On Jan 30, 11:33 am, bmcda...@pvco.net wrote:

Barbara,

I'm not a doctor.  Your father's doctors can give better information
than I can, but some doctors don't like to be the bearers of bad
news and may not explain as much about what is coming as you
would like to know.

Have the doctors suggested any further treatments?

When hormone therapy fails the options become less and less
attractive.  There are palliative options for reducing pain, but your
father doesn't need them yet.  There is chemotherapy, which
actually extends life by an average of several months when given
at a late stage in the disease.  Some doctors are now experimenting
with giving it earlier in the hope that it will do more good if there
is less cancer to be treated, but I don't think there is yet any
medical consensus about whether that is a good idea or not.

Chemotherapy will not cure his cancer.  At best, it will set it
back.  How far back varies from individual to individual, but at
your father's age, I wouldn't be too optimistic.

There are also clinical trials of new treatments.  But the treatments
available in trials are highly experimental and cannot be expected
to be cures.  And at your Dad's age, he might not qualify for most
of them.

I think it would be a good idea to make plans for the future
based on the assumption that the cancer will get worse and
will take him within the next several years.  There are things
he might want to do before then.  Now is the time to do them.

I think it is also a good idea to make plans for handling the
disease if it gets worse, i.e., if he doesn't die of something
else first.  When the time comes, you'll want to locate a good
specialist in palliative care who can treat serious pain with
drugs, radiation, or whatever they have.  It is my understanding
that a good palliative care physician can make a great
difference in a patient's quality of life.  I remember that when
an uncle of mine had terminal cancer, a specialist was able
to remove almost all his pain and make his life very bearable
for much the time.

When you and your Dad talk to the doctors, I would tell them
that you understand that this disease is terminal but you want
to discuss it honestly and get all the information that you can
about how to deal with it effectively and humanely.  The doctors
may be able to give you estimates of how much time he has
and referrals to the right people to see for pain management,
hospice care, etc. - though it is still a little early to line all of
that up.

Finally, I advise both you and your Dad to recognize that life
isn't over yet.  There are good times to be had.  Don't let this
make you depressed and unhappy.  We all have to go
eventually, but we don't need to despair about that.  Life is
still there to be had for some time to come.  I hope it is a
significant amount of time.

My best to you, your Dad, and your family.

   Alan

How can the doctor say your father has prostata cancer,
have they done a prostata biopsie?

Ernst Sauer

If the 4-month shot is Lupron, then he's had prostate cancer for at least
two years.  It would be nice to know what the rest of his history is.

But, it sounds like he's had cancer, they didn't do surgery or radiation
because of his age, the hormone treatments are not effective anymore and
he's got a bleak outlook.  He can try chemotherapy, but if he doesn't handle
it well, he would be better of salvaging the quality of the rest of his life
than the quantity.

I am sorry.

On Jan 30, 9:33 am, bmcda...@pvco.net wrote:

Hi Barbara...It sounds like your dad has been having injections of an
LHRH analogue, like Lupron, and also taking a 5AR-2 inhibitor
(Proscar).  Recently the Proscar was stopped and Casodex was added.  
If that is correct and his PSA is rising, it may signal that his
prostate cancer has become hormone refractory.  Some docs will
withdraw the Casodex at this time and see if the PSa falls, signalling
that the cancer can thrive on extremely small amounts of androgen.

There are other treatments that can be tried before moving to
chemotherapy.  Estrogen therapy and high dose ketoconazole are two of
the possibilities.  Working with an oncologist who specializes in
prostate cancer could be quite helpful in terms of discussing these
options.  Also more information from men who have "been there and done
that" may be available at the Hormone Refractory PCa website...
http://www.hrpca.org/index.html

It's a nice thing you are doing for your dad, I wish you both the
best...Best wishes and good health, ron

On January 30, Barbara wrote:

*IF* prostate cancer is confirmed, go to a medical (not radiation)
oncologist -- a cancer specialist -- preferably one who specializes in
treatment (tx) of prostate cancer.

I emphasized "IF."

What is the specialty of the "doctor" who reported that the patient had
prostate cancer (PCa) and hormone resistant PCa at that?

Upon what evidence did he make that evaluation?

Why was he "taken off" Proscar? More importantly, why has he not
restarted it?

And has he had a biopsy? This is absolutely vital. The biopsy is the
"gold standard" of PCa diagnosis. If he has had a biopsy what are the
results -- in detail? If he has not had a biopsy that found PCa,
preferably validated by a specialist pathology lab, he simply cannot IMO
be considered to have PCa.

The records of the medic should be evaluated by an oncologist. The
patient has the right to copies of those records.

Something about this has an unpleasant aroma.

Regards,

Steve J

"Flagrantly, we docs ignore the declaration of biology. We do this out
of ignorance, greed or both. The prime directive of the physician, the
real physician, is patient outcome, & not physician income (or ego)."
-- Stephen B. Strum, MD