Oncology letter

Hello Big Col 

Simple language - you are having two scans to see if the cancer has gone "walkabout" (left the Prostrate).  You are being put on a one drug HT at this moment - but if the cancer has gone walkabout you look like you will be going onto "Triplet Therapy" which is Hormone Therapy combined with Chemotherapy called Docetaxel.

It won't cure the cancer as it's gone walkabout but it will help to keep it under control.

I hope this helps  I will tag Shar into this post as her husband has been through this in the last 6 months and is doing great (I hope you don't mind Shar!!).

I know it's not the answer you wanted but - it may not have spread - your oncologist is going off the PSA and testosterone levels.

Best wishes - Brian.

Of course I don't mind Brian I am always happy to help where I can 

Hi big col. My husband had a psa of 59.9 on diagnosis with spread. He completed his chemo docetaxel in November and has done remarkably well. Click on my rabbit picture to read our profile. His PSA is currently 0.06. whilst ant treatment especially chemo can sound horrendous it doesn't have to be that way. I also think keeping an open mind and being positive really helps. Please ask any questions and I will try my best to help

Thanks  

Just read your profile....didn't appreciate chemo outcomes could be so good...hope he is well now. 

There a mention of if funding available?because I've been treated before. 

Several options for you.

Your cancer should be restaged after all the scans and this will direct treatment choices, depending on the risk.

Bicalutamide acts by blocking androgen receptors so will bring PSA down rapidly but will not reduce testosterone. To do this you have the option of different LHRH drugs such as Leuprorelin or Goserelin which are administered by 3 or 6 monthly implants and act in a different way to actually stop testosterone production. 

From there treatment may depend on where the metastasis are. If they are in an area which has not already been treated with radiotherapy then you could be offered SBRT which would be designed to kill the cancer cells in a focal way. If they are in the prostate bed then additional radiotherapy is not normally an option.

Second generation antiandrogens such as Enzalutamide, Aptalutamide, Abiraterone and Darolutamide may be offered which are taken as daily tablets. These act in a different way again to stop testosterone production and can put the cancer into hibernation. One question to ask is ' what is the best order to give them in' as trials to date have shown different outcomes from different orders and some cannot be used sequentially, so might limit future options. Degree of risk from restaging would normally dictate which one is recommended. What these drugs do is weaken the cancer cells and make therapies like chemotherapy and radiotherapy more effective.

Chemotherapy is designed to systemically kill cancer cells and is usually given in 6 cycles at three weekly intervals - this takes account of the replication cycle of cancer cells and gives the best chance at getting rid of them all. 

Sometimes traditional scans cannot detect metastasis hence my previous comments about the PSMA PET scan, but this would need to be done before the PSA drops too far, but also the Bicalutamide can interfere with the cancer protein binding to the Gadolinium, as it can with the bone scan.

A lot clearer now...so I have 5 weeks till my next oncology appointment.and my psa should drop rapidly surely that's a good thing.?

Yes it is good because it will show that the testosterone is being stopped from binding to the cancer cells by the Bicalutamide. 

Big Col, the others have given you possible options.  I had chemo over 6 years ago, RT over 5 years ago and am still here.

Easily said, but try not to worry and have faith in your team.  Good luck.  David