Prostate cancer treatment

Former Member
Former Member
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My 93 year old father has been diagnosed with a “ low - intermediate “ grade of prostate cancer. He has had a bone scan ( clear ) and biopsies. 5 of the 22 ‘cores’? had cancer cells. His PSA is 23.1. He has PI-RADS 5 lesions. He has Gleason 3+4  - 73% of cancer cores. His liver is fine.

He has been put on Casodex tablets (50g ) and told he will have to take one a day for the rest of his life. It seems that these tablets are usually given alongside injections which Dad has not been offered. He will be seen again in three months. 

He's been told the side effects of the pills will be like going through the menopause. If he can’t cope with the side effects, they will stop the pills, but not said if there is an alternative.

He has not been offered surgery or any other options  - I assume this is because of his age. Nor has he been given a Macmillan nurse to support him ( as I was when I had breast cancer and my late mother had when she had lung cancer ). We understand there is a pandemic and the Nhs is stretched to breaking point, but feel somewhat abandoned. Dad has tried to get a doctors appointment in order to ask him what it all means, but he is only able to get an appointment by phone ( no visits to the surgery are allowed )  and by the time he gets through, all the appointments have gone. 

Can you give us some idea of what these numbers/words  etc. mean? Looking on line it says Casodex is prescribed for advanced prostate cancer, is this  the case?

Dad is normally very fit, he swims and goes to the gym regularly. He had both knees replaced before the pandemic and has found this diagnosis devastating. He is very tearful and just wants some idea of how long he has left or whether these pills will cure the cancer - or at least give him a reasonable life. 

Stephjc ( daughter)

  • Hi Stephjc, 

    Welcome to our online community and thanks for posting your question. I’m sorry to hear about your father’s recent prostate cancer diagnosis. It can be a lot to try get your heads around. Especially if you feel you’ve not had the opportunity to discuss the diagnosis in more detail. 

    It might be worth getting back in touch with the urology team to find out if they have a Macmillan Nurse within the team. Or you can contact the consultant via the secretary for more information.

    I will explain what each of the pieces of information means in more detail below but essentially, the Pl-RADS reports whether a suspicious area is likely to be cancer or not. The Gleason score give an indication of how many cancer cells there are and how abnormal they are. And the PSA guides how active the cancer is and how well treatment is doing, your father will have this the blood test periodically repeated. 

    It’s all this information that helps the doctors decide what treatment, if any, is needed.

    Hormone therapy can be given on its own or in combination with other treatments. It may be, given your fathers age and the fact it is not a high grade/fast growing cancer they are starting with a less invasive way to manage this. Intensive treatment comes with more difficult side effects and can impact quality of life for a period of time during recovery.

    Here is a more detailed description and links: 

    PSA (prostate specific antigen) – This is a hormone produced by normal and cancer cells in the prostate. When it goes above a certain level, depending on age, it suggests there may be a problem with the prostate. Once a cancer has been confirmed, it can also be used as a good indicator as to how well treatment is working.

    The Gleason score grades prostate cancer. It looks at the patterns of cancer cells in the prostate and identifies the two most common pattern of cells from the sample 1 being similar to normal prostate through to 5 being very abnormal. The scores are then added and that is why you may hear your fathers Gleason score being described as 7 or 3+4. This means most cells look similar to normal prostate cells and the cancer is likely to grow slowly. 

    PI-RADS (Prostate Imaging Reporting and Data System) is a system radiologists use to report how likely a suspicious area is likely not a cancer (1) through to very suspicious (5).

    Cores just mean samples. Multiple Samples are taken during the biopsy to make sure they get as much information about the prostate cells as possible. They usually take at least 10-12 samples and then they are calculated into how many were cancer or not. And in your fathers’ case – 73% of the samples taken were cancer.

    Casodex (bicalutamide) can be used in early and advanced prostate cancer. Bicalutamide is a type of hormone therapy. It stops testosterone from reaching the cancer cells. This can slow the growth of your cancer and may shrink it. This medication can be given alone or alongside other treatment or drugs to help manage a prostate cancer diagnosis. 

    I hope this helps. I’m sure your father’s cancer team would be happy to explain to you both why they have offered this specific treatment. 

    Please don’t hesitate to get back in touch if you have any more questions. Sometimes it can be good to talk through what’s happening. If you think it would help you can call us free on 0808 808 0000. Our line is open 7 days a week, 8am – 8pm. 

    Best Wishes,

    Amy C

    Macmillan Cancer Information Nurse Specialist