What Treatment Should We Do?

So I have written before, but we just went for my dads second opinion yesterday and we have some decisions to make.

My dad is 57. He has a psa originally of 161, rechecked yesterday it was 107, and a gleason of 8 (4+4) He had a bone scan that showed something small on his rib, they followed up with an xray, still indeterminate. They said we will watch it. His CT did not show any growth. However they say that there is most likely "microscopic cancer cells" floating around his body.

Both doctors state that he is not a candidate for surgery.  The first doctor told us that we should start hormone therapy (casodex and a shot that would last 6 months) and then see what kind of treatment could be done after that.

The other doctor wants us to start hormone therapy (only the shot, but states he can manipulate the dosage to give the shot every 4 months (the other doctor states that is not correct) ) and radiation beam therapy, of course under the care of a radiation oncologist. We have read a lot of information that states you want to shrink the prostate down to provide more effective radiation, and less harm to the body.

We were told that a cure is not likely, but we are staying positive. we feel that since this cancer is so aggressive, we should treat it aggressively.

any suggestions?

any suggestions?"'

Yes : read my previous posts

Im sorry,but Im new to all this-how do I look up your previous posts? Thanks

Laura 

I do not know full details of your diagnosis.

Here are my comments in addition to my previous posts under "Really high PSA" and "Hormone therapy"

Gleason 8 and high PSA indicates high risk cancer. Although scans have not clearly determined bone involvement, it is prudent  to approach this as being of high risk that mets could well be a distinct prospect, and treat  this in a systemic way.

"" However they say that there is most likely microscopic cancer cells floating around his body""

Answer: I agree. Scans might not show clusters at an early stage. 

"" Both doctors state that he is not a candidate for surgery""

Answer:  It is true that Surgery and Radiation are local treatments that can not "cure" cancer that is no longer local cancer contained in the prostate. Surgery or Radiation can and are  used in addition to hormone therapy to "debulk" the main tumor, and men often do better long term this way. This depends on overall health and bearing in mind that each treatment has it's own potential side effects to consider.

"" The first doctor told us that we should start hormone therapy (casodex and a shot that would last 6 months) and then see what kind of treatment could be done afte that""

Answer: there are various kinds of hormone medications available in 3 to 6 month forms. It's best to use casodex (or similar) before starting the main hormone. Casodex is usually used for at leat 14 days and is optional after  that. Some men find some kinds of medication more effective or have less problems with one kind compared to another.

It's logical to start hormone therapy now, which enables you to take time to further consider your options and potential side issues involved with additional treatment that might be  suggested.

I strongly recommend that you read the book about Hormone Therapy by Dr Charles Myers that  I previously suggested. He has a wealth of information, including details on this particular subject. Dr Myers used radiation and hormone therapy for his own high risk cancer about 9 years ago. He has since used hormone therapy for many of his patients since then.

Obtain full print outs of your tests and biopsy report to keep in a folder so you have all your details on hand for future consultations.

Treatment choices often come down to each individual situation, personal preferences, and which side effects are most palatable for you: if you need further help with your decision making, consult a medical oncologist expert in PC. A medical oncologist is not the one who will perform your radiation or treatment, but will give you an objective opinion and guide you through the decision making process.

Start the hormone therapy and in 3-4 months do the radiation. 

LOL