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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18757
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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My husband has been diagnosed with prostate cancer. His PSA

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My husband has been diagnosed with prostate cancer. His PSA was initially 106 in Feb, placed on hormone treatment it is now Nov 0.3. His bone scan showed no spread, however the treatment makes him feel very exhausted with muscle aches and sweating. He copes with the sweating but not the constant "feeling ill". We have asked the urologist specialist for possible alternatives such as targeted radiology but this was dismissed without explanation. He has not been offered anything else and none has been discussed. My husband is 79 and normally very fit. Should we ask for a second opinion please?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.
Targeted radiation therapy would usually only be an option if there is disease that is identifiable in specific locations. From you description, there does bot appear to be any identification of tumor in any specific location, and this is likely why it is felt that hormonal therapy is the only good option.
You mention the negative bone scan, but has there been any other evaluation to try to identify the location of tumor that was causing the PSA of 106?
Customer: replied 1 year ago.
The prostate had the result of 106 - no other investigation has taken place except the finger test and the bone scan.
Expert:  Dr. D. Love replied 1 year ago.
To answer your specific question of whether it would be appropriate to ask for a second opinion, the answer is yes. When dealing with any significant cancer, it is reasonable to seek a second opinion.
They have likely dismissed other options as they are generally not as well tolerated as the hormonal therapy. When the PSA is this elevated, it usually needs systemic therapy, particularly if no specific location of the cancer can be identified. The systemic therapies that are option includes hormonal therapy or chemotherapy, and chemotherapy is usually not as well tolerated as hormonal therapy.
Another option that is sometimes not readily discussed is whether to do nothing. By default, we typically try to treat with any option that is potentially effective, and in his case, there is good evidence that he has responded well, since his PSA has improved dramatically. But when someone has significant side effects from a treatment that seems to be otherwise working well, the patient may prefer to discuss the risk of stopping the treatment that is causing significant side effects. We see this more often in people getting significant side effects from chemotherapy, but the same discussion may be appropriate for any treatment that is causing the patient to have significant side effects.
If I can provide any further information, please let me know.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18757
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 2 other Medical Specialists are ready to help you
Expert:  Dr. David replied 1 year ago.
This is Dr. DavidI am a cancer doctor who treats prostate cancer patients.in the UK, radiation therapy is expensive and so the cancer doctors there like to ration the use of radiation therapy.with a PSA level of 100, there is a high chance of metastatic disease elsewhere in the body, even if it is not seen on bone scan.however, there is evidence that even with advanced prostate cancer, the use of hormone therapy alone is not as good as with hormone therapy and with radiation to the prostate gland.this has been studied in a randomized trialhttps://www.ncbi.nlm.nih.gov/pubmed/19091394?dopt=AbstractconclusionIn patients with high risk or locally advance prostate cancer, addition of RT to ADT improved survival, with acceptable side effectstake this study to his doctors.if there is no evidence of prostate cancer spread to bones, then he may be a candidate to undergo radiation therapy along with hormone therapy to improve his long term survival odds.lupron or zoladex anti-androgen therapy will drop his testosterone levels very very low and cause his PSA levels to drop by making prostate cancer dormant in his body, but it doesn't kill prostate cancer cells. this will cause hot flashes and fatigue, loss of libido, muscle mass loss over timein europe, they often will use high dose bicalutamide therapy at 150mg a day as a way to block prostate cancer growth and maintain the body's testosterone level as bicalutamide works inside of the prostate cancer cells. but it can cause gynecomastia and breast growth as a side effect and so some patients get radiation to the breast for 5-10 days to prevent breast growth if they opt for bicalutimide therapyask his doctors about these options