Options in Canada vs US

Hi all,

Firstly, thank you for sharing your paths and all the information you have gathered. I am the best friend of someone with prostate cancer and I have learned so much from reading this forum. We are in Vancouver, Canada and my dear friend is a patient of Dr. Gleave. I don’t have all the details but here is a brief summary of his path thus far:
- diagnosed with prostate cancer in August following a hospital admission for what they thought was a kidney stone
- PSA of 64 at time of diagnosis
- cancer spread to regional lymph nodes (which I believe makes him stage IV)
- ADT including Zolodex brought PSA to ~1 in December
- by February PSA up to ~4, May ~6
- 20 rounds of radiation just finished on Tuesday
-PSA on Tuesday ~7
The oncologist is basically telling him that chemo is the next step but to get his affairs in order. He is giving no hope. Dr Gleave’s outlook seems more optimistic. Who is in charge and who do we listen to? The oncologist and Dr Gleave are often at odds. What are our next options? It seems as though he is not being treated as aggressively here as people with similar situations in other jurisdictions. Any thoughts or suggestions are welcome.

Not sure I understand your post title, are you wondering if something would be different in the US?

A PSA test immediately after radiation treatment concluded may not be indicative of anything if that is what happened. It would seem that checking again at 30 days and 3 months would provide some better information to act on.

You indicate cancer was in lymph nodes. Was this based on a high powered scan of some sort? I assume that other areas were negative and the lymph nodes were part of the radiation treatment?

Sounds like the PCa is castrate sensitive (ADT worked) so all the variations of that can be explored. I agree with F8 about finding an oncologist that can help more and be more encouraging. There are too many folks here that have been around for years with a poor diagnosis and modern treatment schemes to accept a pessimistic approach towards the future.

At first glance, the treatment of ADT + Radiation seems reasonable as adjacent lymph nodes are typically considered a local occurrence vs. metastasis so they take a shot at blasting them with the prostate. Not sure what the 20 treatments represent and what was expected.

The plot definitely thickens if his PSA continues to rise after ADT and radiation as that means there is enough cancer somewhere else that has not been found generating the higher PSA. An oncologist should be able to try quite a few drug combinations with him to see if anything can control his PSA short of chemo. It may be that that no “cure” is in the cards anymore but that is not reason to give up all hope. They may want to do genetic testing on him to see if that yields anything.

I might be missing somehting, but i have a problem with an oncologist who tells a patient to "get your affairs in order" with a PSA of 7. I'd get another opinion

Please remember that the medical systems are very different between Canada and the USA. Here we are very patient centric with great choices driven by the patient as to what providers to see and where they might be, Even in network driven commercial insurance plans, the patient can go anywhere outside their network, just at a potentially higher amount of self-pay. Once on traditional Medicare there are no cost differences and the patient is free to go where ever and can self refer.

In Canada, there is considerably less ability for that and much more treatment direction by the medical system as to the providers one can see and the treatment that is provided. This greatly limits self-advocacy and choice, by comparison. Plus, each province establishes their own systems and are oriented to their residents limiting the ability of leaving one’s own province just because they want access to different providers or treatments.

As to the original question whether the USA system would generally be more aggressive given the same circumstance, I would certainly say yes. Most doctors we have seen would be continuing first line ADT as it is clear it has been working. The PSA Appears to have gone up after the ADT was stopped, so go back on first line ADT and see if the PSA goes down. Many doctors would add a second line ADT. Chemo may be indicated. Provenge can be considered. More scans to determine where the cancer is and consider spot radiation, where possible. Genetic testing for strains that are not sensitive to ADT. And more. And, if the patient isn’t happy or wants more options simply call any one of thousands of medical oncologists for another assessment.

I hope all this can help your friend as he seeks different treatments, but we have seen that many patients in Canada simply don’t have the same choices or ability to pursue different treatments as are possible and routine in the USA. Best wishes and I hope his experience can improve.