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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 46964
Experience:  Board Certified Physician
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What would you do? I have prostate cancer and have choices

Customer Question

What would you do? I have prostate cancer and have choices as to my treatment,therefore i need to take the BEST option
1) Do I have a pet scan..Yes /No
2) HT, +/- Patch Trial, +RT,
2) HT, =/- Patch Trial + Chemo + RT
If the pet scan is +:- HT + Chemo?, NO R.T,
OR
Stampede Trial for metastic patients +/- Chemo
....
male...58 years
trus with gleason score 9....4+5 prostate cancer in 6 cores on the left hand side.
max core was 100%.Perenineural invasion present
SMDT outcome was mri T3b N1 M0
PSA of 97 prostate volume 43cc
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with COPD 0
Submitted: 1 year ago.
Category: Medical
Customer: replied 1 year ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. David replied 1 year ago.

This is Dr. David

I am a cancer doctor.

1. you should have at least a nuclear medicine bone scan as well as a CT scan of the abdomen and pelvis if you don't want to have a PET/CT scan. you need some sort of scans to look for evidence of prostate cancer spread to other parts of your body

2. without the scan, we don't know if you have metastatic disease or not. from your biopsy and PSA levels, you have a chance you could have metastatic disease. but I have had patients who didn't have mets with your gleason and PSA levels.

lymph node spread is not the same as metastatic disease and can be included in the pelvic radiation field and you could still be curable of your prostate cancer.

I would go with anti-testosterone hormone therapy and with radiation therapy to your pelvis and prostate gland if you don't have metastatic disease.

let me know if you have questions and when you would like to talk about your case by phone

Customer: replied 1 year ago.
I would like a phone call please,have already had a Ct and bone scan
Expert:  Dr. David replied 1 year ago.

you would need to accept additional live phone consultation services for me to call you.

did your CT scan and bone scan show evidence of cancer spread to your bones or outside of your pelvis?

Customer: replied 1 year ago.
No neither, but the Doctor suggested a pet scan because of the gleason score and my age
Expert:  Dr. David replied 1 year ago.

well, that is a rare thing in the UK.

that is an expensive scan.

if you look at NCCN (National Comprehensive Cancer Network) guidelines, there is no mention of having to do a PET/CT scan for advanced disease when the bone scan and CT scan don't show cancer spread when you have high gleason and PSA levels.

it sounds like your doctor is trying to find evidence of metastatic disease so they can call your cancer not curable and they won't have to do radiation therapy for you.

I wouldn't do the PET/CT scan

I would ask for curative treatment including hormone therapy and radiation therapy to the pelvis for 5 weeks and then cone down to the prostate gland for the last 3 weeks.

ask for feducial markers to be placed into the prostate for image guided radiation therapy and see if they are able to do that for more accuracy in radiation targeting the entire prostate gland.

Expert:  Dr. David replied 1 year ago.

let me know if you have other questions.

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you can always reach me directly with "a question for Dr. David" in the medicine or oncology categories if you have other questions

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Customer: replied 1 year ago.
What she said was A) the patch trial was randomly computer generated only....She did the radiation treatment at Brighton..The Pet scan was a suggestion because of my age and the cancer was aggressive to the point that there was a good chance the pet scan would show metasses in the bones? Thats why I need some expert advice here
Expert:  Dr. David replied 1 year ago.

it sounds like they are pushing this patch trial hard

http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-looking-at-hormone-patches-for-prostate-cancer

estrogen has been used to treat prostate cancer before, not in patch for, but in injection form. it was used in the 1960s and 1970 when we didn't have LHRH agonist to take away testosterone.

I don't know why they are looking at an estrogen patch instead of using a proven LHRH agonist like Goserelin to take away your body's testosterone. I wouldn't want more estrogen in my system to fight prostate cancer.

this seems like a stupid trial.

I would not want my choice to be Goserelin vs estrogen patchs.

I would want radiation and Goserelin for sure.

thanks for the positive feedback

thanks for using JustAnswer.com

Customer: replied 1 year ago.
What about the chemo as this was included in the choices?
Expert:  Dr. David replied 1 year ago.

chemotherapy has been shown to improve survival odds when added with anti-testosteorne hormone therapy in patients who have proven metastatic disease.

on your scans so far, it doesn't look like you have metastatic disease.

your cancer could still be curable, even if it is high risk and low chance for cure, but still potentially curable.

it is unclear if chemotherapy is needed in yours situation or not. some doctors may not recommend chemotherapy for you

Customer: replied 1 year ago.
as to make this quite CLEAR for me,I've taken about 1month of Bicalutamide tablets (50mg)...have the HT injections with RT and no chemo...NO TRIALS!...however the written info. we are given, suggests the patches do less damage to the liver and less to the bones.
Customer: replied 1 year ago.
The chemo would be Docetaxol in 3 weekly or 6 cycles
Expert:  Dr. David replied 1 year ago.

the estogen patches could cause you to grow breast.

and estrogen patches can increase your risks for blood clots. which can be fatal.

that is not good.

chemo could be an option and could improve your odds of survival possibly.

I think there should be a trial for that as well in advanced prostate cancers like yours when it hasn't spread.

Customer: replied 1 year ago.
What about HT...no patches...+ chemo...+RT with your suggestion?
Expert:  Dr. David replied 1 year ago.

I would go with that.