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Prostate cancer return.

User
Posted 27 Sep 2023 at 10:59

I thought I’d start a new post rather than adding to the old one. DH diagnosed 9 years ago age 57. Psa 3.7 3+3 He had brachytherapy. Over the next few years psa went as low as 0.03 after 5 years the psa started to creep up, slowly at first. The consultant said to get back in contact once it hit 2.1. So 3 months ago it was 2.9 (2.0 3 months before) DH had an MRI. Nothing showed. So he had psa pet scan. PSA result this Monday was 4.9. The consultant has phoned this morning. I didn’t listen to the conversation, but DH says the prostate cancer isn’t in his prostate and the treatment worked, however it is in his lymph nodes in his stomach and may have been there years. So, my question is, does this sound likely? Did DH listen properly?

The consultant is writing a letter to the gp and he’s to start zoladex injections soon. DH is convinced he’s only on them for one month. I had zoladex years ago and he knows how I suffered, though I think side effects may differ for woman, I put on over 2 stone in 5 months, I refused my 6 injection (I was only having it 6 months) I am sure it will be more that one month for the zoladex or even forever. Also he’s to be prescribed Cavadex. 
 
Once it’s in the lymph nodes I take it there is no cure, it is just hoped it shrinks down on hormones. 

I knew as soon as the psa started raising that it wasn’t good. But they didn’t want to do anything until it reached 2.1

Edited by member 05 Nov 2023 at 21:55  | Reason: Not specified

User
Posted 27 Sep 2023 at 17:56

Originally Posted by: Online Community Member

Thanks for your helpful replies. I find the telephone conversations unhelpful as there will always be unanswered questions. We can’t both speak to the consultant and my husband doesn’t really ask questions. Let’s hope the follow is face to face. 

If you have a mobile phone you could use its “speaker” setting and both be able to hear and speak to the consultant if your next consultation is another telephone one.

Chris

 

User
Posted 29 Sep 2023 at 17:58
Quote:

Could the 1 month have been bicalutamide? I’m not sure if it works the same with zoladex but my husband is on decapeptyl and with this HT drug he was to have bicalutamide tablets 2 weeks before and after his first injection to prevent tumour flare. 

Hope everything works out well for your husband and he is able to have some targeted RT 

Elaine

 

Elaine you might be right  the tablets turned up in the post  casodex and bicalutamide are the same tablet  so maybe that for a month alongside zoladex  

 

User
Posted 01 Oct 2023 at 12:11

Originally Posted by: Online Community Member

They may give him a date to start the casodex when they contact you about the injection.

Got everything crossed that it will go well 🤞🏼

 

Thanks Elaine. I have been reading about your husband. I hope his journey goes well. You are similar in that I am quite a bit younger than my husband. I am 15 years younger. 

User
Posted 05 Nov 2023 at 19:53
I would also go for a second opinion. Some oncologists will treat more aggressively than others. It can be that once in the lymphatic system even if treated it could emerge elsewhere but treatment could buy more time. The Royal Marsden are known to get a lot of requests for a second opinion although there are of course other hospitals and consultants that could be tried.
Barry
User
Posted 05 Nov 2023 at 20:45
I think that 'staging' is a confusing word. In prostate cancer, there is two kinds of staging - a man can be T2 or T3 but stage 4 .... in other words, the tumour hasn't burst out of his prostate but it has metastasised. The problem in your case seems to be that the onco hasn't communicated clearly - he appears to be treating this as a stage 4 metastatic cancer but hasn't said so in a straightforward way. There is a tiny possibility that he has started the HT with a view to radiotherapy or SABR or something in a few months time and, somehow, this has been missed in the conversations and letter.

The difficulty is with your OH not wanting to rock the boat or have you asking questions - I guess that it would not be easy for you to persuade him to ask for clarity from the onco or a second opinion from someone else even though that's what we all think is needed :-(

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

User
Posted 05 Nov 2023 at 20:50

Originally Posted by: Online Community Member

DH thinks the consultant said he can’t have more radiotherapy as he’s had the maximum dose when he had brachytherapy. I understand he can’t have the prostate zapped again, but if the nodes are in his tummy then surely that is different. 

Lymph nodes in the tummy area would usually be considered relevant to maximum dose.  

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

User
Posted 06 Nov 2023 at 19:17

Wiosal, I started with surgery, followed by 66gys salvage RT to the prostate bed. Last year I had 40gys to a pelvic lymph node and this year had another 30 gys to another pelvic lymph node. 

More SABR treatment to additional pelvic tumors have not been ruled out. I moved from the NHS to private treatment because the NHS does have limitations on what they will treat. Without health insurance I wouldn't be having the treatment I am now having,far too expensive.

Hope you get some answers.

Thanks Chris 

User
Posted 07 Nov 2023 at 14:22
The clinical trials of up front Enza Abi etc have all demonstrated significant benefit to up front use.

Several men on here have had it as part of trials and as normal treatment now. My only caveat is I'm not sure they have demonstrated it in a salvage scenario like your DH.

All questions for the Onco I would suggest. If DH hates the idea of HT it is also an acceptable option to do nothing until he has symptoms, then throw the book at it! You will possibly be trading quality of life for quantity but that is DHs decision.

Having the node biopsied to prove it is PC and what Gleason it is would help that decision too. If it's still a 3+3 leaving it be might be a sensible option until it causes trouble.

User
Posted 08 Nov 2023 at 21:19
I don't think that there is a strong evidence base to suggest that BRCA2 stops HT from being effective or makes men more likely to be hormone-independent (castrate-resistant) earlier than others. However, when a BRCA2 man does become castrate-resistant, there is a second line HT treatment that only works for those men.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 26 Nov 2023 at 23:52
Men have fought for years for the right to have Abiraterone or Enzalutimide from the start, rather than later when the standard HT has begun to fail. Now research has shown that men live longer if they have abi / enza early and the price has dropped so it has been approved for this use. Your OH is being offered something that only 2 or 3 years ago, men with PCa could only dream of (unless they had unlimited amounts of money or a very generous health insurer). I guess the same applies to the newer drug, Apalutimide, as well but not so much to daralutimide.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 13 Feb 2024 at 21:07

I thought I’d do an update. Now that DH has been on enzalutamide for a few months and zoladex almost 4 months. He’s been quite tired on the drugs, he’s really slowed down on our dog walks, I used to struggle to keep up, but now we often have to stop for a rest. But he’s keeping up the walking, so that’s good. He’s been busy decorating too. The worst thing has been headaches, muzziness and sharp pains in the back of his head, the pains lasting only a few seconds each time, a couple of times a day, but still a bit worrying. At his nurse phone consultation she suggested stopping them for a week, that didn’t make any difference, after the week he was put on 3 tablets instead of 4. But still the same. The nurse did suggest trying a different drug, the one with the steroid, but dh says he doesn’t want steroids. But I’ve read if you are going to change drug, it has to be done in a certain time frame. So dh should probably think seriously about it. I have read enza is the better drug though.

Dh didn’t have any hot flushes at all just on zoladex, but does now they’ve added enza. I’ve been joking about with him, as he makes such a fuss, I said it’s a bit like man flu. I know they aren’t nice and I shouldn’t joke, but he started it by saying “when you used to get hot flushes” I still do get them regularly, I just don’t tell everyone, strip off and have to stop whatever I’m doing like him. I’m only messing about with him, of course his situation is a lot worse. 

Dh had a diabetes and cholesterol test done recently as the drugs can cause diabetes and he was pre diabetic before, he is already on statins even though his cholesterol was never high, enza can stop the statins working. The blood sugar was high, well into the diabetes zone, but they said re test in 6 months and no treatment needed. Cholesterol was 5.01 which isn’t high, but the gp said to double the dose anyway. Not sure on the theory there.

PSA was less than 1.0 at the last test, he’s having it done again in a couple weeks, before the nurse consultation, plus other bloods to check he’s ok on the enza.

One thing…dh has had a bad back for years, it has got worse the last 2 or 3. Now he’s on HT his back has improved with little pain at all. I did have a thought that maybe he’d got mets in his spine, but surely they’d have been picked up on the psma scan, plus his back has been bad for such a long time it can’t be prostate cancer related as it would have been much worse after all this time. So no idea why the drugs are helping his back, but a good thing. 

The last thing to add, the lack of libido. It is so strange, I’ve had 29 years of him driving me mad in that department. A week without and he’d get bad tempered and moody. So now doesn’t get moody, the lack of testosterone certainly makes a difference there. It still feels really odd, the thought of him never really wanting me is still hard to take, of course life is more important though. If he puts his mind to it, he can still “perform” so I guess that is a plus too. Zoladex alone had no effect on libido, but he was only on it for a couple of months before enza was added. Maybe it wasn’t long enough. 

DH never had a face to face appointment with the consultant, that is a bit disappointing. Just the one phone call. Now he gets phone calls from the nurse. Next one end of Feb. I guess that’s all we will get as long as the drugs keep working. 

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User
Posted 27 Sep 2023 at 12:28
If it's just a couple of nodes and they are outside the original treatment area then YES they can be treated. You need to make sure you ask about this

User
Posted 27 Sep 2023 at 12:55

Yes, it depends a bit on where they are, but if it's just a couple of lymph nodes, he should ask about having SABR (pinpoint external beam radiotherapy) on them. Not everywhere can do this, so it may need a referral or second opinion somewhere that does.

One month's Zoladex in total doesn't make any sense in the circumstances.

By the way, while Zoladex is 4-weekly for women, it's usually 12-weekly for men (higher dose), although the first implant may be a 4-weekly dose.

Edited by member 27 Sep 2023 at 12:58  | Reason: Not specified

User
Posted 27 Sep 2023 at 13:14

Thanks for replies. DH said the lymph nodes just inside his belly button. He just had brachytherapy to the prostrate. No other treatment. I know he will be on zoladex longer, there’s little point in one injection. Interesting the man’s one lasts longer. I think I misspelled the other drug. I copied what DH had written down. Looking on google I think it’s casodex. I am assuming they can’t remove these nodes as it’s not been suggested. I have read both these drugs can cause diabetes. DH has been pre diabetic for several years. So this will need discussing too. I’m hoping there will be a face to face consultation at some point so I can ask questions. 

User
Posted 27 Sep 2023 at 13:36

Wiosal, I had surgery in 2014  and salvage RT in 2017, my PSA then continued to slowly rise. Last year I had a PSMA scan and SABR treatment to a single pelvic lymph node. This year following a further rise in my PSA I had SABR treatment to another pelvic lymph node and started six months of bicalutamide.

You ask the question,once in the lymph nodes is it incurable,I hope not but bear in mind no two cases are the same. I will continue on a curable treatment path as long as my insurance company pays for it and until the oncologist calls time and suggests lifetime HT.

Thanks Chris 

 

User
Posted 27 Sep 2023 at 16:34

Thanks for your helpful replies. I find the telephone conversations unhelpful as there will always be unanswered questions. We can’t both speak to the consultant and my husband doesn’t really ask questions. Let’s hope the follow is face to face. 

User
Posted 27 Sep 2023 at 17:56

Originally Posted by: Online Community Member

Thanks for your helpful replies. I find the telephone conversations unhelpful as there will always be unanswered questions. We can’t both speak to the consultant and my husband doesn’t really ask questions. Let’s hope the follow is face to face. 

If you have a mobile phone you could use its “speaker” setting and both be able to hear and speak to the consultant if your next consultation is another telephone one.

Chris

 

User
Posted 27 Sep 2023 at 18:20

Thanks Chris. DH wouldn’t let me listen today. He said I’d talk, then he wouldn’t be able to hear and also thought I would interfere. So that was that. However he’s happy for me to be there face to face. 

User
Posted 27 Sep 2023 at 20:01

DH thinks the consultant said he can’t have more radiotherapy as he’s had the maximum dose when he had brachytherapy. I understand he can’t have the prostate zapped again, but if the nodes are in his tummy then surely that is different. 

User
Posted 28 Sep 2023 at 11:10
Yes, if it's to a different part of the body it should be ok.

Chris

User
Posted 28 Sep 2023 at 11:14

Yes thanks Chris. That’s what I thought. Dh left straight after the phone call as it was already planned to go and stay with his daughter for a few days. He hasn’t told her and isn’t planning to. But now he’s gone we can’t discuss it. But I keep wondering why radiotherapy or removal of the lymph nodes wasn’t suggested. It it is there and not in the prostate. Perhaps that is the next step after the hormone treatment. 

User
Posted 28 Sep 2023 at 11:25

Originally Posted by: Online Community Member

The consultant is writing a letter to the gp and he’s to start zoladex injections soon. DH is convinced he’s only on them for one month. I had zoladex years ago and he knows how I suffered, though I think side effects may differ for woman, I put on over 2 stone in 5 months, I refused my 6 injection (I was only having it 6 months) I am sure it will be more that one month for the zoladex or even forever. 

Could the 1 month have been bicalutamide? I’m not sure if it works the same with zoladex but my husband is on decapeptyl and with this HT drug he was to have bicalutamide tablets 2 weeks before and after his first injection to prevent tumour flare. 

Hope everything works out well for your husband and he is able to have some targeted RT 

Elaine

 

User
Posted 28 Sep 2023 at 11:39

Hello Elaine. Thanks for reply. DH has written down Zoladex injection and Casadex tablets, he’s actually written cavadex but I think he must mean casadex as I can see that drug online. He’s to try it for a month and see how it goes, I think that means he will have  blood tests etc after a month. Not stop after a month. 

User
Posted 28 Sep 2023 at 12:08

Ah ok that’s good then. I would have liked my husbands first injection to be for less than 6 months but I forgot to say at the meeting and she had already prescribed the 6 month. Touch wood though he seems to be coping ok on the treatment ok. He’s had what he would say is a bit of a groin strain feeling so not sure if that’s the medication or cancer if the HT isn’t working 🤦🏻‍♀️ always something to worry about. Having some bloods next week so hopefully that will give us some info. 

Best of luck for when he starts the treatment, hopefully he won’t have any or many side effects x

User
Posted 29 Sep 2023 at 17:58
Quote:

Could the 1 month have been bicalutamide? I’m not sure if it works the same with zoladex but my husband is on decapeptyl and with this HT drug he was to have bicalutamide tablets 2 weeks before and after his first injection to prevent tumour flare. 

Hope everything works out well for your husband and he is able to have some targeted RT 

Elaine

 

Elaine you might be right  the tablets turned up in the post  casodex and bicalutamide are the same tablet  so maybe that for a month alongside zoladex  

 

User
Posted 29 Sep 2023 at 21:09

Ah Casodex is the brand name then….I should maybe have realised that as it would have had the name on Robs tablets.

That would make sense then. Obviously check with your doctor but rob has had them twice and was instructed to take them 2 weeks before his first injection and then to continue for 2 weeks after just to try and prevent tumour flare. Best of luck with them….I hate saying this but ‘touch wood’ Rob has been fine since starting HT…we will find out next week if it has been working 🤦🏻‍♀️

User
Posted 29 Sep 2023 at 21:28

Tablets came in the post with no instructions as to when to start them. They do say one a day. DH won’t start them until he’s phoned the hospital Monday. He’s dreading the side effects. As I said above I had zoladex for 5 months and couldn’t stand it, so refused the 6th. It was completely different for me though as they weren’t for cancer. The hot flushes and weight gain were the worst side effects. I remember feeling exhausted too as they simulate the menopause. That was 22 years ago. Now I’m early 50’s and have similar symptoms for real. Though I’d say hot flushes and weight gain were worse on zoladex. Let’s hope he’s not so bad as I was. 

I still can’t get my head round why no other treatment has been offered. If it is only in the lymph nodes and not his prostate surely it can be treated. DH said the consultant said he “can live with it in his nodes” Not sure if that means the hormones are to be taken forever or they’ll kill it (which I doubt) Or are there no treatments? Others on here have had the nodes zapped. I will have to wait for the next consultation as I have lots of questions. But it might be a while, it’s bound to be a telephone consult again too. 

User
Posted 29 Sep 2023 at 21:39

Has he got a date to go for his injection yet? I think it’s important to have certainly some of the tablets before the injection.

Rob has only ever had prostap and decapeptyl but he’s generally been ok on both so far 🤞🏼🤞🏼it’s early days though. The prostap felt worse but I think that was possibly because it was right at the diagnosis time and we were a bit all over the place anyway.

Sounds like you had a terrible time on it, these medications are always different for everyone so hope your husband will be ok.

I’ve got it all to come with the hot flushes, not looking forward to it 🤦🏻‍♀️

User
Posted 29 Sep 2023 at 22:17

No date for zoladex yet. The consultant is writing to the gp. We haven’t had a copy of the letter yet, so the surgery won’t have had one. I know it had to be ordered in when I had it. So it’ll be the same again. But they only needed a days notice. Hot flushes aren’t nice. I know not everyone has them. They were much more intense on zoladex than now. Not everyone has the weight gain either. 

User
Posted 29 Sep 2023 at 23:42

They may give him a date to start the casodex when they contact you about the injection.

Got everything crossed that it will go well 🤞🏼

User
Posted 01 Oct 2023 at 12:11

Originally Posted by: Online Community Member

They may give him a date to start the casodex when they contact you about the injection.

Got everything crossed that it will go well 🤞🏼

 

Thanks Elaine. I have been reading about your husband. I hope his journey goes well. You are similar in that I am quite a bit younger than my husband. I am 15 years younger. 

User
Posted 02 Oct 2023 at 11:09

Thank you Wiosal. I think he must just have wanted a younger wife so always someone to look after him 🤣 

User
Posted 02 Oct 2023 at 11:54
Lol, smart guy. My wife also 15 years younger and doing a great job keeping me going!! Zoladex not so bad and has very effectively put my cancer cells "to sleep" as my Oncologist put it. Hot flushes annoying, but not so terrible really. Could be that zapping lymph nodes not necessary if cancer not elsewhere, but I am getting my pelvic ones done at same time as my prostate. They are also considering zapping the ones close to the lower spine, as a precaution and as part of the "Pearls Trial" (think that is right name!). Anyway ladies, good luck with your other halves, we men do not always make the best patients!!
User
Posted 02 Oct 2023 at 12:36

Glad you are being well looked after Kerm 👍 best of luck with all of your treatment too x

User
Posted 02 Oct 2023 at 14:20

Originally Posted by: Online Community Member
Lol, smart guy. My wife also 15 years younger and doing a great job keeping me going!! Zoladex not so bad and has very effectively put my cancer cells "to sleep" as my Oncologist put it. Hot flushes annoying, but not so terrible really. Could be that zapping lymph nodes not necessary if cancer not elsewhere, but I am getting my pelvic ones done at same time as my prostate. They are also considering zapping the ones close to the lower spine, as a precaution and as part of the "Pearls Trial" (think that is right name!). Anyway ladies, good luck with your other halves, we men do not always make the best patients!!

Thanks kerm. You make zoladex sound not so bad. But having taken it myself I know it is, or at least was for me. That’s the thing about zapping the nodes, we’ve no idea whether this is an option. DH may have alreadt had the max. radiation to his pelvis with the brachy. We don’t know if it’s in lots of nodes or just a couple. The consultant didn’t say anything about further up the line. I am assuming it’s hormones indefinitely. Even the letter that came just says dh is to go on hormones due to rising psa. It doesn’t mention nodes. We feel a bit in the dark. Next telephone consultation is in November. 

User
Posted 03 Oct 2023 at 20:11

Originally Posted by: Online Community Member
Lol, Could be that zapping lymph nodes not necessary if cancer not elsewhere, but I am getting my pelvic ones done at same time as my prostate. They are also considering zapping the ones close to the lower spine, as a precaution and as part of the "Pearls Trial!!

Kerm what did you mean by “could be that zapping lymph nodes is not necessary” ? thanks. 

 

 

 

 

 

User
Posted 31 Oct 2023 at 21:51

It won’t allow me to make a new post. So I’m adding to this one and hoping it is seen. 

Has anyone else suffered tummy pains on zoladex? DH is 2 weeks into zoladex and had tummy ache for 3 days now. He’s not one to ever get tummy pains. So I’m a bit concerned. He’s taken himself to bed. They started the day after he stopped the casodex. 

User
Posted 05 Nov 2023 at 11:06

DH is still getting tummy pains, but they have eased off. That was strange as started a day or so after the casodex stopped. 

3 weeks into zoladex the only real side effect so far is being tired. He’s asleep on the sofa by 8pm. Then about 9.30pm he will shower and go to bed. He’s out for the count all night. He doesn’t wake when I go up and put the tv on. He’s always woken early too, but now he doesn’t wake until I bring tea up. I hope he settles into zoladex and this isn’t our life now. 
 We have the telephone consultation next week. I’m not sure what to ask really. I was going to ask staging etc of the cancer as he’s not given any info. But probably not much point. I can see online it’s stage 4 now it’s in the nodes. The consultant seems to play everything down. So i feel I don’t want to ask much. DH had a psa test this week. So we will find out if the zoladex has reduced it. Though not sure 2 weeks is long enough to effect it. I don’t think he’s had his testosterone reduced much yet. 

User
Posted 05 Nov 2023 at 11:39

He really should regard exercise as mandatory while on Zoladex (or any hormone therapy). It counteracts many of the side effects. Even just a walk is good.

User
Posted 05 Nov 2023 at 11:45

Thanks Andy. Yes we do 2 dog walks a day. Usually about a mile and a half to 2 miles each walk. Sometimes we go further. He’s usually out in the garden trimming hedges or doing other outdoor activities in the day like clay pigeon shooting. So he does move about during the day. It’s just evenings he’s asleep! 

User
Posted 05 Nov 2023 at 18:56
Wiosal, stage 4 is when it has spread out of the prostate and invaded other local structures like the bladder, rectum etc, if it's only in the nodes you will get an N number on your original staging eg T3 N2.

You really need to get the oncologist to put in writing why those nodes cannot be zapped, then take that letter and get a second opinion.

Your husband is basically getting the same treatment my dad had 25 years ago! What about adjuvant chemo or Enzo? And of course he really needs to explain why a couple of nodes outside the original treatment area that may have been missed from before cannot be treated now. Otherwise it's HT for life...

User
Posted 05 Nov 2023 at 19:13

Originally Posted by: Online Community Member
Wiosal, stage 4 is when it has spread out of the prostate and invaded other local structures like the bladder, rectum etc, if it's only in the nodes you will get an N number on your original staging eg T3 N2.

You really need to get the oncologist to put in writing why those nodes cannot be zapped, then take that letter and get a second opinion.

Thanks for reply. The original diagnosis from 9 years ago says T0 N0 Gleason 3+3 before brachy. He hasn’t updated the letter, just kept it the same as 9 years ago.

 At this point there is no cancer in his prostate as the brachy killed it off. So nothing to biopsy this time round so we won’t get those scores. The cells are only in the nodes in his tummy, we don’t know how many nodes involved. I am assuming it must’ve been in his nodes 9 years ago at the original diagnosis and has been lying dormant. I don’t understand enough about the disease to know how it is in the nodes and not in the prostate. 

It says online once it gone into nodes away from the prostate then it’s stage 4a (with 4b being in bones) so I’m am assuming that’s where we are and incurable  

The consultant said dh can’t have more radiotherapy as he’s had the maximum dose. 

User
Posted 05 Nov 2023 at 19:53
I would also go for a second opinion. Some oncologists will treat more aggressively than others. It can be that once in the lymphatic system even if treated it could emerge elsewhere but treatment could buy more time. The Royal Marsden are known to get a lot of requests for a second opinion although there are of course other hospitals and consultants that could be tried.
Barry
User
Posted 05 Nov 2023 at 20:11

Thanks Barry. I am assuming there must be a good reason why the consultant said that. Does it depend how many nodes are involved, where the nodes are located and the fact dh has already had brachytherapy to the area? Also I’m assuming once it’s in the nodes it’s free to go anywhere and if  it’s in nodes in the tummy does that mean it must be in the nodes next to the prostate? It didn’t show up anywhere else on the psma scan but is that accurate enough to pick it all up? I have all these questions that I would ask if we had a face to face consult. But it’s on the phone. I’m allowed to listen this time, but I have promised not to speak otherwise my husband says he can’t concentrate. 

There is literally nothing on the letter to the gp. Just “please give zoladex going forward” It doesn’t even mention the nodes. I think I said that further up thread. I just wish the consultant would say it how it is. 

User
Posted 05 Nov 2023 at 20:45
I think that 'staging' is a confusing word. In prostate cancer, there is two kinds of staging - a man can be T2 or T3 but stage 4 .... in other words, the tumour hasn't burst out of his prostate but it has metastasised. The problem in your case seems to be that the onco hasn't communicated clearly - he appears to be treating this as a stage 4 metastatic cancer but hasn't said so in a straightforward way. There is a tiny possibility that he has started the HT with a view to radiotherapy or SABR or something in a few months time and, somehow, this has been missed in the conversations and letter.

The difficulty is with your OH not wanting to rock the boat or have you asking questions - I guess that it would not be easy for you to persuade him to ask for clarity from the onco or a second opinion from someone else even though that's what we all think is needed :-(

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

User
Posted 05 Nov 2023 at 20:50

Originally Posted by: Online Community Member

DH thinks the consultant said he can’t have more radiotherapy as he’s had the maximum dose when he had brachytherapy. I understand he can’t have the prostate zapped again, but if the nodes are in his tummy then surely that is different. 

Lymph nodes in the tummy area would usually be considered relevant to maximum dose.  

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

User
Posted 05 Nov 2023 at 21:05

Thanks Lyn. You are always full of helpful advice. Any idea how it would be in abdominal nodes and not in the prostate? Does that mean the initial diagnosis was wrong? DH’s psa was 0.01 for 4 years. I remember you queried it being that low, so I looked on the hospital letter and it was definitely that low.

DH did ask if he can have radiotherapy and the consultant said no and that he’d had the max. dose already. So I am assuming it isn’t an option.

I guess staging doesn’t really matter that much as it won’t change things. I just wish the consultant explained to dh if he’s on a no cure course as that is what I’m assuming. DH seems to think he’s only on hormones temporarily. But as it’s in nodes with a psa doubling time of about 4 months, to me that doesn’t look that great. Also throwing in the fact dh carries the brca2 gene. PSA was 4.9 (2.7 3 months before) so it’s not that high. We will find out if it has gone down on weds as he had psa test weds. I’m not sure 2 weeks on zoladex is enough time to reduce it though (plus 4 weeks on casodex) 

User
Posted 05 Nov 2023 at 22:38
I can't work out from your profile how old your husband is but if he is still young and in good health the Onco really should be discussing up front chemo or 2nd line HT even if only to rule it out.

He is being treated no different to how he would have been 25 years ago, that does not seem right.

User
Posted 06 Nov 2023 at 06:06

Francij DH is a young 66 fit and healthy (I’m 15 years younger and he’s as fit as me) the only health problems he’s had is a bad back. He’s a retired farmer. He’s never ill either. So it’s strange seeing him so tired. 

The letter from the consultant, which has disappeared, says due to psa raising please give zoladex going forward, then it adds that if DH tolerates zoladex well then he will add another drug it was initials, but can’t remember the drug. 

Edited by member 06 Nov 2023 at 15:12  | Reason: Not specified

User
Posted 06 Nov 2023 at 15:14

I found the letter. DH had filed it but it was randomly in among his paperwork rather than in date order. 

So it says he will discuss adding ARTA if dh is getting on well with zoladex. I think these are drugs like enzalutamide, abiraterone, I’ve seen people on here mention them. But I don’t know anything about them. Does that sound like the right way to go?

Edited by member 06 Nov 2023 at 15:20  | Reason: Not specified

User
Posted 06 Nov 2023 at 19:17

Wiosal, I started with surgery, followed by 66gys salvage RT to the prostate bed. Last year I had 40gys to a pelvic lymph node and this year had another 30 gys to another pelvic lymph node. 

More SABR treatment to additional pelvic tumors have not been ruled out. I moved from the NHS to private treatment because the NHS does have limitations on what they will treat. Without health insurance I wouldn't be having the treatment I am now having,far too expensive.

Hope you get some answers.

Thanks Chris 

User
Posted 06 Nov 2023 at 19:58

Thanks Chris. I will get dh to ask about SABR but I think the answer is that he’s had max. radiotherapy. 

Looking online, it looks like ARTA is usually given once the cancer has become castrate resistant. So I am not sure whether it’s a good idea to start it this early into treatment. Surely it is best to wait for that point to come. 

User
Posted 07 Nov 2023 at 07:19
Waiting until castrate resistant for 2nd line androgen or chemo is old school unless that is the patients informed choice.

Still think you need the oncologist to explain exactly why his lymph node cannot be treated.

User
Posted 07 Nov 2023 at 09:14

Thanks francij So if he goes on ARTA now, what happens when he does become castrate resistant, as I know that is what eventually happens? I get a feeling the HT won’t reduce his testosterone enough, I have always said he’s got far too much testosterone. 

I will see if DH will ask why he can’t have SABR. But DH is saying he can’t ask again as he asked last time and was told no because of the brachytherapy. 

User
Posted 07 Nov 2023 at 10:21

Wiosal, I know all cases are different, but have you spoke to the specialist nurses on this site. I find a two way conversation can sometimes be better.

Thanks Chris 

User
Posted 07 Nov 2023 at 10:39

Thanks Chris. No I haven’t spoken to anyone as feel we don’t have enough info. I have a list of questions for the telephone consult tomorrow morn. I will get dh to ask how many nodes are involved, where they are, whether they can be treated. I also want him to confirm we are on a management path rather than a cure. We will get the latest psa result too, not sure it will be reduced this early on. We will see what other drug is on offer. I can’t think what else to get dh to ask, knowing him he won’t ask any of my questions. I know dh wants to ask what his options are if he refuses HT. for me that is not an option, he has to continue with it. 

User
Posted 07 Nov 2023 at 14:22
The clinical trials of up front Enza Abi etc have all demonstrated significant benefit to up front use.

Several men on here have had it as part of trials and as normal treatment now. My only caveat is I'm not sure they have demonstrated it in a salvage scenario like your DH.

All questions for the Onco I would suggest. If DH hates the idea of HT it is also an acceptable option to do nothing until he has symptoms, then throw the book at it! You will possibly be trading quality of life for quantity but that is DHs decision.

Having the node biopsied to prove it is PC and what Gleason it is would help that decision too. If it's still a 3+3 leaving it be might be a sensible option until it causes trouble.

User
Posted 07 Nov 2023 at 14:53

Wiosal, just to add,a couple of years ago my next progression would have been HT for life, to control the cancer. I didn't want HT.  My onco was going to wait until my PSA reached 2,4,8 or even 10, before putting me on lifetime HT. Advances in technology and having an oncologist who moves with the times meant a totally different direction for me. 

Following my first reported elevated PSA and referral to urology, I did not want my wife involved in the process. Her first meeting with the consultant was on the day of my surgery when she dropped me off at the hospital. Not saying it was the right action, but we all deal with things in our own way. 

Good luck for your upcoming appointment.

Thanks Chris 

 

User
Posted 07 Nov 2023 at 17:25

Thanks both of you. I think leaving it isn’t an option as in 3 months dh’s psa went from 2.7 to 4.9 that’s quite a big jump isn’t it? We will see what it is tomorrow. But if it was only rising slowly then it would be completely different. Would they offer to biopsy nodes? I don’t think they will suggest that. 

User
Posted 07 Nov 2023 at 21:34

I’ve written all my questions down. Just read them out to dh and he said no way am I asking all those. There are 9. That’s not that many. One of them is asking whether we are stage 4 and incurable. DH says no way is it a stage 4 and I’m not to ask that question. I think a stage 4 prostate cancer isn’t quite so alarming as other stage 4’s. Appointment phone call 8.45 tomorrow. Though it says be available an hour either side. First call was 20 mins early. The last was about 15 mins late. 

 
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