Father diagnosed with advanced prostate cancer

It will all depend on the gleason score and staging which he will get from the MRI and biopsy as to what treatment options he is offered.  As a rule his age and possibly the COPD could mean he would not be offered a prostatectomy - though that may not always be the case as I live close to a 76 year old who had a prostatectomy and recovered well from it.  Just depends on individual hospitals and of course on the actual gleason and staging.  I don't think that any of the othe treatments such as radiotherapy, hormone therapy etc would pose a problem I am not sure about diabetes but generally from what I learnt on my prostate journey through which I have spoken to dozens of men at our Maggies Cancer Centre diabetes and medication for it can accommodate most treatments.

Keep in touch and let us know his results so that we can advice you further when you have more information.

All the best

Des

Thanks Des

I thought they only did prostatectomy if it was local not when it was advanced?  Also I've read it can take 15 years to spread.  Does it become more aggressive do you know when it's broken out of prostate?  It's just if it's taken a long time to get.to the stage he's at now and grows at the same rate at 77 he could die if something totally unrelated!!

Thanks again

Robbo

Hi Robbo.

Sorry for the worrying situation that you find yourself in. I'm not an expert, just a very interested individual trying to make sense of my own situation, but I've never read of a prostatectomy being performed for advanced prostate cancer. As far as I know the NHS protocols for that situation are hormone therapy (to arrest the spread) and chemotherapy (to attack the cancer cells). Hormone therapy, which I've been on since January, does have side effects, which although troubling for some, seem nonetheless to be fairly mild for most people compared to other therapies. Chemotherapy is another matter, as it does put the body through quite a lot, and its applicability in your father's case may depend on his general health and any other conditions he may have. I am in chemotherapy myself at present and it IS fairly challenging. My first cycle was particularly so, BUT the intensity of the chemotherapy can be varied according to individual needs and circumstances. 

My impression re your question 'Does it get more aggressive when it's broken out of the prostate?' is that the main risk factor when it comes to spread is a high Gleason score. It was explained to me by a senior specialist nurse that cells of a similar type normally bind together, a phenomenon he referred to as 'stickiness'. High Gleason score cells in particular are 'non-sticky', which seems to mean that they have a tendency to drift off in either the blood stream or the lymph system. That, apparently, is what generates spread as opposed to tumour growth. Once in either of these two circulatory systems the cells that they are most likely to bind to are bone cells I believe.

I hope that that attempt at answering your questions is of some help.

Very best wishes,

Jonathan.

Hi Jonathan

Thanks for responding.

Thank you for the info this makes sense.  It's all come as a bit of a shock as it's been diagnosed following a minor urology issue!  I think dad would rather not have known but now we do it just seems bad news after bad and nowhere to go.

All I can think of is the horrible treatment to come, the effects it will have on him at his age and it may not gain him anything then when I start thinking on that route I become even more desperate.  But we're hear and we have to deal with it as best we can.  We don't yet know which bones are affected but doc doesn't think it's spread to his lymph nodes.  Not sure if this is better or worse?!*

Hope everything works out for you.  Hopefully if it's contained you will get a positive outcome.

I'm sure we'll be chatting again if that's ok.

Robbo

Sorry Robbo,

missed that you said advanced pc.  they will probably offer chemo along with radiotherapy for some of the spread he also may be offered Hormone treatment, and some other medication - there are so many things out there.  It will not be a cure but the treatment can keep him quite well for some time.   My brother-in-law was diagnosed at 54 with advanced PC and lived a healthy 15 years afterwards though the last 18 months were not good for him - that was a long time ago and there are a lot more treatments and different medications out there now that he couldn't have - indeed his consultant saw my sister-in-law a year or so ago and told her if abiraterone (sp?) had been available it would probably have given him even longer. The MRI will show if there has been spread outside the prostate.  a bone scan will show if there is spread to the bones - though it must be remembered that tiny metastases will not show on these scans - though I believe he will be scanned as he goes through treatment so any metastases that grow will be picked up as they enlarge and can be seen on the scans. 

I was 73 hen diagnosed and 74 when I got my treatment a month of radiotherapy after 9 months on hrmone treatment.  It was seen from the MRI that the cancer was pressing on the capsule so radiotherapy was the way forward as it would mop up any cancer cells which may have escaped which could have been missed by operating.  Had it not been so close to the prostate edge I may have been able to have a prostatetomy - though pre existing bladder and bowel conditions may have precluded me from this.  With my PSA and gleason score active surveillance may have been an option with PSA tests every 3 months and a biopsy every year , as at my age they again first thought I was not at risk of dying from the PCa but once the MRI showed the tumour pressing against the capsule this was definitely not an option.

Just as an afterthought Robbo I hope you are getting a PSA test every year or two as now your Dad has been diagnosed I think you and any brothers and your/their sons and your Dad's brothers are three times more likely to also get prostate cancer so get a regular PSA check so that any rise can be checked out and if any cancer is found it can be treated early and cured.  Thankfully I managed to get my sons to do this and my brother and he is now at the stage where he needs a biopsy after a quick rise in his PSA over a 4 month period.  He was lucky as he had had a PSA test and was having more blood tests and asked the Doc to add PSA to it so the rise was caught sooner than it would have been. 

All the best Des

Hi Des

Thank you for the info.  I think the thought of what he has to go through is almost (almost!!) As bad as getting the diagnosis.  As I think I've said we travel loads (they have an apartment in Spain) and have holiday booked totwhich Florida later in the year which will now be put on hold as he won't be able to fly and I wont want to leave him.  I'm a woman thankfully although I did wonder about my son - what's the link for grandchildren do you know?  I can't seem to find much.

We know it's in the bones as the a and e doc blurted it out and then wouldn't go any further.  He finished it off with an almost throw away comment of "there's treatment for it"!  Would they not start him on hormone therapy to bring PSA down and take it from there? We have a number of family and friends with it but it's all at the early stages and just being monitored.

The word "years" sounds wonderful to me at the moment as I have read many horror stories with his diagnosis.  I just feel really helpless and then of course there's my mum who relies on dad so heavily for everything as she doesn't drive and not brilliant on her legs! 

All we can do is wait and I'll continue to read anything I can find to see the best treatment for him.

I hope your treatment continues to go well and no doubt I'll be back for your advice.

Robbo 

Aha, Sorry for making the assumption that you were mail from your name - Robbo being Robert!  I do not know about grandsons but men should be checked from at least 50 preferably 45 (my brother in South Africa has been having them since he was around 40 as part of his work medical examination every year and at 71 he is still working in a consultancy role - s lucky thing still has health insurance - other wise he would be in a sticky place healthwise out there) by PSA blood tests.  I know how difficult it is to get this done as so many GP's say this is not worthwhile because you get a lot of false positives and false negatives - however, there are also a lot of young men ie under 60 and under 50 who manage to get a PSA test done even though they haye have no symptoms (usually their wives nag them to do this) and they are found to have prostate cancer.  I was at my Maggies Walnut Club on Wednesday and one young man of just 59 was pestered into getting a PSA test done - his wife had been a nurse so wanted him to get this done,.  His GP kept saying no, no, no, but he did have the test and he was found to have a PSA of 684 which is pretty high and the cancer has spread to his bones.  The thing that GP's need to tell younger men is that there are other things that can cause a high PSA level - ie benign prostate enlargement, infection and possibly other things but a PSA test result can give you the head up that something is wrong and something has to be done or checked out to ensure that it is not cancer.

Sometimes, the doc will start on hormone therapy straight away and sometimes once all tests are done they start on early chemo.  But all tests must be carried out first and then usually a MDT Multi Disciplinary Team meet and discuss how best to treat the individual - that will comprise of maybe a urologist, oncologist and radiotherapist.

Hope everything goes well with your Dad and for you and your family.

All the best

Des

All the best to you and your Dad

Hi Robbo

Sorry to read of your fathers father's situation 

Being diagnosed with advance or metastatic prostate cancer will usually result in immediate treatment with hormone therapy & followed by chemotherapy, 

The new rule is to give chemotherapy  fairly early on in the treatment path as research has shown this to have long term benefits.  Unfortunately surgery or radiotherapy are out of the question as far as treatment options go, although radiotherapy can be given for palliative care (once for pain relief)

Hormone therapy is usually effective for 18-24 months, then an additional hormone therapy like bicalutamide can be introduced to work alongside the original treatment.  Again may be effective for 12-24 months then there are newer treatments like enzalutamide or Abiraterone. 

These are pretty standard treatments for advance prostate cancer and unfortunately we all have different reactions to these treatments, some work better, some work longer and some don't work at all as none of us are the same.

Don't get to hung up on what you read online, 6 years on I'm still doing everything I want to do and have very little in the way of pain or side effects. I still travel although insurance can be an issue ( costs a lot more) so I don't bother with it! If I feel that unwell I can just get a flight home.....

Don't give up hope there could be many happy years ahead.

Steve