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PSA must be max 0.01?

User
Posted 21 May 2023 at 14:41

I'm back with my dad to stay for several weeks. He is in a bad, depressive state. From a PSA at diagnosis of nearly 1700, now 7 months later, it has dropped to 2.54. He's on apalutamide and 3 monthly injections. His urologist has been telling him that he wants his PSA to drop to <0.01 or else, his cancer is very aggressive and he warned that his PSA would start rising again unless my dad opted for chemo at this point.

He is 81 years old and very distressed, not getting on with the urologist at all. He lives outside the UK.

Is there any danger in letting him wait to see how low the drugs and HT can drop the PSA? His Gleason score is 4+5 and he has had a spread to the ribs and spine, but feels no pain. He says he'd rather give up than have chemo at this point. EDIT TO ADD: He went to the appointment alone and I worry he has misunderstood the doctor. Hence my asking here if any of this sounds plausible.

Very distressing for my mother and I...  :-( Would appreciate any thoughts on whether he should get a second opinion from a different doctor or whether he may have misheard/misunderstood. Apart from seeking a second doctor we have no other recourse for advice.

Worried Daughter

 

Edited by member 21 May 2023 at 23:36  | Reason: Not specified

User
Posted 21 May 2023 at 23:55
Informed consent! Your father and if possible you should be able to get the full picture and all the options available for treatment. Then he should decide what's best for him.
User
Posted 26 May 2023 at 23:18
I thought I had replied to this post - sorry.

I think that the onco sounds like a bully - could you go to the next appointment to make very clear that dad does not want chemo. In the country where your dad lives, do oncologists get paid more for delivering chemo? Not all men get down to 0.01 on hormone treatment- that doesn’t mean it isn’t working

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

User
Posted 27 May 2023 at 22:12
You say he is outside the UK, where?
User
Posted 01 Jun 2023 at 23:46

Hi Lyn, thanks for your reply. I'm not really familiar with how the doctors get paid in this private healthcare system - all I know is that the urologist is currently his principle doctor while he only sees the onco when he is actually having chemo! Last year when he saw the onco, he told my dad he was too weak and in no condition to do chemo especially at his age. It's his urologist who administers the HT injections and whom he sees regularly, and he has been pressuring my dad about chemo.

I am bearing in mind that this is the same guy who, after he was first diagnosed, sent my dad for BRCA testing, without conducting a proper family history or even telling any of us! Needless to say, I was horrified when I found out - not only because we ultimately had to foot the large bill for the test. It all turned out negative but we had a pretty intense few weeks while waiting for the result. So as this is a private hospital, we got the impression that money was a possible motivation. Which doesn't help with trust issues...!

We are seeing the urologist next week for the next hormone injection and we will see what he says, as well as what the PSA is this time. I can't tell you how stressful this whole ordeal has been for the family. My dad was in denial for years about his prostate issues and you can guess he has not been reacting well to any of this!

Thanks again for replying, it does make me feel less alone dealing with this somehow, as a close family member...

WW

 

User
Posted 01 Jun 2023 at 23:49

My parents live in Malaysia, which does have a public healthcare system not totally unlike the NHS (although some operations are only subsidised and not free) - however the waiting lists are horrendously long and many people opt for private medical care - whose standards can vary widely. It's stressful for me having to fly out here every few months to support them and to try and attend their appointments with them. Very few prostate cancer support services are available out here which compounds the problem.

WW

 

 
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