How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. David Your Own Question
Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 47527
Experience:  Board Certified Oncologist
41363181
Type Your Oncology Question Here...
Dr. David is online now

My husband had a routine private health screening in late January.

Resolved Question:

My husband had a routine private health screening in late January. He had been well, showed no sign of any discomfort, this was totally a case of "human MOT".
Age 64 in June 2014
PSA at 52.4
After DRE, biopsie and MRI and PET Scan
Gleason 9 (5+4)
Invasion of seminal vesicles
One pelvic lymph node involved
Bone scan - clear
Started Decapeptyl hormone treatment. After 3 months, PSA dropped to 16.5 and in early July was down to 2.6
7.5 weeks of IMRT Radiotherapy during July/August
Some side effects of increased urinating needs especially at nights and some mucus as well as loose bowel movements. Switching to a low fibre diet greatly helped. Altogether, he remained well though getting tired more easily.
Will remain on Hormone treatment till December 2015.
RT finished on 27th August and the first PSA post RT was at the end of September with a 0.8 result.
It was explained to us that the first PSA post RT could be slightly elevated due to overall inflammation, and that it can take several months for all cancer cells to die.
We are both mentally in full acceptance of this health situation, seeing it as total random bad luck i.e. nothing personal and basically grateful that chance had it that he had a health screening before more damage could spread.
We are aware that with a Gleason 9 and involvement of a lymph node that he is in a high risk category of recurrence.
We also understand that as the prostate was not removed, that some "normal psa" would still occur.
We also understand that the hormone treatment which is going on would lower the psa as long as his body does not offer a resistance.
We also understand the IMRT radiotherapy has the advantages of being more precise and therefore able to deliver higher dose of radiation to the pelvic lymph node with decreased risk to surrounding tissues. As our oncologist explained, logic indicates that treating the pelvic lymph node with the safest highest dose would work, however as this is fairly new, there is not sufficient data yet available.
Every patient is obviously different and therefore may react differently and I fully understand the reluctance from our oncologist to offer a view about the future.
We are however frustrated with the lack of feed-back of average statistics for my husband's particular case.
He has not reached an optimal 0.2 PSA. He may do so by next PSA but then how do we know whether this is from the RT having been effective or the hormone treatment fuelling this result?
Or is it that we are asking the wrong questions to our oncologist, in which case what are the questions which we should ask.
We mainly wish to prepare for the future.
If for example, statistics showed that he is at a high risk of recurrence within 3 years, in which case there would be no cure but Time ahead may be of a few years, we would prefer to know so that he can choose whether to retire or not.
If he is at risk of recurrence, when on average could this happen?
After recurrence, what is an average span of time afterwards?
We have asked when a PET scan could be done to see whether there are active cancer cells somewhere. We were told that this is not a routine way forward and a scan is only done if the PSA starts to rise, with the NADIR way this would be therefore after a several months gap.
Understanding and accepting the way the NHS has to work, we would be willing to pay for this on a private basis, and yet this was shrugged off by our NHS oncologist.
Having no issue at all with the way my husband was cared for during diagnosis process and during RT, I do feel very disappointed with the After Care options.
I would therefore most welcome feed-back on "statistics" for his particular case, questions to ask our Oncologist, and seeing that we are willing to pay privately what options are available to us regarding being pro-active in this battle. Again we both realise that his cancer may not be curable, but we do feel that the more we can catch a spread early the more quality of time left we can buy.
He is altogether in good health, a little bit of weight loss would do no harm but the hormone treatment is not helping! There is no family history of prostate cancer but his twin brother has had issues of inflammation.
His previous PSA test (.e. before last January) was in 2009 and was around 3. The one prior to that was 2 years before and was around 1.5. There had been an increase but it was within the 0 - 4 and therefore shrugged off by GP. In 2009 my husband had spoken to the GP about feeling that his ejaculation was less "powerful" this was shrugged off as "getting older". We will never know. Only adding this, as it is possible that the cancer had started prior to 2009 and maybe had started to invade the seminal vesicles?
Thank you in advance and trusting you to be open. Trish
Any input would be most welcome
Submitted: 3 years ago.
Category: Oncology
Expert:  Dr. David replied 3 years ago.
Dr. David :

This is Dr. David

Dr. David :

thank you for your question.

Dr. David :

your husband's prostate cancer is high risk.

Dr. David :

the best data for long term hormone therapy and radiation therapy to the prostate cancer comes from Dr. Bolla from europe.

Dr. David :

http://www.ncbi.nlm.nih.gov/pubmed/12126818?dopt=Abstract

Dr. David :

5-year clinical disease-free survival was 40% (95% CI 32-48) in the radiotherapy-alone group and 74% (67-81) in the combined-treatment group (p=0.0001). 5-year overall survival was 62% (52-72) and 78% (72-84), respectively (p=0.0002) and 5-year specific survival 79% (72-86) and 94% (90-98).

Dr. David :

there is no "optimal" PSA at this point of 0.2. everyone is different.

Dr. David :

he just needs to continue on with androgen ablation therapy for 2-3 years. better 3 years total.

Dr. David :

after radiation therapy there is a lot of waiting and you can feel helpless to fighting the prostate cancer.

Dr. David :

PET scan will be negative at this point and will not be beneficial.

Dr. David :

he should work on protecting his heart and bones with no testosterone in his body by exercising regularly and working out and making sure he doesn't gain too much weight

Dr. David :

with no testosterone in the body, it is easy to loose muscle mass and gain weight.

Dr. David :

there are no signs now that his cancer is not curable.

Dr. David :

the purpose of this long 2-3 years of androgen ablation is to freeze and make dormant any rogue prostate cancer cells which could have escaped his prostate and allow time for his own body's immune system to hunt them down and kill them.

Dr. David :

so boostering his immune system, getting him exercise and a good diet and plenty of sleep and drinking lots of fluids all help his immune system to function properly.

Dr. David :

there is no way to know when his prostate cancer started

Dr. David :

let me know if you have questions.

Customer:

Thank you very much for this response.

Customer:

Thank you very much for this reponse.

Dr. David :

you are welcome

Dr. David :

did you see my whole reply above?

Dr. David :

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

Customer:

Hitting the send before being finished! Are there tests he should do on ay regular basis for his heart and/or bones? He sometimes feels that his ankles are achy? And I am aware that Hormone treatment can play havoc with bone density. And yet I am amazed that NHS is not providing any follow-up on this. Hence our wish to be pro-active. Next question is assuming that he fares well with hormone treatment till Dec 2015 i.e. no "resistance" can we ask for an extra year of hormone treatment? Even if this means paying for it privately? When would a PET scan show a truth of what is? Thank you

Dr. David :

low testosterone can cause joint aches and pains.

Dr. David :

for men, low bone density is usually not a problem like it is for women after menopause. because men have testosterone after age 50 while women loose their estrogen.

Dr. David :

so a few years without testosterone is usually not such a big deal.

Dr. David :

you should show them the Bolla trial I gave you, that is really the standard of care for gleason 9 prostate cancer.

Dr. David :

http://www.ncbi.nlm.nih.gov/pubmed/12126818?dopt=Abstract


Dr. David :

the NHS should pay for 3 years of hormone therapy.

Dr. David :

PET scan would be negative now and not be helpful and would just be expensive.

Customer:

I will look at the Bolla trial . At which stage of going forward would a PET scan be indicative of reality?

Dr. David :

PET scans are rarely used for prostate cancer and even more expensive in the UK.

Dr. David :

bone scans are useful to look for bone mets

Dr. David :

after his hormone therapy stops, his testosterone levels will normally return.

Dr. David :

this will cause a normal rise of his PSA back up which is normal.

Dr. David :

if his testosterone returns and levels off and if his PSA continues to rise, then a bone scan should be done at that point to look for evidence of possible metastasis.

Dr. David :

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

Dr. David and other Oncology Specialists are ready to help you