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PSA .17, 5 years later, need advice

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Posted 3/3/2014 7:29 AM (GMT -5)
I'm posting for a friend who doesn't have a computer. We both had RP surgery about six years ago. His urologist said the PC was confined after the surgery. His PSA has been zero until recently. The test before last I believe was .12 and a retest was .17. He's 68 years old and is struggling with chronic severe digestive problems, diverticulitis, IBS, and other bowel related problems his doctors can't seem to diagnose. This has been going on for years. He has a lot of difficulties finding foods he can tolerate, keeping weight on, stamina, etc.

He met with a radiologist and of course he recommended radiation. He meets with his urologist soon and I'm trying to get him up to speed on questions for the Doc, and what his options are. He's not very knowledgable on PC issues, he assumed that was all behind him. How critical is the time element in choosing a treatment? Would radiation have a good chance of damaging his bowels further (his main concern)? He's related to me that he feels like he'd be happy if he lived 10 plus more years. Would hormone therapy be a sensible alternative to radiation?

Any help or advice would be greatly appreciated. Thanks.
Posted 3/3/2014 8:46 AM (GMT -5)
With his severe internal issues, radiation could be an extreme risk to make things much worse. I am a person that is still living with internal damage from salvage radiation that went very wrong. Knowing what I know about radiation damage, I couldn't imagine many RO's pushing him to have radiation in his condition. I would want at least 3-4 opinions all agreeing it would be safe, and even then be cautious.

HT comes with a price with other quality of life issues, but it would sound the much safer path to me. He also might want to wait to see if his PSA starts creeping steadily above .20 before making any secondary treatment decision.

David
Posted 3/3/2014 10:58 AM (GMT -5)
Not the best set of choices. Radiation could add extra problems to the bowels so I'd approach that with caution. HT is likely the better choice but the real question would be when to start. At .17 he could wait awhile. Possibly months or a year or two. Depends how fast the PSA is rising and if there are any known mets.

It's possible HT could get him ten years but it's so hard to predict.

Andrew
Posted 3/3/2014 11:38 AM (GMT -5)
Nobody here is a doctor and we don't know enough to make any particular recommendations about his treatment options. Radiation does always seem to have some impact on the bowels so that is an issue he needs to stress with his doctors.

My only firm suggestion would be for him to talk to a medical oncologist who sees a lot of prostate cancer patients. The MO will be able to tell him what can be expected from hormones.
Posted 3/3/2014 12:19 PM (GMT -5)
I agree with Peter. This is a very complex medical question and there are pros and cons. You (he) need to ask the hard questions of your doctors.

He needs to see a medical oncologist specializing in PC.

I would lean towards HT given that special set of circumstances. But my advice is worth what you paid for it!

Mel

Posted 3/3/2014 1:35 PM (GMT -5)
He already knows we are not doctors here, he freely came to ask opinions, and that's what's been given. Nothing more.

There's already a lot of potential bowel, rectal wall, etc. damage potential from the very nature of salvage radiation. So it would be extremely risky and chancy at best in my opinion. And I as I know all too well first hand, once any part of your body is "melted", "fused", disturbed, or changed by the effects of radiation, there is no way to fix or repair such damage.

I agree that the best opinion would come from a PC verse medical oncologist, who wouldn't (or shouldn't) have a vested interest in a radiation clinic/center. Needs a good treatment neutral medical opinion.

While even I suggested HT as being a safer choice, with a PSA of .17, I think most medical oncologists would feel that even doing that with a PSA so low (and assuming no mets) would really be pulling the HT trigger way too soon. I know my own oncologist would agree to that line of thinking.

David
Posted 3/3/2014 2:52 PM (GMT -5)
I think he's right to be concerned about bowel damage from salvage radiation. However, some of the new super-precise linacs may minimize that. Amifostine has been used. Mesalamine might reduce inflammation. If his RO confines the radiation to the prostate bed and does not treat the entire pelvis, that may mitigate some of the exposure, but if the nodes appear to be already involved, that may not be an option. All good topics for discussion.

- Allen
Posted 3/3/2014 7:11 PM (GMT -5)
Thanks for all the responses. Very informative. Please keep them coming. I spent a lot of time reading on this forum back in 2008 during my recovery. The value of your advice and opinions based on experience (plus a lot of practical knowledge) is what makes this forum such a valuable resource, and that's the kind of help that's needed here. We're glad you are not doctors. Most of the answers to my questions that I asked my doctor during my treatment were delivered with a shrug of the shoulders and a "who knows" expression.
Posted 3/3/2014 7:37 PM (GMT -5)
Since I had a lot of colo-rectal issues and prior surgeries, there were concerns about my RT (adjuvant) inflaming the scar tissue, and looking back, they were all more than justified. Not all of the worst-case scenarios happened, but some did. Enough to change my lifestyle.
Posted 3/3/2014 7:49 PM (GMT -5)
Another question. "mets" has been mentioned a couple of times in these response posts. I assume this means metastasis. How is that diagnosed?

Does 5 years seem like a long time for a recurrence to crank up, especially with the good post op pathology report? It seems like I was reading a post about prostate tissue remaining in the body that can trigger a measurable PSA. I know that my urologist told me after 5 years of zeros that my chances of a reoccurence were negligible. I talked to my friend tonight, his wife helped him navigate through these posts on her computer, and I know he is thankful for the information, and feeling less helpless and confused.
Posted 3/4/2014 12:57 AM (GMT -5)
Five years seems a long time, but anything is possible with PCa.

Mets = metastasis. Hard to spot until they are big with common bone or CT scans. There are advanced scans at limited sites that can do better. The guys will chime in about those.
Posted 3/4/2014 10:33 AM (GMT -5)
With your pathology, I would be shrugging my shoulders too. With your pathology if there was a recurrence, it probably is systemic and radiation would probably fail. The only question, imo, is when to start HT, IF, you ever have a recurrence, which I don't think is in the cards for you . I appreciate your concern, but I would go back to the life you had between visits here. Yours was probably an indolent case, and after 5 years, I think you can handle that personnel assessment with out a lot of angst. visa a v over treatment possibility.
Posted 3/4/2014 11:10 AM (GMT -5)
Logos,

Huh?
Posted 3/4/2014 12:53 PM (GMT -5)
bb48,
Someone has to so I'll go out on a limb based on personal experience and Logo's logic. With your friend's severe digestive bowel problems and his fear of radiation exacerbating his problems, I would rule out radiation since there is always a chance of proctitis; it can make life miserable.
Since he will feel better knowing that he is fighting the disease, a few weeks of casodex to prevent "flare" followed by a 3 month lupron shot may be all that he ever needs. This treatment may decrease his psa for a long time and if it rises again repeat the process. I guess we can call it "intermittent therapy". A member of my support group in in his late 70's and has been on lupron for 10 years and his psa is stable at .2 psa. His Dr took him off the drug for a short period and it started to rise so placed him back on lupron..He has no ill effects and runs half marathons.
Thanks for trying to guide your friend in this maze that is prostate cancer.
Bill idea
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