My husband was diagnosed with PC with a 4.9 psa

[MalindaCarolyn]

They basically gave him no choices, they said he  was 77 and they would radiate it unless it had spread. "why close the door after the horse got out" they said quote.

This doesn't seem right. They didn't ask him what he wanted. Now, after hormone shot two months ago, it has gone down to 2.75 but they are still not wanting to give him radiation except maybe in the back where it metastized because of "quality of life."

He has told me that he wants it gone. Radiation of the prostate would prevent any more loose cannons from the prostate.

While I am prepared that the metatastic cancer may go further, why won't they consider radiation of the prostate as well as where the cancer went, into t-8.

We have gotten many different scenarios, and the last said they  would (reluctently) radiate the prostate if the back had to be done. back. (the first one said he could take no pain meds and could have a sudden shatter"if he sat wrong.)

He's pretty.. 'errr..wildly  grumpy and depressed.

We need some direction.

[HeinrikMD]

Hi
Treatment decisions are based on indications, whether something is known to work.

If the cancer was confined to the prostate, then there is a role for either radiation of surgery. These are treatments that will only be limited to the prostate.

If the cancer is no longer confined to the prostate, then performing surgery or radiation to the prostate would have no clear benefit. This is what they mean about the analogy of the horse. You want to trap the horse. But actually the horse has multiplied and hence, while there is still a horse in the barn, burning the barn would do nothing about all the other horses that have already escaped.  While it may sound logical to deliver radiation to the prostate in order to limit further spread (meaning radiation may limit the amount of new cancer sites developing because the “source of the cancer” is controlled), new cancer sites do not need to arise from the original site. There is a limit as to how much radiation anyone can handle, so using radiation for the prostate in this matter may make the use of radiation in the future inapplicable. If theoretically you had the prostate radiated, then come 3 months or so, one of the backbones has severe pain – since radiation has been delivered already, optimal radiation cannot be given (this is what they mean when they say, they may consider including it when the clearer use of radiation – which is to prevent the bone from breaking would arise).

I think what you need to realize is that, while there are several tools that can be used to fix the problem, there are limits as to how many times any tool can be used – and hence a clear scenario that the tool would make a difference is generally sought. Another thing to consider is that, in general - if the disease is still in its early stages there are more choices... as the disease advances and progresses, options get limited.

It seems the patient and the doctor doesn't see eye to eye here. I hope that the miscommunication can be resolved, as this would make things run better. Patients who do not agree with the direction their treatment is taking would be less empowered and hence would be more likely to fail as there is little initiative to push things forward.