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User
Posted 20 Sep 2022 at 15:50

Hi everybody, here is my father's story:


- April 2018: 54yo, Da Vinci RP, Gleason 4+4, pT3bN1, initial PSA 8,97


- June 2018: PSA persistence 0,17 but contraindication to adjuvant RT for previous pelvic irradiation (Lymphoma).


- July 2018: Start adjuvant HT (leuprolide)


- July 2018- July 2021: PSA 0,04


- July 2021: Stop adjuvant HT and monitoring 


- September 2021: PSA 0,08 and rising until now


- PSA-DT 4.8 months


- September 2022: PSA 0,48. PSMA-PET inconclusive, no indication to ablative radiation therapy.


Now the oncologist proposes to resume hormone therapy (Degarelix) but my father wants to repeat a PSMA-scan at higher psa values to locate and perform direct therapy on metastases in order to delay hormone therapy and its side effects.


Oncologists at the center where he is followed disagree with him as they claim it is dangerous. A second oncologist says it is possible and safe to wait 3 months and repeat the exam.


What do you think about it? what would you do?


Thank you

User
Posted 20 Sep 2022 at 16:36
I would be asking why he is not being offered Chemo as well as HT.

Your dad's approach is also reasonable especially if he puts quality of life over quantity. Read our own Chris Js story.
User
Posted 21 Sep 2022 at 11:28

I am in a similar situation to your father. My first PSA after radical prostatectomy was 0.28. Gleason 4+3, stage T3bN1M0. 36 lymph nodes were removed during the surgery. A subsequent PSMA scan was inconclusive and the next PSA three months later was 0.61. My Oncologist gave me two choices. I could wait and repeat the PSMA scan but he did emphasise it was risky with an aggressive (4) cancer and it was not guaranteed to pick anything up. The other option was to do salvage radiotherapy to the prostate bed, along with HT (150 mg Bicalutamide) for six months. The histology on my prostate did indicate a positive margin so it is a best guess that this is where the cancer might be. In the end I decided to opt for radiotherapy. I was given a choice and only time will tell if it was a good choice. The Oncologist should really have given your father a choice in the matter. PSMA scans are expensive and I wonder if that had some impact on the decision.

Edited by member 21 Sep 2022 at 19:42  | Reason: Not specified

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User
Posted 20 Sep 2022 at 16:36
I would be asking why he is not being offered Chemo as well as HT.

Your dad's approach is also reasonable especially if he puts quality of life over quantity. Read our own Chris Js story.
User
Posted 20 Sep 2022 at 17:08

I will read it! Thanks 


They said chemo will be an option when hormone resistance occur. 

User
Posted 21 Sep 2022 at 11:28

I am in a similar situation to your father. My first PSA after radical prostatectomy was 0.28. Gleason 4+3, stage T3bN1M0. 36 lymph nodes were removed during the surgery. A subsequent PSMA scan was inconclusive and the next PSA three months later was 0.61. My Oncologist gave me two choices. I could wait and repeat the PSMA scan but he did emphasise it was risky with an aggressive (4) cancer and it was not guaranteed to pick anything up. The other option was to do salvage radiotherapy to the prostate bed, along with HT (150 mg Bicalutamide) for six months. The histology on my prostate did indicate a positive margin so it is a best guess that this is where the cancer might be. In the end I decided to opt for radiotherapy. I was given a choice and only time will tell if it was a good choice. The Oncologist should really have given your father a choice in the matter. PSMA scans are expensive and I wonder if that had some impact on the decision.

Edited by member 21 Sep 2022 at 19:42  | Reason: Not specified

User
Posted 21 Sep 2022 at 13:11

Very similar story but unfortunately my dad cannot undergo adjuvant/salvage radiation therapy on the pelvis, which is potentially curative in your case. 


He has already done three years of HT and has felt reborn since he quit.


We know that hormone therapy has only a palliative purpose, sooner or later the cancer spreads.


So if there was a possibility of hitting these outbreaks with SABR, it could increase the time off from HT therapy.


I don't know why is this an absurd idea according to oncologists?!

 
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