Treatment options

Hi Robbo

If its likely that the cancer cells have moved outside the prostate then its not worth the trauma of going thru the surgery. (in my mind)

If it has caused mets then chemo,  possibly together  with HT would be best although I think that RT can be used on the mets to reduce pain if necessary.

If its moved JUST outside the prostate capsule  then RT and HT would probably be best.

In my mind ( and this is just my opinion so doesn't mean to say that it's right) ,  if the tumour is not too large, not more than 1 or 2  tumours showing on the Mri and near the middle of the prostate and not near the capsule edge then surgery has a good chance of working. 

Otherwise, surgery, no, again just my thoughts.

Surgery at later stages has a higher chance of not working which would mean RT (salvage) which would possibly increase the likelihood of more side effects,

See what others say

Regards

Steve

Hi Steve

Thanks for your thoughts.  I think this probably explains why op wasn't an option.  I think doc said it was contained within the capsule so presumably broken out of the prostate but not the capsule but must be pushing it.

Any ideas on the alternatives to the chemo? As I say concerned at the age of 77 what affect it would have on his health but are drugs best used when all else has failed?

Thanks

Jackie

Jackie

You really need those CT results, any more news on that  one?

If it has spread to the bones then chemo is probably going to be his best bet unless u can get him on a trial like immunotherapy.

Steve

I can't really tell you why his treatment chloices haver been limited  other than the ones that have already been discussed.

I do know that these treatment options are usually discussed by a multidisciplinary team made up of urologists, surgeons, oncologists radiotherapists etc.  They consider what the most appropriate options are.  In my case for example, I was told either surgery or external radiation were the only options.  Surgery was recommended as better as I had a history if chronic prostatitis and my prostate was a bit like calcified scrambled eggs!

It may be that your dads age and general health are not conducive to surgery and anaeasthetic.

If you want more information on  chemotherapy, this booklet might be helpful

https://community.macmillan.org.uk/cfs-file/__key/communityserver-discussions-components-files/142/MAC11619E15Und_2D00_ChemotherapyLowresPDFHS20182210.pdf

Thanks Steve

His nurse is looking into results and we have appointment on 7th August to supposedly discuss them and treatment route.

I asked about immunotherapy and nurse said not necessary in this case - whatever that means?!*

Jackie

Thank you.  It maybe his COPD although his gp upped his bp meds in case they had to operate with the minor problem he originally went with.  Although of course the prostate op would be extremely bigger than that!

I may email his nurse and ask her the same questions.  We don't even know the type of cancer he has either so will ask that too.

Thanks again all

Jackie

Jackie

Immunotherapy is still early days and the nurse may have very little knowledge of it. 

Your hospital probably wouldn't steer u down that route if they don't deal with that treatment which they probably don't.

Try the prostate cancer research website I think that they give a list of clinical trials available. Also try and do some research online to find out more, anything like that can only help your situation. Although possibly wait for CT results. 

Steve

Jackie

Athough I’m not in a position to give you absolute facts I can perhaps offer some comments to put things into context.

Immunotherapy for prostate cancer is I believe not yet generally available.  Some patients selected for trials may be receiving it.  I think there are selection criteria.  A “nurse” saying it is “not necessary” might say more about the “nurse” than it does about immunotherapy per se,  see below.

From my own involvement with health services during my career, my own experience of prostate cancer 8 years ago and my continuing engagement with health services since, I may be able to give you some insight into the process of being diagnosed and treated for prostate cancer.  There are some variations in the process around  the country and some changes are being proposed however.  So by all means do not accept what I say as absolute fact.

Where I live I know from current personal experience that it is still current practice that when all investigations have been completed and reports available, they are all presented to a multi-disciplinary team (MDT)  made up of urologists, surgeons, oncologists, radiotherapists etc.  It is the MDT who decide  what the best treatment options for an individual will be.  Those options should then be discussed with the patient so that a joint decision (doctor - patient) can be made.  Since any treatment requires “informed consent” by law, the treatment options, their benefits, risks and alternatives need to be explained to the patient.  It should be ensured that the patient can, and does understand the information.

Prior to the MDT meeting that discusses a case, doctors and or “nurses” might mention various treatment options as possibilities, but these are only possibilities and taking them as being definite might be misleading.

As regards “nurses”, you should be careful to differentiate between someone who appears to be a nurse, but who is actually a “care assistant”, a general registered nurse, a Nurse Practitioner, and a Clinical Nurse Specialist, (CNS).  A Nurse Practitioner is a nurse who has specialist skills e.g. carrying out minor surgical procedure and investigations, endoscopy,   TRUS biopsies etc.

I’d say, which is only an opinion, the CNS is the only source of information which is anywhere near reliable.  Even a CNS cannot diagnose prostate cancer or prescribe treatment.

I believe it is generally agreed that for locally advanced prostate cancer which I believe is stage T3, that although surgery may be possible, Radiation (RT) may be preferable.  Possibly along with hormone therapy.

You might find this web page helpful, it applies to locally advanced prostate cancer only and since your dad hasn’t been given this diagnosis as yet it might be irrelevant.

COPD may be considered a risk for surgery because of the general anaesthetic potentially causing an exacerbation.  I’m not sure if prostatectomy can be carried out using a spinal anaesthetic.

High Blood Pressure (BP)  (along with raised cholesterol) even if controlled may also be a risk factor for surgery.  The risk may not be so much the BP itself but its underlying causes.  “Essential Hypertension” is just high blood pressure with no apparent cause, otherwise Hypertension is a symptom of a condition, not a condition in itself.

I know it’s awful being in the position of someone giving information without being in possession of all the relevant information, (the doctor or the nurse).  People ask and you want to give them an answer, you don’t want to leave them wondering or not knowing the possibilities because this is a source of anxiety.  However, knowing something, but nothing definite can also be anxiety provoking.  It then seems natural to focus on every little detail to try and find some significance in it.  It’s easy to come to see the “wrong” significance.

Since it appears that not all results for your dad are available, so they won’t have  gone to an MDT. There can’t be any certainty about what the treatment options are.  Then, your Dad can expect and ask for explanations and should get them in the light of ALL the factors.

I hope this helps, I know it’s hard to wait for when you’ll be told what’s what with any certainty.

Thank you

Yes I get the COPD and high blood pressure may be a problem.  You're right that knowing something rather than the full picture is distressing and I presume even more so for my dad even though he doesn't say anything!! 

I'm aware of the difference in nurses and it is only his clinical nurse specialist that I have been speaking with. I have emailed to ask if his results are through in preparation for his appointment next week but she is currently on holiday.  We can't do anything until results are through but the way they were speaking at the appointment it was chemo if scan showed mets and radiotherapy with no bone mets.  There were no other options mentioned at all and they were supposed to have had the MDT meeting but not sure how without results!  I just want to make sure the results are there for next week.

Jackie

Jackie

Yes, I hope all results are available at the next appointment and been seen by the MDT, unless they already decided on options pending scan results, which could possibly be the case.

It’s your choice but I wouldn’t ring the CNS for results of these investigations.  I don’t believe that she/he is really allowed to give them over the phone.

I have been in similar situations myself where people have asked me for information and I haven’t been able to tell them despite knowing.  If the answer is really positive sometimes I gave hints, but if it’s negative I’ve said, “I can’t tell you” which is bad, because then people think the worst.

That’s why I don’t ask until I have an appointment.

Hopefully the scans will be OK and the treatment will be Radiotherapy, (RT)

I hope you’re not disappointed that surgery has been ruled out.   RT is known to be just as effective as surgery.