular PSA tests and the PSA had started low and then crept up very slowly it would suggest that some cancer cells were just left behind where the prostate used to be. That is the area that they will target with the radiotherapy. Cancer cells in the prostate bed are not mets.

To be honest, he should have been referred to oncology before his PSA even got to 0.5. No idea why someone told you that RT normally starts at 3 - the threshold is usually between 0.1 and 0.2.

I don't really understand why he wasn't having PSA tests at his GP practice but the clock can't be turned back, unfortunately. Since his PSA is now 9, it would be sensible for him to ask for proper scans before they start RT just to check that the tumours are actually in the prostate bed. If there are mets, RT is going to be a waste of time with some unnecessary and possibly unpleasant side effects.

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

User
Posted 13 Sep 2019 at 23:15

Lyn gives good advice and is much more knowledgeable than me.  Although I recall a huge pain in my hip during diagnosis and thought it might be advanced cancer.  My objective was not to jeopardise my upcoming operation as it would likely have been cancelled if they thought it was advanced. 

I could therefore say I'd prefer to have the radiotherapy and not jeopardise it with a scan if in your position.  It could be it would be a waste of time but there is the possibility it will get rid of all or even most of the stray cells which should still be helpful.

On the other hand it is possible that a scan could find something nearby that could be helped by targeting the radiotherapy.  

There is another possibility and that is a psa of 9 is often said to be too low to show anything on a scan and some people wait till it gets to 20 for a scan.  That is much more than for a slow rising psa needing adjuvant radiotherapy.

Another consideration is whether hormone therapy would be given before the radiotherapy, I don't think I'd like my psa to be rising with nothing being done for long if they said it could be treated as curable and there is thought the psa should be around 1 before radiotherapy.

I think I'd be asking about having another psa test to try to establish a trend.   Asking whether a scan would be beneficial while hoping they feel confident of where they're scanning.  Asking how wide an area they'll be scanning.  Asking if hormone treatment should be used to reduce the cells before radiotherapy.  Also that the radiotherapy isn't a long time away.

Sorry to throw those thoughts into the pool and I must admit that as a layman there is so much to consider that you can forget where you started.  Although those thoughts might be worth thinking about and someone may come on and say why they're good or bad which might give a better answer.

Edited by member 13 Sep 2019 at 23:17  | Reason: Not specified

User
Posted 14 Sep 2019 at 02:29
I think investigation should already have been done so should now be done by scan(s) to check whether there are a few suspicious sites that could benefit from RT as well as the Prostate bed (Oligometastases).
Barry
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User
Posted 13 Sep 2019 at 21:38
Not necessarily; if his PSA had never really gone low after the op, and / or it rose very quickly that would suggest that there were already mets before he had the operation and these hadn't been noticed. If he had been having his regular PSA tests and the PSA had started low and then crept up very slowly it would suggest that some cancer cells were just left behind where the prostate used to be. That is the area that they will target with the radiotherapy. Cancer cells in the prostate bed are not mets.

To be honest, he should have been referred to oncology before his PSA even got to 0.5. No idea why someone told you that RT normally starts at 3 - the threshold is usually between 0.1 and 0.2.

I don't really understand why he wasn't having PSA tests at his GP practice but the clock can't be turned back, unfortunately. Since his PSA is now 9, it would be sensible for him to ask for proper scans before they start RT just to check that the tumours are actually in the prostate bed. If there are mets, RT is going to be a waste of time with some unnecessary and possibly unpleasant side effects.

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

User
Posted 13 Sep 2019 at 23:15

Lyn gives good advice and is much more knowledgeable than me.  Although I recall a huge pain in my hip during diagnosis and thought it might be advanced cancer.  My objective was not to jeopardise my upcoming operation as it would likely have been cancelled if they thought it was advanced. 

I could therefore say I'd prefer to have the radiotherapy and not jeopardise it with a scan if in your position.  It could be it would be a waste of time but there is the possibility it will get rid of all or even most of the stray cells which should still be helpful.

On the other hand it is possible that a scan could find something nearby that could be helped by targeting the radiotherapy.  

There is another possibility and that is a psa of 9 is often said to be too low to show anything on a scan and some people wait till it gets to 20 for a scan.  That is much more than for a slow rising psa needing adjuvant radiotherapy.

Another consideration is whether hormone therapy would be given before the radiotherapy, I don't think I'd like my psa to be rising with nothing being done for long if they said it could be treated as curable and there is thought the psa should be around 1 before radiotherapy.

I think I'd be asking about having another psa test to try to establish a trend.   Asking whether a scan would be beneficial while hoping they feel confident of where they're scanning.  Asking how wide an area they'll be scanning.  Asking if hormone treatment should be used to reduce the cells before radiotherapy.  Also that the radiotherapy isn't a long time away.

Sorry to throw those thoughts into the pool and I must admit that as a layman there is so much to consider that you can forget where you started.  Although those thoughts might be worth thinking about and someone may come on and say why they're good or bad which might give a better answer.

Edited by member 13 Sep 2019 at 23:17  | Reason: Not specified

User
Posted 14 Sep 2019 at 02:29
I think investigation should already have been done so should now be done by scan(s) to check whether there are a few suspicious sites that could benefit from RT as well as the Prostate bed (Oligometastases).
Barry
User
Posted 14 Sep 2019 at 19:36

Quick update, he went for a scan this week and now a 3 week wait for results and start of RT.

Its just a waiting game for the results now.

 

Thank you all for your replies.

Sx

 

User
Posted 15 Sep 2019 at 01:01
Was the scan looking for active cancer clusters or was it a planning scan for the RT? At a planning scan, they usually mark the patient with a couple of tiny tattoos or implant a few gold seeds. Have they started him on hormone treatment, or mentioned him having hormones?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 19 Sep 2019 at 12:12

it was a planning scan for RT, there has been no mention of hormone treatment. He starts RT when in 3 weeks when he gets results of his scan. Thats really all they have said.

Thanks for all your input LynEyre you are very knowledgeable.

 
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