Hi Sorry you find yourself here. You are right that things you read on the internet may suggest he has a poor prognosis, but you are not necessarily looking at the right things on the internet. Doctor Google is useful, but he hasn't seen all your father's test results, for that matter neither have you, and I certainly haven't so I can't be of much help.
What I can say is that the chance that the lump is caused by prostate cancer is very low. The majority of men diagnosed with prostate cancer are diagnosed whilst being investigated for some other symptom, and prostate cancer is diagnosed by accident. I think it highly likely your father is in that situation.
The main reason I think the lump is not related to prostate cancer is that by the time the cancer has spread to other parts of the body the PSA is in the many hundreds or even thousands. Also pain in the bones and fractures are the usual symptoms of cancer spread to the bones not lumps.
A PSA of 20 is much more likely to be cancer in the prostate than advanced cancer.
There are varieties of prostate cancer which have low PSA and have spread, but these are probably in about one in a thousand cases. So just because I think his PSA is too low for advanced cancer doesn't completely rule it out.
The CT scan will have been for most of his abdomen. Do you know whether the "indicative of cancer" was only for the prostate, only for the lump, or for both?
I think at the moment you will be better googling outcomes of medium risk prostate cancer, and regarding the lump as unrelated unless/until some medic categorically says they are related. You will see the prognosis for any cancer less than advanced cancer is quite good (curable), and even in advanced cancer(incurable with today's medicine) the life expectancy is of the order of five years .
Keep us informed, particularly as you get more test results, when the picture starts to get clearer.
Edited by member 04 Apr 2024 at 02:18
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The fact that they have started him on hormone treatment without a biopsy suggests that the scans were showing clear cancer spots. It isn't usually possible to diagnose prostate cancer without a biopsy and they wouldn't have started him on HT just because of his PSA.
So yes, it seems that the doctors have seen indicators of locally advanced or advanced cancer. If it turns out they are wrong and the biopsy is clear, they will just ask him to stop taking the bicalutimide tablets.
In terms of what you have scared yourself with on Google - worth knowing that many men with advanced PCa live for 5-10 years on HT and some exceed this! If it turns out to be locally advanced rather than advanced, it is still possible to get full remission.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Hi, thank you so much for your reply. The ‘indicative of cancer’ came after the original CT scan on the lump and blood test (not sure what the blood test was for but I imagine this was the PSA as he hadn’t had another blood test since then.
The first CT scan was unsuccessful as they were unable to find the lump on the scan. They then marked it with a pen and second time round was successful. Around a week after this scan he was called in to say it was indicative of cancer. He was then ordered an MRI, XRAY of the chest and bone scan (the bone scan is the only test we haven’t had results for yet according to the urologist yesterday).
I guess this is what I was struggling to understand as the PSA level was so low in comparison to the many people on here who said their PSA was much higher when finding mets.
however the urologist yesterday did say that the hormone pills should help with the ‘other lump’ and back pain it was causing so I presume maybe the MRI has picked this up.
I know there is a lot of presuming at this stage and we won’t know anything fully until the rest of the scans and IDM come through but it’s just all so difficult to wrap my head around.
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UPDATE: just had a call from the MacMillan nurse asking him to stop taking the tablets until next week’s prostate biopsy. So back off the meds until then.
Had a look at his original CT scan report and it mentioned a destructive lesion on the right hip no more than 39mm. Something about soft tissue component too. Most commonly seen in bone metastasis and suggested urgent referral. So seemingly they are connected. Hard to wrap my head around with only a 20 PSA.
He’s been told to take the hormone tablets after the biopsy next week and then in around a month he’ll have a meeting with the oncologist. Is this standard practice - it all seems like a long time to be waiting? I’m really worried about his outlook. No other bone pain and the back lump only causes slight niggly pain, nothing major.
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Hi daughter97, It is good you have access to the full CT scan report. Yes it does sound like the lump and prostate cancer are related. Lyn's point that they started him on hormones, also suggests that they have clearly identified significant cancer is also valid.
The hormones will shrink the tumour so the biopsy would not be very accurate if done once he had started hormones. I can see that at the hospital there would have been some confusion as to when to start the hormones, once it is diagnosed as advanced cancer that is the best initial treatment, but it is better to get the full picture from the biopsy first.
My statement about 1 in a 1000. Having low PSA is roughly correct, in the UK that would mean about 50 cases per year, so I think your dad is one of them.
Obviously the biopsy and bone scan results are needed to know more, but people can't help googling and wider knowledge in context is a good thing.
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PSA doesn't tell enough of a story on its own - it just indicates that further investigation is needed. We have had men on here with a PSA of 3 and mets all over their body and men with PSA of 80 or more who didn't have cancer.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Does anyone know whether PSA indicates how aggressive the cancer is / how likely it is to respond well to treatment? Does a lower PSA mean better outlook?
So sorry for all the questions, just trying to wrap my head around everything as it’s all come on so quick.
I’m going to be running the London Royal Parks Half Marathon to raise money for Prostate Cancer this year. Thought it would be a better outlet for my anxiety than excessive googling and worrying !
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Some aggressive cancers give off very little PSA.
It may be worth calling the number at the top of the page and speaking to one of the brilliant nurses, the answer to one question often throws up another question, a two way conversation sometimes works better.
Thanks Chris
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The biopsy results will be able to tell the nature of the cancer and how aggressive it is.
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Thank you so much everyone for such thoughtful responses, I'm so grateful for the advice and support. This has been such a difficult time and I have so many questions. It's so heartwarming to have people like you to help. I know the next few months / years will be hard so I know it's time to be brave for my Dad. His humour and positive outlook is currently getting him though and I know it's time for me to do the same. Staying off Dr Google has been very good advice. The doctor said his prognosis was good so I need to put the trust in them and stop trying to find answers / statistics myself.