Dad got the bad news yesterday

Hi I'm sorry you find yourself here. I've been on this forum about five years. My scores were much lower, and thanks to radiotherapy I am probably now cured. I have seen posts with numbers this high before.

The most important thing to know is that Hormone therapy can suppress prostate cancer almost immediately and it can keep it suppressed for a number of years. That is what they mean by manageable. If it were confined in the prostate then they could target it and kill it, then he would be described as curable.

Though hormone therapy (HT) makes the cancer dormant, no one can ever predict for how long it will work, in the worst case it is about six months, in the best case it is 20 years. On average it is about 3 years. Some cancers have genes which make them respond better to different treatments I suspect the biopsy is to find if they can choose a better HT.

The outlook in the next few months is surprisingly good, the HT can have side effects I was on it for two years, it was not too bad.

Hopefully others will be along with more help. 

Hi HOF,

T4NOM1b means the cancer has spread from the prostate to other nearby organs. In your dad's case, the bladder. N0 means there is no lymph node involvement. M1b means the disease has metastasized to one or more bones. In your dad's case a rib.

Our site explains things well.

https://prostatecanceruk.org/prostate-information-and-support/just-diagnosed/advanced-prostate-cancer

Its lovely that you have found us to help your dad. You'll get lots of support here. ×

If you were to go on the internet and look for an image of prostate cancer bone scan, you would see what looks like an x-ray of the entire skeleton. For some the image is that simple, however for others the image will have one, two or hundreds of black dots. These are caused by the bone constantly repairing it self because it is constantly being damaged by cancer cells. If there are more than a few dots then it is almost certainly cancer, or you've been in a boxing match with Mike Tyson. If there is just one dot, it does give rise to the possibility that it is just a bone injury being repaired.

Now the people who interpret these scans might be able to tell if a dot looks more like cancer than an old broken bone, so don't hold out much hope that it is not cancer.  Bone scan costs the NHS about £1000 they are happy to do loads of those.

A PSMA PET scan, can detect the actual prostate cells, his prostate should only have these in it, and there should be none anywhere else in his body. So if a PSMA PET scan shows the same spot on the rib has prostate cells in it, you know it must be cancer, the scan may also show prostate cells in other organs which a bone scan can't do. Problems with the scan are that about 10% of men have prostate cells that do not show up in that type of scan so it is useless on those men, also the scan costs about £5000 so they are not so keen on using it.

My guess is that the PSA being so high, is such a strong predictor of metastatic spread that they don't think a PSMA PET scan is necessary. However with only one hotspot on the bone scan, that is quite weak evidence for metastatic spread. Remember I and everyone else on this forum are amateurs, the experts are far more likely to judge these things better than us.

HT should suppress any cancer growth anywhere in the body, so that is the treatment to start with. Surgery on the rib, or prostate which is already in the bladder neck would be impossible. Radiotherapy to the prostate would kill* any cancer there, radiotherapy to that rib would kill* any cancer there, and if he absolutely did not have any cancer cells anywhere else he would be cured.

*In reality radiotherapy kills all the cancer cells only in about 90% of men. So some men are never cured even though the cancer has been well targeted. In addition another 20% of men have metastatic cancer which is not detected in the early stages, the prostate can be cured, but the other cells develop in to secondary cancers years later. Hence only about 70% of prostate cancers are cured, unless caught very early.

If you can set your mobile phone to record, then take it to the meeting and ask if you can record it. That way you can replay parts you may have missed.

Edited by member 13 Nov 2025 at 00:23  | Reason: Not specified

Dave, as usual, explains things so well, I wish my consultant had been so clear and articulate.

I also had the same thoughts as him on the hot spot on your dad's rib.

Recently one of the lads, DaveyH, had a  single hot spot on his spine. He later wrote:

With me the bone scan found a “hot spot” on my spine lumber 2, potential metastasis. I was then sent for a PSMA PET scan about 3 weeks later to confirm or otherwise. Then another 2 to 3 weeks to get the result. In my case the PET scan didn’t find any mets. The bone scan gave a false positive on a degenerative condition, probably a bit of arthritis. It was a massive relief, but I went through around 5 to 6 weeks of purgatory thinking my prostate cancer had spread. 

The big difference, however, is that your dad's PSA is much higher than Davey's was, but your dad also has spread to to the bladder neck, which I suppose could account for his high PSA level.

When I had my CT scan. They found, 'indeterminate lytic areas' all over my pelvis, hips and and both legs. Fortunately, after a bone scan, a couple of weeks, later they put these suspicious areas down to arthritis and degenerative wear and tear. I never had a PMSA scan. 

Hi.

As Dave said, none of us are medically trained. We just do our best, to help people by using what we've learned, and ours and others past experiences. 

I'd certainly question whether they can confirm that the the hot spot on your dad's rib is definitely cancerous.

Being in good general health is good news. HT reduces testosterone and that tends to result in lower strength, it can cause hot flushes like the menopause, exercise in considered a good way of avoiding the worst effects of HT.

The usual way to administer radiotherapy (RT), if it is being done with curative intent, is to start the patient on HT for six months, then do about 30 sessions of RT over about 6 weeks, but keeping the patient on HT for another two years. 

If incurable then the treatment is HT then moving to stronger HT drugs, then trying chemotherapy, and once all these have failed, using RT as a way to control pain in the final few months of life, this would be referred to as palliative RT.

Since I was treated 7 years ago, treatment for incurable people has become more intense. Now it can include RT and chemo, much earlier on rather than waiting for each treatment to fail and trying a stronger one. Some evidence, says do all treatments together earlier on, and this will knock the cancer so hard it will take a long time to return. I think the phrase for this more aggressive early approach involving HT, chemo and RT is called triple therapy.

Definitely the next thing is to find out for sure if he is classed as incurable and if any tests could be done which may change that diagnosis. 

Then if he is curable, if the plan is RT with curative intent, (usually after six months HT).

If he is incurable, whether the plan is a slow progression to stronger drugs, eventually leading to palliative care, or a hit it hard and early approach, though eventually leading to the same outcome but hopefully later on.

I have to say with a high PSA and a doubling time of three months, I would be surprised if he is curable, but there is still hope.