Quizzes & Puzzles32 mins ago
Prostate Cancer
45 Answers
Hi anyone (esp squad) able to help with positive scenario
My dad : 72yr
Below is text from my mum.
PSA 14
Prostate swollen, hard lump which makes urologist think tumour. MRI will give further detail. Also did ultrasound. If MRI indicates tumour next will be a biopsy. He is not emptying bladder fully. After sample for dr there was still 250ml in bladder. Of course, he doesn't want to drink much and I worry about flushing kidneys and dehydration but can understand.
The mri will show grading and type of cancer. If aggressive will need prostate removal if slow then medication
As they left urologist he said “sorry to give you probable bad news”
(My own concerns are - if it’s aggressive is it curable ? Symptoms do seem to have come on quite fast.
Also at 72 my dad still works full time (he lives in South Africa there is no nhs and he must work as cannot afford not to) and if there is a prostatectomy I think he will surely be unable to work for a while! And wld they prob do chemo I wonder?
My dad : 72yr
Below is text from my mum.
PSA 14
Prostate swollen, hard lump which makes urologist think tumour. MRI will give further detail. Also did ultrasound. If MRI indicates tumour next will be a biopsy. He is not emptying bladder fully. After sample for dr there was still 250ml in bladder. Of course, he doesn't want to drink much and I worry about flushing kidneys and dehydration but can understand.
The mri will show grading and type of cancer. If aggressive will need prostate removal if slow then medication
As they left urologist he said “sorry to give you probable bad news”
(My own concerns are - if it’s aggressive is it curable ? Symptoms do seem to have come on quite fast.
Also at 72 my dad still works full time (he lives in South Africa there is no nhs and he must work as cannot afford not to) and if there is a prostatectomy I think he will surely be unable to work for a while! And wld they prob do chemo I wonder?
Answers
Sqad's input will obviously be far more valuable than mine but, as I've got prostate cancer myself (and have therefore boned up a bit on the subject), I'll throw in my tuppence worth anyway. Firstly, a bit about PSA levels: In a man under 50, a 'normal' PSA level is under 5 but for those who're are older, it might get up to around 8 without causing any real concern....
15:32 Sat 02nd Oct 2021
Not an easy question to give advice upon,something which is best discussed with his Urologist.
Firstly I wish that all patients in the NHS had MRI scans and am cheered that this was almost routine in South Africa and signifies first class treatment.
It all depends on the results of the biopsy as this will suggest further lines of treatment.
If it is aggressive then he will probably be offered either Radical Prostatectomy or Radiation Therapy and according to one study gives a 90% survival over 10 years ( I think that is abit optimistic myself, but there you go)
So all is not lost.
Prostate tumours are graded in a rather complex way and I would suggest that I say nothing further until the biopsy is taken and reported on.
The hesitancy and urgency is a problem and will remain so until a diagnosis is obtained and treatment instituted.
Go easy on the water drinking and tell him to drink just enough water to keep his urine pale yellow in colour.
We will make further comments on receiving the biopsy results.
Firstly I wish that all patients in the NHS had MRI scans and am cheered that this was almost routine in South Africa and signifies first class treatment.
It all depends on the results of the biopsy as this will suggest further lines of treatment.
If it is aggressive then he will probably be offered either Radical Prostatectomy or Radiation Therapy and according to one study gives a 90% survival over 10 years ( I think that is abit optimistic myself, but there you go)
So all is not lost.
Prostate tumours are graded in a rather complex way and I would suggest that I say nothing further until the biopsy is taken and reported on.
The hesitancy and urgency is a problem and will remain so until a diagnosis is obtained and treatment instituted.
Go easy on the water drinking and tell him to drink just enough water to keep his urine pale yellow in colour.
We will make further comments on receiving the biopsy results.
Thank you sqad.
My 69yo mum has been battling breast cancer this year (winning) and now my dad.
Sa is still in red zone so no hope of me getting there anytime soon.
The PRIVATE med system in sa is first class but Costs him equiv of £800 per month.
If it was government they wldnt even ref to urologist / oncologist as he’s over 70 - I kid you not!
My 69yo mum has been battling breast cancer this year (winning) and now my dad.
Sa is still in red zone so no hope of me getting there anytime soon.
The PRIVATE med system in sa is first class but Costs him equiv of £800 per month.
If it was government they wldnt even ref to urologist / oncologist as he’s over 70 - I kid you not!
Had the same thing only I was passing something like Coffee granules
had the biopsy and the m/l thing telling me I had urine left in my kidneys after using the toilet This was also with a private hospital they decided to ream the prostate out and give me injections in my belly after telling me it was cancer
Well I had the injections for a couple of years but gave them up after two years and never went back and was forty rears ago
All the best to your Dad
had the biopsy and the m/l thing telling me I had urine left in my kidneys after using the toilet This was also with a private hospital they decided to ream the prostate out and give me injections in my belly after telling me it was cancer
Well I had the injections for a couple of years but gave them up after two years and never went back and was forty rears ago
All the best to your Dad
Sqad's input will obviously be far more valuable than mine but, as I've got prostate cancer myself (and have therefore boned up a bit on the subject), I'll throw in my tuppence worth anyway.
Firstly, a bit about PSA levels: In a man under 50, a 'normal' PSA level is under 5 but for those who're are older, it might get up to around 8 without causing any real concern. So 14 is definitely worth investigating but it's nowhere near as high as some can be. (My own PSA level, at the time of diagnosis, was 135. Someone has posted here about their father-in-law having a PSA level of 314).
My own prostate cancer was discovered when the tissue from a prostate reduction op was looked at. (So, unlike your father, I'd already had a biopsy performed before the word 'cancer' was mentioned to me). The level of aggressiveness of prostate cancer is graded on the so-called Gleason scale, where two figures (primary and secondary) are added together to provide a total. Each of those figures is between 3 and 5, so a Gleason score can range from 6 to 10. (Mine was 4 + 5 = 9).
I had an MRI scan the day after I was called in to be told that cancer had been discovered, with a CT scan two days later. (The CT scan was one where they inject the patient with a radioactive substance, and then tell him to go away for a few hours, before carrying out the scan).
If the scans show that the cancer hasn't spread beyond the prostate, a patient is given the choice between having the prostate removed or undergoing several months of chemotherapy. (There are advantages and disadvantages to both). The removal op is, in this area at least, carried out by a robot and involves just a one night stay in hospital.
[NB: The preceding paragraph refers to a patient like me, with a high Gleason score. As Sqad indicates, someone with a lower Gleason score might simply be offered medication].
If the cancer has been found to have spread beyond the prostate itself, then removal of the prostate ceases to be an option at that point. In my case there was found to be some spread of the cancer to my lymph nodes and bones, so it was then a case of "let's throw everything at it that we've got", That meant that I was quickly started on hormone therapy (which I'm on for the rest of my life), with 10 maximum-dose courses of chemotherapy (at 3-weekly intervals) commencing shortly afterwards. Following that I was given 37 radiotherapy treatments, requiring me to attend the hospital every weekday for seven and a half weeks.
At the moment everything appears to be going well in my case, with my recent check-up showing a PSA level of just 0.46 and with no further checks required for the next six months. So even having a high Gleason score, with spread of the cancer beyond the prostate, clearly isn't an immediate death sentence!
You have expressed concern with regard to your father's ability to work after a possible prostate removal op. Page 18 of this document might provide some guidance in that respect:
https:/
The side effects of any potential chemotherapy vary greatly between patients. However tiredness is almost inevitable (especially at higher doses). Such tiredness tends to be cumulative, so that it's hardly noticeable after the first chemo session but almost totally overpowering after the final one. (It can also last for many months afterwards). So that's also something that needs to be taken into account when thinking about your father's ability to work. (Radiotherapy can lead to a lot of tiredness too).
That's all that comes to mind at the moment but, if you require any further information from someone who's been on the receiving end of prostate cancer treatment, please don't hesitate to ask me.
Firstly, a bit about PSA levels: In a man under 50, a 'normal' PSA level is under 5 but for those who're are older, it might get up to around 8 without causing any real concern. So 14 is definitely worth investigating but it's nowhere near as high as some can be. (My own PSA level, at the time of diagnosis, was 135. Someone has posted here about their father-in-law having a PSA level of 314).
My own prostate cancer was discovered when the tissue from a prostate reduction op was looked at. (So, unlike your father, I'd already had a biopsy performed before the word 'cancer' was mentioned to me). The level of aggressiveness of prostate cancer is graded on the so-called Gleason scale, where two figures (primary and secondary) are added together to provide a total. Each of those figures is between 3 and 5, so a Gleason score can range from 6 to 10. (Mine was 4 + 5 = 9).
I had an MRI scan the day after I was called in to be told that cancer had been discovered, with a CT scan two days later. (The CT scan was one where they inject the patient with a radioactive substance, and then tell him to go away for a few hours, before carrying out the scan).
If the scans show that the cancer hasn't spread beyond the prostate, a patient is given the choice between having the prostate removed or undergoing several months of chemotherapy. (There are advantages and disadvantages to both). The removal op is, in this area at least, carried out by a robot and involves just a one night stay in hospital.
[NB: The preceding paragraph refers to a patient like me, with a high Gleason score. As Sqad indicates, someone with a lower Gleason score might simply be offered medication].
If the cancer has been found to have spread beyond the prostate itself, then removal of the prostate ceases to be an option at that point. In my case there was found to be some spread of the cancer to my lymph nodes and bones, so it was then a case of "let's throw everything at it that we've got", That meant that I was quickly started on hormone therapy (which I'm on for the rest of my life), with 10 maximum-dose courses of chemotherapy (at 3-weekly intervals) commencing shortly afterwards. Following that I was given 37 radiotherapy treatments, requiring me to attend the hospital every weekday for seven and a half weeks.
At the moment everything appears to be going well in my case, with my recent check-up showing a PSA level of just 0.46 and with no further checks required for the next six months. So even having a high Gleason score, with spread of the cancer beyond the prostate, clearly isn't an immediate death sentence!
You have expressed concern with regard to your father's ability to work after a possible prostate removal op. Page 18 of this document might provide some guidance in that respect:
https:/
The side effects of any potential chemotherapy vary greatly between patients. However tiredness is almost inevitable (especially at higher doses). Such tiredness tends to be cumulative, so that it's hardly noticeable after the first chemo session but almost totally overpowering after the final one. (It can also last for many months afterwards). So that's also something that needs to be taken into account when thinking about your father's ability to work. (Radiotherapy can lead to a lot of tiredness too).
That's all that comes to mind at the moment but, if you require any further information from someone who's been on the receiving end of prostate cancer treatment, please don't hesitate to ask me.
Good answer from Buenchico
investigate and assess
and then discuss options with the surgeon - who will have seen more than one!
There are more than one option and the view of the medical staff is changing quite a lot - what to do and when - especially in milder cases
(Chris' with lymph spread would put him in stage III and I cant imagine you sit and look at that)
and then you follow the surgeons advice
They do have MDTs
The multi-disciplinary team (MDT) is the group of health professionals at the hospital involved in your care. Members of your MDT will do tests to confirm you have prostate cancer and talk you through your treatment options and any relevant clinical trials.
The MDT is like an oscar meeting where they discuss all the cases and vote on what to do on a case-by-case meeting
O god I have just seen he is in SA - no idea about treatment
durr sorry.....
you are asking a group of anglos how they treat Prostate ca in SA?
investigate and assess
and then discuss options with the surgeon - who will have seen more than one!
There are more than one option and the view of the medical staff is changing quite a lot - what to do and when - especially in milder cases
(Chris' with lymph spread would put him in stage III and I cant imagine you sit and look at that)
and then you follow the surgeons advice
They do have MDTs
The multi-disciplinary team (MDT) is the group of health professionals at the hospital involved in your care. Members of your MDT will do tests to confirm you have prostate cancer and talk you through your treatment options and any relevant clinical trials.
The MDT is like an oscar meeting where they discuss all the cases and vote on what to do on a case-by-case meeting
O god I have just seen he is in SA - no idea about treatment
durr sorry.....
you are asking a group of anglos how they treat Prostate ca in SA?
TY everyone- I really appreciate your input.
Bentaxle fabulous to hear you’re still cancer free all this time later.
Dave - waiting is hard - thinking of you !
Buenchico - what a fantastic, informative reply! Thank you so much for taking the time to explain. It gives me some hope to hear you’re doing so well with a psa so low …. When yours was much higher than my dads
The urologist said he cld feel the hard lump (rather than swelling only) manually and hence he believes it likely to be a tumour (obv mri will confirm).
Buenchico can I ask how long ago you were diagnosed ? At what age were you? ( And also did you have bad bone aches and tiredness before it was discovered?
It’s just that even tho I’m 47 my dad is still my (in my eyes) the strongest healthiest man and to hear (from my mom) that he’s so tired now and bones sore and just doesn’t have energy for anything is so worrying
PP -yes it’s sa but I think the treatment once dx will be broadly similar. They also have the MDT after reviewing results etc
etc
Bentaxle fabulous to hear you’re still cancer free all this time later.
Dave - waiting is hard - thinking of you !
Buenchico - what a fantastic, informative reply! Thank you so much for taking the time to explain. It gives me some hope to hear you’re doing so well with a psa so low …. When yours was much higher than my dads
The urologist said he cld feel the hard lump (rather than swelling only) manually and hence he believes it likely to be a tumour (obv mri will confirm).
Buenchico can I ask how long ago you were diagnosed ? At what age were you? ( And also did you have bad bone aches and tiredness before it was discovered?
It’s just that even tho I’m 47 my dad is still my (in my eyes) the strongest healthiest man and to hear (from my mom) that he’s so tired now and bones sore and just doesn’t have energy for anything is so worrying
PP -yes it’s sa but I think the treatment once dx will be broadly similar. They also have the MDT after reviewing results etc
etc
>>> Buenchico can I ask how long ago you were diagnosed ?
It's a bit of a long story but here goes . . .
I'd been ignoring a need to pee frequently, and urgently, for several years until, at the end of January in 2019, I found that, despite a desperate desire to do so, I couldn't pee at all. Like a fool, I spent the next 11 days (without peeing, without sleep and without hardly eating) telling myself that the problem was bound to go away eventually. At that point, in agony with kidney pain and feeling totally exhausted, I called an ambulance to get me to hospital.
The hospital found that, through having had no release for 11 days, my kidney function was at the lowest level possible short of total failure, so I was kept in for 5 nights while they persuaded my kidneys to start functioning again. I was then sent home, with a catheter inserted to overcome the peeing problem, having been put on the waiting list for a prostate reduction operation (as it was apparent to the doctors that an enlarged prostate was at the root of my problems).
11½ months later, at the start of 2020, I finally had that prostate reduction operation. It was examination of the tissue removed at that time that showed that I'd got cancer, with a Gleason score of 9. Within days, as explained above, I had an MRI scan and a CT scan, which showed that the cancer had spread beyond my prostate. I was 66 at the time. (I'm 68 now).
So, although I was 66 when my cancer was diagnosed, there had actually been symptoms that suggested prostate enlargement (and consequently possible prostate cancer) for several years before that.
I've never experienced many aches in my bones. Much of the tiredness I've had since my cancer was diagnosed can almost certainly be attributed to the treatments I was receiving, rather than to the cancer itself. I still have some very tired days now (roughly a year after my chemo ended and about nine months after my radiotherapy ended) but it's difficult to decide whether I should put those down to my cancer, the treatments (which can have side effects lasting up to 10 years) or simply old age.
I hope that your father's tests show that his cancer hasn't spread and that he's got a low Gleason score. Even if that doesn't turn out to be the case though, the fact that I'm still here (and currently needing nothing more than six-monthly check-ups) helps to reassure you that he's likely to be with you for many more years yet.
It's a bit of a long story but here goes . . .
I'd been ignoring a need to pee frequently, and urgently, for several years until, at the end of January in 2019, I found that, despite a desperate desire to do so, I couldn't pee at all. Like a fool, I spent the next 11 days (without peeing, without sleep and without hardly eating) telling myself that the problem was bound to go away eventually. At that point, in agony with kidney pain and feeling totally exhausted, I called an ambulance to get me to hospital.
The hospital found that, through having had no release for 11 days, my kidney function was at the lowest level possible short of total failure, so I was kept in for 5 nights while they persuaded my kidneys to start functioning again. I was then sent home, with a catheter inserted to overcome the peeing problem, having been put on the waiting list for a prostate reduction operation (as it was apparent to the doctors that an enlarged prostate was at the root of my problems).
11½ months later, at the start of 2020, I finally had that prostate reduction operation. It was examination of the tissue removed at that time that showed that I'd got cancer, with a Gleason score of 9. Within days, as explained above, I had an MRI scan and a CT scan, which showed that the cancer had spread beyond my prostate. I was 66 at the time. (I'm 68 now).
So, although I was 66 when my cancer was diagnosed, there had actually been symptoms that suggested prostate enlargement (and consequently possible prostate cancer) for several years before that.
I've never experienced many aches in my bones. Much of the tiredness I've had since my cancer was diagnosed can almost certainly be attributed to the treatments I was receiving, rather than to the cancer itself. I still have some very tired days now (roughly a year after my chemo ended and about nine months after my radiotherapy ended) but it's difficult to decide whether I should put those down to my cancer, the treatments (which can have side effects lasting up to 10 years) or simply old age.
I hope that your father's tests show that his cancer hasn't spread and that he's got a low Gleason score. Even if that doesn't turn out to be the case though, the fact that I'm still here (and currently needing nothing more than six-monthly check-ups) helps to reassure you that he's likely to be with you for many more years yet.
Thanks Barry for your kind thoughts.
Well I feel a lot more hopeful. In that:
Its deffo prostate cancer.
The MRI report to say if it had spread was lost somewhere in the dark recesses of cyberland but....doc says even if it has spread there are things they can do too slow it down.
My dad is having a biopsy next week.
After that it is likely prostatectomy and hormones.
Whole family was comforted to hear that there is no urgent hurry for prostatectomy - it will likely be December.
Despite my dad having good medical insurance (he lives in South Africa) there is already (!!!) a shortfall of R6000 (£300) just a few weeks into this journey. He (or us his kids ) will need to pay this or treatment will not commence. the costs will just escalate throughout -
Aren't we so lucky to have our amazing NHS?
Well I feel a lot more hopeful. In that:
Its deffo prostate cancer.
The MRI report to say if it had spread was lost somewhere in the dark recesses of cyberland but....doc says even if it has spread there are things they can do too slow it down.
My dad is having a biopsy next week.
After that it is likely prostatectomy and hormones.
Whole family was comforted to hear that there is no urgent hurry for prostatectomy - it will likely be December.
Despite my dad having good medical insurance (he lives in South Africa) there is already (!!!) a shortfall of R6000 (£300) just a few weeks into this journey. He (or us his kids ) will need to pay this or treatment will not commence. the costs will just escalate throughout -
Aren't we so lucky to have our amazing NHS?
So as many of you know my dad has been having tests for prostate cancer.
Will you (esp sqad) be able to put some things into layman’s terms please?
Some comments from MRI report
Large PI RADS 5 lesion involving invasion of the left base, body and apex PZ posteriorly with direct transitional zone and suspected urethral invasion. Capsule invasion with large left base posterosuperior extra prostatic soft tissue conponent. SVI and neurovascular invasion. Subcentimetre left internal iliac adenopathy.
Most of those terms i understand. The part I don’t it when it refers to “invasion” wld that (likely) mean the cancer has spread to urethra, into the prostate capsule (ie the membrane surrounding prostate) and seminal vessels ?
I realise you can’t diagnose over AB but just want explanation as to what they mean
Will you (esp sqad) be able to put some things into layman’s terms please?
Some comments from MRI report
Large PI RADS 5 lesion involving invasion of the left base, body and apex PZ posteriorly with direct transitional zone and suspected urethral invasion. Capsule invasion with large left base posterosuperior extra prostatic soft tissue conponent. SVI and neurovascular invasion. Subcentimetre left internal iliac adenopathy.
Most of those terms i understand. The part I don’t it when it refers to “invasion” wld that (likely) mean the cancer has spread to urethra, into the prostate capsule (ie the membrane surrounding prostate) and seminal vessels ?
I realise you can’t diagnose over AB but just want explanation as to what they mean
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