Watch and wait versus hormone therapy
Posted , 9 users are following.
my father is 82 and just been diagnosed with prostate cancer.
psa 13.7
gleason score 7 (4+3) - intermediate risk!!
he has been advised to follow watch and watch surveillance for 6mths with a repeat psa prior to appt in may.
his consultant has advised his GP to commence hormone therapy if he becomes anxious and psa rises to 20+
his therapy would be bicalutamide 150mg daily and tamoxifen 40mg twice daily.
has anyone uses this hormone therapy, if so, did they experience any serious side effects?
i would be very interested to hear from anyone regarding this please.
0 likes, 26 replies
StevenRose carol76739
Posted
My scores are a lot lower than that and I have been offered Brachytherapy, they do have a new treatment now as well, both of which are less invasive and faster recovery time too. I would suggest you talk to your consultant about this as it would also reduce and remove a lot of his meds too. If he has an infection, they will want to clear that up first, but taking the prostate out should be the last consideration in my opinion.
Good luck Carol and best wishes.
Update us please of the progress I will be interested as a fellow prostate cancer sufferer how your father progresses.
carol76739 StevenRose
Posted
Hello and many thanks for your message.
I think because my father's Gleason score is intermediate risk, brachytherapy is not an option. He has seen both an Uro-oncology nurse specialist who informed him that the oncology team would consider him for hormone and radiotherapy treatment, as he is very fit for 82yrs.
He saw the Urology Consultant a week after this appt who advised watch and wait. Obviously my father was actually quite confused about the two treatment options. I think he is quite anxious waiting for a psa test in 6mths, so is going to contact his GP to do another psa in three months and will take it from there. All prostate cancer pathways at his urology dept suggest hormone and radiotherapy treatment for intermediate risk.
good luck with your treatment and best wishes.
romneyj carol76739
Posted
Lol, this is not always a simple decison and the pathways drawn out are very general. Surgeons and physicians will never agree too... so if you have an operable cancer the surgeon will always tell you surgery is best and the oncologist will tell you radiotherapy is best
Many thanks for your wishes.
carol76739 romneyj
Posted
surgery would certainly not be an option for him at 82yrs of age.
dbcriss carol76739
Posted
Keep in mind that getting lab work at the GP is probably going to result in a different PSA from lab work at the urologist because each lab will have their own variables.
carol76739 dbcriss
Posted
romneyj carol76739
Posted
Hi Carol,
There will be decisions made just because his current life expectancy is more limited than with a younger man. Anything that bears on his longevity (eg diabetes, heart disease etc) will also come into the frame. If he were expecting 25+ more years the approach is different from ~15 yrs just because most prostate cancers are slow growing.
Questions:
1. Is it a typical prostate adenocarcinoma? (these are the most predictable and slowest)
2. Has he had a multiparametric MRI? This enables it to be graded and for lymph node involvement and metastatic disease to be assessed.
If he is M0N0 and and a T3a or less and it is a typical adenocarcinoma, he most probably would outlive his cancer by doing nothing. A younger man would be offered surgery or radiotherapy in order to maximise survival time.
Some people find that hormone therapy difficult with many unwanted side effects. Others don't have a problem. A few opt for castration as being actually a better option in terms of comfort and well being. This is really a longish conversation and not black and white. It would be interesting to know what life expectation his consultant gave him were he to opt for no treatment v that should he decide to go for the treatment.
Please treat this as an opener. There are many far more personally experienced than I (I have never been on bicalutamide or tamoxifen) and in fact went down a very quirky route of cannabinoids (something that may appeal to an older man).
I do hope you get enough information to help with this decision making. It isn't easy.
carol76739 romneyj
Posted
thanks for message.
he has typical prostate adenocarcinoma.
he has had an MRI which showed no extensive spread, but some leakage into one of her seminal vessels
not too sure anout the MONO and T3a??
if he opts for NO treatment his consultant said he would have 50:50 chance of 15yrs survival.
i think he is finding very difficult living with this diagnosis and no treatment at present.
romneyj carol76739
Posted
This is a difficult disease on a personal level for us guys just becuase we have to make decisions based on so many things.
carol76739 romneyj
Posted
romneyj carol76739
Posted
mariner2021 carol76739
Posted
Hi Carol,
I have been taking Bicalutamide 150mg for two months now to drastically reduce my testerone production to arrest the spread of my Pca before I go into Hospital tomorrow for a Da Vinci Robotic Prostectomy.
For the first couple of weeks I was aware of a few changes to my body caused by the drug. I started going tyo the Loo 2 or 3 times a day but it was not liquid. I have a pain in my thigh and some other occasional joint pain but that may not be attributable to the bicalutamide. (I have had a clear bone scan so it shouldn't be Metastasis). The worst thing is Breast swelling & pain which is something that I shall be glad to be rid of - however the pain is not severe and only there when "knocked".
So my experience is not bad - but as I read the experiences of others there seems to be no "norm" for anything in the PCa domain - everthing seems to rely on the individuals body and maybe mind reactions.
For Background - I am 74, diagnosed 3 years ago 1x 2.3mm Lesion Gleason 3+3 discovered after MRI Scan and a 52core Biopsy (which gave me ED for 18 months).
Decided on Active Surveillance as the treatment.
Next year refused another Biopsy although 2nd MRI had shown a small increase in the size of the "suspect area".
This year further MRI scan now showed Lesion bigger - conceeded to 2nd Biopsy, which found 7 of 13 cores (all in one side of the prostate) 2x Gleason 4+4 1x Gleason 4+3 - longest core 7mm. No perineural invasion & Pca still contained within the prostate.
However in my opinion - time to act - I have opted for surgery, which leaves options open for further Radiation Therapy which I hope will not be needed.
I hope that this is of some help to your father in his decision making
Best of Luck and Kind Regards
carol76739 mariner2021
Posted
Hello and thanks for your helpful and informative message.
I so agree with your saying everything seems to rely on the individuals body and psychological outlook etc. It has been helpful to hear about you taking Bicalutamide. I think my father just feels it is worth taking this medication to arrest the cancer somewhat. His consultant has suggested in his discharge letter to GP to go ahead with prescribing if my father wishes this. It's early days.
I wish you well with your robotic prostatectomy tomorrow and hope you have a good recovery.
good luck and regards.
Roger2Dodger carol76739
Posted
My story is similar to your Fathers.
I am 76 years old and was diagnosed with PCa
In March 2016. My PSA was 5.86, and Gleason score 4+3=7 . My urologist advised me to go Active Survillance ,and have been on AS until present. I have not been on any hormone treatment.
You did not mention if he had a MRI, I would have one performed. At his age 82 ,he could very well die with some other cause other than Prostate cancer.
carol76739 Roger2Dodger
Posted
Hello and thanks for your message.
he's had an MRI with no lymph node and metastatic involvement.
i totally agree with you regarding another cause other than Pca causing his death. Unfortunately he's unable rationalise this currently. Apart from having a mild heart heart attack a few years ago (wasn't hospitalised) he's always been really well. His psa is 13.7 with Gleason 4+3=7 currently.
he's just understandably very anxious at the moment.
Roger2Dodger carol76739
Posted
My biopsy remains were sent to Prolaris, for genetic testing, the results came back in the non aggressive range,this is why I chose AS.
I just had a follow up on PSA testing and it read 6.86. I am scheduled for a MRI guided biopsy this Friday. After I get the results of the guided MRI, I can make an informed decision in treatment or stay on AS. Hopefully I can stay on AS. At my age 76 any kind of treatment is invasive. Your Father in my opinion at age 82 avoid treatment if all posdible.