Treatment for prostate cancer

[mary2]

My dad (76; lives abroad) was diagnosed with prostate cancer in January this year by exam. Urologist felt a lump. Two out of six biopsies were positive for prostae cancer, Gleason 7 (3,4). His PSA was 0.8 and repeated 1.2. He had US of abdomen but no other workup. Prostate size is 26.3 cm3 and size of the tumor 1.62 x 0.47 x 1.4 cm. He is otherwise in reasonable shape, still works several hours a day and has stable angina (not an issue for few years), history of TIA in 2005 and hypertension.
His urologist started him on Androcur (cyproteronum) and Zoladex.
Reading about it, the hormonal therapy is used in the US only for metastatic cancer, which my dad does not have.

What would be the recommended treatement (radiation, brachytherapy, surgery)?
Is hormonal treatment sufficient? How will they know if the cancer progresses (his PSA is low)?
Can hormonal therapy reduces the size of cancer? Do you get resistent to it?
What are the chances (%) of this stage of cancer to metastasize and shorten my dad's survival?
Would you recommend bone scan or CT?

Thanks you

[Ash Tewari, MD, M.Ch.]

You have not mentioned what the stage of the cancer is. This is derived from the examination and any imaging studies that may have been done such as an MRI of the prostate.

If the urologist says that it is a T2 cancer, i.e. confined to the prostate then surgery, watchful waiting or radiation are all acceptable options. For a patient of 76 with a history of heart problems, radiation is a reasonable option.

For a patient with T3 disease ie locally invasive carcinoma, which has spread just beyond the prostate but there are no metastasis, the treatment options would be radiation with or without hormonal therapy and surgery.

After any definitive treatment such as surgery or radiation, the PSA should be undetectable. Then the disease is monitored by following the PSA levels.

A bone scan and CT scan  would probably be low yield with a PSA of 1.2 and a Gleason of 3 + 4.

This answer is not intended and does not substitute for medical advice- the information is for patient education only.

[TWOCENTCIGAR]

Hormones are Urologist's way to make money only!  Discuss one study showing the efficacy of hormones in the Tx of Prostate cancer!  Just ask any Urologists in the USA how their Lupron usage declined after the rug was pulled out from under them with reimbursement rates!  Unfortunately as we are not in Canada, whatever procedure they can make the most $$$ with will drive their Tx reccomendations in this country!

It all depends on WHO is delivering the procedure! A "radical" is exactly that and I would never let anyone cut out my prostate! Just ask NY Yankee Manager Joe Torre that! He had surgery and upon sending the specimen to the pathology lab, they learned he had positive margins and therefore required radiation! Not to mention the incontinence and impotence rates associated!

I would elect prostate brachytherapy with a stranded technology! I'd also reccomend a premier Radiation Oncologist and hospital! (ie. Mt. Sinai of New York City and Dr.'s Cesserati or Stock) Where do you live?

Providing of course he's an ideal candidate for treatment! Active surveilance never hurt anyone as MOST men die with prostate cancer and RARELY from it!

Hope this helps!