Did you say the PSA was 100 ? That is very high and if that number is real (ie, from cancer, but not from prostatitis or other non-cancer reasons) then there are few surgeons in the United States who would pursue surgery alone as a curative options. If you plug those values into most nomograms the likelihood of metastatic disease is high -- likely well over 50%.
In addition to getting a second opinion on the biopsy I would strongly consider doing a prostate/pelvis MRI at a high volume center. You may very well find suspicous lymph nodes, extracapsular extension beyond the prostate, or other findings which may help guide your treatment decision.View Thread
It sounds like you're doing your due diligence and taking all the correct steps to get the information you need. I always tell my low risk patients (based on Gleason score, PSA, and clinical staging) that there is no wrong answer. Weigh all the options, get all the opinions from various experts and then confidently make your decision. It will be the correct one.View Thread
With a Gleason 8 prostate cancer there is certainly a chance of PSA recurrence after surgery. Just because the prostate is removed, doesn't mean that it hadn't already spread (microscopically -- ie, no way to tell on CT/x-ray/etc.) to either the local area where the prostate was located or to the lymph nodes/bone.
The fact that the PSA never went to 0 after surgery suggests that it was always present even after surgery.
At this point you need to get some imaging studies -- bone scan and CT or MRI. If there is obvious metastatic disease than likely homone therapy is the next step. If there is no evidence of visible disease on imaging studies than you need to consult with your urologist and possibly a radiation oncologist as to whether radiation therapy may be worth considering.
I would typically not expect the T alone to cause such a dramatic increase. More likely this is some type of prostatitis. That said, the fear in using T is that theoretically many believe it is "fuel" to a prostate cancer fire.
Bottom line is I would re-check the PS and make sure it returns to normal (some would treat w/ antibiotics as well in case there is prostatitis present). If the PSA remains elevated above baseline, I would strongly consider doing a biopsy.
You have many options. Are you currently on hormone therapy (Lupron) ? If not, than that is the first step -- androgen deprivation. This is usually achieved through an LHRG agonist (like Lupron) with or without an oral agent such as casodex.
After that fails, then you have a whole host of options. Given your metastatic disease you are an excellent candidate for Provenge. (roughly a 6 week treatment -- 3 treatments total -- one every 2 weeks).
After that you and your urologist/medical oncologist can consider chemotherapy (Taxol), Zytiga (oral drug) or Xtandi (new oral drug).
Actually your father has multiple options at this point. There have been many new drugs developed for castrate resistant prostate cancer and I would bet they may possibly available in the international markets as well. (soon if not already)
1. chemotherapy -- (Taxol) still considered by many to be the first line treatment for CRPC patients
2. Provenge -- CRPC patients w/ metastatic disease. I believe is available in Germany (if not, then soon)
3. Zytiga -- typically need to try chemo first in the states, but this is likely to change soon
4. Xtandi -- newest drug on the market. also an oral drug. Right now, likely most med oncologists will want to put patient on at least some type of chemo first
I will fully admit that I am not an expert in proton beam therapy. In general I think the first decision to make is if local therapy is likely to be of benefit in an 80 year old.
Assuming the metastatic workup is negative (bone scan, CT scan, MRI, etc.) you need to ask your urologist what the likelihood of "cure" or 10-year PSA free recurrence is in somebody with your particular Gleason score, PSA, etc.
Next, you need to look at the risks and side effects of each treatment -- whether its radiation, proton beam, etc.
Then spend some time weights the potential benefit of any treatment versus the risks and decide what is right for you.
In general, I would say not to make any medical decisions based on insurance co-pays. I would say you are doing the right thing by doing your due diligence and getting all the information before making a final decision. Best of luck.View Thread
Re-check it in a few weeks. You may want to consider treating with antibiotics as well and then see if it is a true elevation or elevated for benign reasons.
If its still elevated and you are not wishing to undergo a repeat (extended) prostate biopsy, you can consider use of a 5-alpha reductase inhibitor (proscar or avodart) with serial PSA checks or possibly an MRI. (assuming the PSA remains elevated)View Thread
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