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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2005looking to help my dad abroad
Hi All, I am wondering where to get help if any, so I post it here; My dad lives in Moscow, Russia. 75 y.o. otherwise healthy white male. tells me not to worry - he got the best docs and technology available there, but from my experience they do not always know how to use the latest... I was wondering if I could get this reviewed by an American/Western doc, is it ever possible, how do I go about that, etc.? perhaps, there are may organisations that fascilitate some kind of coordination? He tells me he is being treated by some pills: Casodex, Triptorelin, and may be something else... he tells me he is considering brachiyterapy, but he has not made his mind on all options offered to him including radical surgery.. I am worried about the surgery since it's not customary over there to give the patients doctors' stats and there is no certainty that the supplies and medicines are genuine - there is a lot copycats and knock-offs of anything there.. Increase in his PSA was noticed first time in 08/2002: up to 5 ng/ml. In 03/2003 his PSA was 15 ng/ml. On 04/13/2003 he had a biopsy done which came out negative on cancer; general chronic prostatitis. On 03/25/2004 PSA was 10.3 ng/ml, % free 14% On 08/09/2004 another biopsy (10-point) came back negative in regards to cancer with fibrous hyperplasia and chronic prostatitis [my translation might way off the wall]. 09/09/2004 PSA 7.1 ng/ml %free 14% 03/30/2005 PSA 8.0 %free 18% 10/06/2005 PSA 10.1 %free 14%; TRUS (?) [trans-rectal ultrasound] shows signs of adenoma, volume 74.6 cubic cm; traditional rectal exam by his doc shows enlarged prostate, elasticity is consistant, no lumps [again, translationmay be off] (the previous TRUS in Sep-Oct 2003 showed 67 cubic cm volume). 10-point biopsy, stuff sent out to Bostwick Laboratories: Right Lateral Base Adenocarcinoma (Gleason 3+4=7) involving 30% of the specimen. Gleason pattern 4 comprises 20% of the cancer. Cancer volume: 0.000785CC (in 1 of 1 core). treatment alteration score: 0 of 6 (nuclear changes: 0 of 3; architectural changes: 0 of 3) Immunostains for basal cell-specific high molecular weight keratin (34BE12), p63 and Racemase support this diagnosis. Let me know if I need to collect any other info and thank you in advance. ( I can upload his transcripts if necessary) Best, yuri Sorry to hear about your father, Yuri. Due to his age, surgery may not be a likely option. Of course, if he is in better condition that the normal 75-year-old male, there might be a possibility, but usually the body has broken down to the point, by then, that surgery is more dangerous than the cancer. I assume he also fought against the Germans in World War II and, if I understand that conditions correctly, his body probably took a pounding. Brachy is a possibility, but often in a 75-year-old, the cancer grows so slowly, that it is of little concern, especially if the patient is put on androgen deprivation therapy (ADT), such as Casodex. As to the cancer growing slowly, assuming that he had it in 2002 and it was just not found (not unusual outside Russia either), then it has grown very slowly to 10.1 three years later. And now that he is on Casodex, it will likely immediately drop to single digits and probably tenths of a nanogram. I am not a doctor, but if you father is in typical condition of a 75-year-old, I think I would consider ADT only. He will die from something else before he dies of cancer. If, however, he is athletic and has a life expectancy of 90 years or more, I would consider radiation treatment. > Hi All, > [quoted text clipped - 46 lines] > > Best, yuri > Hi All, > [quoted text clipped - 46 lines] > > Best, yuri Steve Kramer has pretty much covered it. It appears that your father's doctors have been doing a thorough job, and it is unlikely that he could do much better in diagnosis with a typical urologist in the US. As Steve says, surgery is seldom recommended in a 75 year old man, but it might be an option if he is in extremely good physical condition and can be expected to live past 90. Radiation is more common, and often this is supplemented with hormone supressing drugs, at least temporarily. The facts about prostate cancer are not specially subtle and competent physicians anywhere in the world whould know about them. So it is not clear anyone in the US would have anything more to say about treatment. If he were much younger and a good candidate for surgery, it might be wortwhile seeking out a surgeon particularly adept at nerve sparing surgery to prevent impotence. But even the best surgeons can do little aobut that in a man past 70. Even in the US, a more typical treatment for a man your father's age would be radiation. Hormone therapy is also very common, but there is some difference of opinion among prostate cancer experts about when to begin it. It is not clear you would get better advice from an American urologist who doesn't have personal knowledge of your father's case. National attitudes about treatment of prostate cancer have to do more with ideas about how effective such treatment may be rather than the overall quality of medicine in the country. In some countries, men are not even routinely screened, and when prostate cancer is detected, even in relatively young men, it is not usually treated until it advances. Then it is treated with hormone therapy. In the US, there is also some difference of opinion in the matter, but most urologists opt for agressive treatment by surgery or radiation for men over 70 and increasingly for healthy men in their early 70s. Most urologists throughout the world are reluctant to try aggressive treatment in older men. It appears that your father's doctors are operating more or less on the US model. This debate is based on balancing the dangers of not treating against the likely side effects of treatment. >> Hi All, >> [quoted text clipped - 77 lines] > some difference of opinion in the matter, but most urologists opt for > agressive treatment by surgery or radiation for men over 70 and Should have been "under 70" > increasingly for healthy men in their early 70s. Most urologists > throughout the world are reluctant to try aggressive treatment in older > men. It appears that your father's doctors are operating more or less > on the US model. This debate is based on balancing the dangers of not > treating against the likely side effects of treatment. Thank you all.. He is in good health; avid tourist and hiker.. Workaholic, cut the number of jobs down to three (I believe).. The problem with surgery down there that there is no transparancy, accountability, liability like here: you can not expect your doc to tell you how many are done, how many failed, succeeded, etc. Besides, anybody worth their salt tries to get out of there and land here... unless you are a bandit = a government beurocrat. The market is flooded with fake goods be it shaving razors, french cogniac or medicines.. hence I worry. > Thank you all.. He is in good health; avid tourist and hiker.. > Workaholic, cut the number of jobs down to three (I believe).. [quoted text clipped - 5 lines] > with fake goods be it shaving razors, french cogniac or medicines.. > hence I worry. I understand what you are saying Yuri. Unfortunately, we are not entirely free of those problems here either. If you ask an American doctor about his success rates you are very unlikely to get any useful information. There is no objective agency that records the success rate of each doctor. Most doctors don't keep statistics on the success or failure of their surgeries or other procedures, and the very few that do won't show them to you. Even other doctors can't find out. In the end, we have to depend on the reputations of the doctors plus our own personal judgment of the doctors we meet. I'm hoping that your father in Moskow is able to find a trustworthy and competent doctor to treat him - even if he can't verify everything. To paraphrase a line in a famous American play, we are all dependent on the kindness of strangers. Alan Thank you all very much indeed.. I heard estimates 28-35k for the radical surgery and I am wondering what would other alternatives cost, at least comparatively. Do I need to get a prescription from an American doctor to buy Casodex or any other necessary drug and are there any alternatives/generics, etc.? That is, provided he stays on this course.. I already talked to 2 oncology and 3 urology specs and it all comes down that they can not come to any definitive opinion until they see the patient |
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