Understanding my dad's diagnosis

The thing I still don't fully undertand is how serious it would be if the cancer were to breach the capsule. Given that it's seemingly a low-grade cancer, would a doctor looking at my dad's case assume that his cancer could still be treated with e.g. radiotheraphy? Or once it's breached the capsule is it inevitable that it will spread? (I know you can't give anything like a definite answer about my dad's case specifically!) A lot of what I've read suggests there's a strong incentive to treat while the cancer is still contained in the prostate, but they haven't suggested that for my dad, and I don't know if that's down to his age.

Another question that's come to mind this evening: should we be asking about hormone therapy, which I gather can keep the cancer at bay without curing it? When I began reading about how prostate cancer is treated, I assumed hormone therapy was given as part of active surveillance, and as a precursor to surgery, but I think that was me misunderstanding things, and hormone therapy is very a treatment in and of itself.

I think I'm just struggling to recocile myself to the fact that nothing's going to happen for another 5 months, and that when it does happen it will only be another blood test.

Hi again.

I know my own dad was diagnosed with prostate cancer in his late seventies. Ashamedly, I don't know what his exact diagnosis was and I wish I'd taken as much interest in his condition as you are doing for your dad.

However, I know that he was deemed too old for radical treatments and I believe was just given periodic hormone injections. I now know hormone therapy doesn't cure cancer but it slows it down. He carried on pretty much as normal until he passed away at 88 years old.

He did, however, struggle for the last month of his life. I know at this stage his PSA was over a thousand and the cancer had spread to his lower back and pelvis.

Until that final month he seemed pretty unfazed by the disease. If he'd been suitable for radical treatment, I don't know how he'd have coped with surgery or radiation, and the side effects those treatments often bring. I don't know if his quality of life would have been better or worse.

Edited by member 12 Jan 2025 at 00:28  | Reason: Typo

That is one for your medical team or perhaps ring the nurses on this site on Monday, the number is at the top of the page. My current doubling time is between 2 and 3 months, I no longer have a prostate and my oncologist is talking about keeping my cancer controlled for 5 years. 

If his team have suggested AS then I suspect they are not too concerned about his rate of rise. 

Thanks Chris 

My dad's been on active surveillance since I first posted here in Jan. His PSA has been steadily climbing (up to around 15 on the last test), and he's also had some symptoms in recent months - waking up at night needing the loo, and general tiredness and fatigue. He's always been very active - keen rock climber, cyclist, lots of time in the garden and at his vegetable plots - but he doesn't have the energy he used to have and the change feels sudden enough that it's hard to attribute it simply to age. He had been worried these might be signs of the cancer spreading, so asked for another MRI, which they did last month. That's now come back and shown a second lesion on the other side of the his prostate, though thankfully they are still grading the cancer as T2, albeit now T2c - contained within the prostate but on both sides. (We don't have a gleason grade for the new lesion but I assume a further biopsy would be needed for that).

My dad's had two calls with the nurses at his hospital and they've suggested the cancer has now reached a stage where treatment would be warranted, though they don't seem to be suggesting there's any urgency. The initial suggestion was that he would have radiotherapy and hormone therapy, though we did also ask about prostate removal and they suggested we could have a consultation with a surgeon if my dad wanted that.

Right now, we're really unsure about the best way forward, and I'm wondering if anyone here has any advice. From what I've read online, my dad would be a candidate for prostatectomy so far as the cancer is thought to be contained within the prostate, but radiotheraphy might still be preferred so far as it has milder/fewer (?) side effects. But from what I can understand there is more risk with radiotherapy of the cancer recurring. Is that broadly accurate?

I had been hoping my dad would be offered RARP so far as it offers a definitive cure, but obviously it's not me having to undergo the surgery! And I don't know if I'm over interpreting the difference in cure rates between radiotherapy and prostatectomy.

I've also been reading online (mostly via the prostatematters website) about focal therapies - HIFU, nanoknife etc. Should we be asking about these? There's been no mention of these in our conversations with the nurses, and so I assume we'd have to ask about my dad being seen at a different hospital (we are near Southampton so that might an option). From what I can understand, these treatments are usually only an option for t2 stage cancer, though I don't know if my dad's t2c staging would rule them out?

My big worry about my dad's cancer has always been that the initial reports flagged the primary lesion as being very close to the edge of his prostate (there was a question of him being t3a), which I assume means a greater chance of it breaching the capsule, if it hasn't already in ways that aren't visible on the MRI. I also don't know if that should influence the treatment options.

The other complicating factor is that my mum is likely going to be undergoing a stem cell transplant early next year - a much more serious procedure that's going to need both me and my dad to act as her caregivers in the months afterwards. My dad is talking about delaying any treatment for his prostate cancer until mum is through the initial stages of the transplant - my feeling is that this might be more of an arguement for him having one of the more targeted therapies with fewer side effects, as I worry if we let his cancer sit for another ~9 months it will only spread.

Sorry for such a long and messy post. If anyone has any advice on how we weight up the different treatment options it would be appreciated.

Thanks Adrian for your reply, and sorry to be slow in acknowledging it. Thanks also for the London Cancer Alliance video - I shared it with my dad (not sure he's looked at it yet, though!)

We've got a bit further with things this week.

At the start of the week, he went to see a doctor privately in Southampton. He was there all day while my mum had an appointment at Southamptom hospital, and we had been discussing the day prior him getting a second opinion, so he just arranged the consultation on the spot and was able to meet with a doctor that same day. The meeting was quite helpful. It was suggested that the recent MRI scan wasn't great quality and so this doctor didn't feel we could say for sure that there's a second cancer lesion (I guess benign lesions in the prostate are possible?) He felt a second scan was needed, but tentatively suggested that my dad might be suitable for HIFU (if no second lesion, or if it's small and negligible), or alternatively RARP.

Since then, my dad has also spoken again to one of the nurses overseeing his NHS care. They've advised a different treatment path, which is hormone therapy to be followed by radiotherapy a few months down the line. Because my dad previously had a blood clot while flying and is on blood thinners, they are advising against prostatectomy, though also said we didn't have to rule it out if my dad wanted to discuss that option. They've also suggested focal therapy wouldn't be an option, though we didn't really get a reason as to why. We did mention the scan apparently being poor quality and asked whether another was needed, but the suggestion was that it likely wouldn't have a bearing on things - the increase in the PSA would be enough to warrant treating my dad's cancer irrespective of whether the second lesion that they think might be visible on the second scan is cancerous or not.

So it feels like there's only really one treatment option for my dad, at least under his current NHS care. I can tell he's wanting to put the cancer out of his mind again, and I think he is happy to go with the hormone therapy and radiotherapy on that basis.

From my perspective, I'm worried having read that radiotherapy isn't always expected to cure the cancer, and that there are few treatment options to look at if the cancer returns, with prostatectomy usually not being an option post-radiotherapy. Am I right to be worried about that, or am I over-interpreting what I'm reading? What are my dad's prospects if the cancer returns following radiotherapy?

The doctor my dad met privately seemed to think he would be suitable for HIFU, and I don't know if there's any benefit in my dad going down that route, even if it means going privately. As far as I can understand, HIFU would still leave open the possibility of prostatectomy or radiotherapy at a later date if the cancer returns/persists, and would have fewer side effects?

Edited by member 08 Dec 2025 at 13:29  | Reason: Not specified

The suggestion is that it's all still contained within the prostate, yes, though if the quality of the scan is poor, I don't know if they can say that for sure. But in any case, they've now given a grading of t2c - contained within the prostate but on both sides.

My dad's received all of the prescriptons and paperwork for the hormone treatment today, and he's meant to start on it right away, to be followed by an injection of Prostap or Decapeptyl in 2-3 weeks' time. He's about to go abroad, so he's rung the hospital to ask if he can delay it, but I think he's otherwise minded to start on the treatment when he gets back next week.

I'm reading the side effects of the hormone therapy and I am worried how it will affect him, as all of his interests and hobbies are outdoors and it's obviously going to have an impact on that.

Re. a second biopsy. I know you cannot give medical advice, but is your feeling that a biopsy might throw up a more benign explanation for the PSA rise and that my dad's cancer might still be suitable for active surveillance, or is it rather that it might influence the choice of treatment? Knowing how my dad has been fretting over things in recent months, I think he's going to want to begin some form of treatment regardless, but if a biopsy is likely to influence the choice of treatment, then I feel he should ask for one.

I assume starting the hormone therapy won't preclude him going back to the hospital and asking for a further assessment of his cancer?