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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.
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did your CT scan and bone scan show evidence of cancer spread to your bones or outside of your pelvis?
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.
let me know if you have other questions.
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it sounds like they are pushing this patch trial hard
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.
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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
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.
I would go with that.