Stroke Patient and Prostate cancer treatment

Hello and welcome User26.

I have bumped this back to the top in the hope that some of the people with heart and/or stroke issues will respond. My husband had a major stroke and TIA's in 1997 and is currently on Beta blockers for his heart. He was diagnosed with T4 prostate cancer in 2020 so the option was to have HT (taking into account the risk to the cardiovascular system) or not having it and having just Radiotherapy and/or Chemotherapy. We chose to have HT as, in our opinion, it gave us a better chance of having longer together. He has been on ADT since 2020, but also Bicalutamide for 18 months and then Enzalutamide for 18 months as the drugs became less effective at controlling the cancer. There is research ongoing as to which form of HT may produce less CV incidents so I think this is a question for the oncologist. I would make sure that they find out whether the recurrence is being driven by the prostate or by metastasis. Alternate treatments available will be dependant on what you had done previously so a little more information from you might help with giving more targeted help. Look forward to hearing from you.

Thanks a million for replying to my post.  My Dad had prostate radiotherapy 10 years ago, finished in 2014 and was on hormone therapy for about 3 years after that.  His PSA has been creeping for the past couple of years but his most recent blood test has shown his PSA has risen from 6 to 12.  He had a PSMA pet scan last September which should a small spread to a lymph node in the abdomen, but the oncologist told us that if he has an ordinary CT scan the lymph node spread would not show, it was so small.  No further action was taken and he said they would keep an eye on the PSA at the next blood test, which was just done.  He said at that time that they would be nervous about putting him back on hormone therapy as it could cause a major stroke.    

Thanks for the additional information. It sounds as if your dad has had excellent care, especially as he has had a PSMA PET scan. Can I suggest you ask about the possibility of SBRT to the abdominal lymph node - it is a high dose radiotherapy used when there is a limited number of mets and only involves a few sessions. It depends on where the lymph node is in the abdomen as it has to be a balancing act between treatment and ensuring that there is little collateral damage to adjacent organs. As your dad has already had radiotherapy and 3 years of HT it would suggest that he was initially diagnosed with a fairly high Gleason score so there was a risk of mets further down the line. If your dad previously had radiotherapy to the prostate then they don't usually do it again there.

Has your dad maintained a prostate cancer friendly diet?

Thanks again for coming back to me.  When my Dad was initially diagnosed 10 years ago his PSA was 80 with Gleeson Score of 9, but he responded really well to the radiotherapy and hormone treatment.  His PSA was 0.05 for a good few years, but has only started climbing in the last couple.  He had a PSMA Pet scan in 2022 and that was clear.  He had another PSMA Pet scan in Sept 2023 which showed the met in a lymph node in the abdomen.  His most recent blood test has shown an increase in his PSA of 6.0 which is very alarming to us.  I will ask his oncologist about the SBRT.  I know when we met him last year he said due to my Dad's history of stroke in the last two years they would be nervous about putting him back on the prostap hormone injection as it could cause him to have a major stroke.