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Dad diagnosed - looking for some guidance

User
Posted 13 Jan 2022 at 13:29

Thank you all for helpful responses, it’s really comforting to have this forum! Will keep you updated, as things progress 

User
Posted 14 Jan 2022 at 02:07
I think it is good to have a positive attitude and hope for a good outcome but also important to be realistic. PSA doesn't really indicate how serious the problem is, only that there might be a problem that needs investigating. A man can have a PSA of 80 and no cancer or a PSA of 3 and multiple bone mets. So while it is good that his PSA is 'only' 8, this does not mean that he will be on a curative path or that the suspicious area is unlikely to be a met. I think I would be frustrated by the delays caused by these multiple scans but if the outcome is that he can go into radical treatment with confidence, it will have been worth the wait.

If it is concluded that the suspicious area on his spine is a met, it doesn't make a huge difference to longevity whether there is one bone met or 10 bone mets seen. We have (or have had) members here with bone mets who are still here and living good lives 10 or 15 years after diagnosis.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 14 Jan 2022 at 10:26

Thanks Lyn - current position is definitely preparing for the worst, but hoping (praying) for the best.

 

Hoping for confirmation of date for MRI today, MDT next Friday and then results following week. 

User
Posted 21 Jan 2022 at 14:23

Quick update. Given MRI was on Weds they didn’t have chance to report ahead of MDT today, as such we now have to wait another week until MDT next Friday…. really disappointed as was hoping for some news today but if he hasn’t been discussed, then feels like there is nothing at all we can do but wait..

User
Posted 29 Jan 2022 at 16:45

update - he was discussed at the MDT on Friday and has been notified that he has a phone appointment Monday morning. First time we’ve had phone appointment and not face to face… obviously don’t want to read too much into it but glad the waiting is almost finally over and we will know one way or another what his treatment pathway is.

In other news, my mum (who was diagnosed after him with breast cancer), is now three weeks post surgery and recovering really well. Keeping positive!

 

will update on Monday. Good weekends all, 

User
Posted 31 Jan 2022 at 11:58

Morning all,

I post today with some bad news, unfortunately the spot on dad’s spine has been confirmed as a met. There are no others showing up on scans but still he is now advanced. 

obviously in shock, but in a strange way feel slightly relieved that the waiting is over. He’s going straight onto hormone tablets. Apparently oncologist will call to speak re treatment soon, but think it may be SBRT on the spot.

he’s super strong and I know will fight it with everything he’s got. We have a long winding road ahead and I’m sure a lot of ups and downs, but trying to keep positive. Thank you all for all your support so far and will keep posting here for updates.

 

User
Posted 31 Jan 2022 at 22:58
Sorry to see this but I think you already knew that the doctors had a strong suspicion. Hopeful that his response to HT is rapid and lasts for many years!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Feb 2022 at 09:21

Thanks Lynn, as you say had a strong suspicion this would be the case. Received prescription through post for 150mg bicalutamide and Zoladex yesterday. Slightly frustrating that we have heard nothing from the hospital since the 20 min call on Monday apart from receiving the prescription. He’s started the bicalutamide yesterday, and assume we will need to book on for Zoladex injections in a few weeks.

No word on Onco appointment yet, hoping fairly soon so we get some visibility on treatment pathway. 

Thanks as ever,

S

User
Posted 02 Feb 2022 at 10:18

Sorry to read this news. So much that can still be done though. I watched a video that someone posted on here a while ago with regards to Oligo metastasis, it was an American doctor (obviously can’t mention names) speaking at a prostate cancer conference and I found it really interesting. 

Hope your mum is still recovering well too x

User
Posted 02 Feb 2022 at 10:23

Thank you Elaine! In a strange way there’s some relief to just know the outcome after months of tests. He’s strong and up for the fight, so let’s see how things go! Mum recovering well thanks, we have appointment today to confirm if chemo or RT for follow up after lumpectomy (fortunately she was stage 1A so the other end of the spectrum!).

 

I read your story, and hope your OH is recovering well! All the best,

User
Posted 02 Feb 2022 at 10:53

Yes I can understand that, the waiting around not knowing really is the worst part. I can’t even imagine what you’ve all been going through with both your parents diagnosis…really good to know they are strong though and getting through it all. Fingers crossed your mum won’t need further treatment.

And thank you, he’s doing really well. Just a step at a time….but feeling more positive x

User
Posted 02 Feb 2022 at 16:24

Quick question if I may. We’ve heard from the Urology nurse who has said we will hear from an Oncologist in “next few weeks”. Is this standard? I expected we would have follow up pretty rapidly…. Grateful for views

User
Posted 02 Feb 2022 at 21:14
He has started his treatment immediately - there isn't very much else for the oncologist to do for the time being. they will probably want to do a PSA test in a few weeks to check that the HT is working effectively.

Have you checked whether he should go to the GP practice for his Zoladex injection or whether the first one is being done at the hospital? Best to book the appointment now as the GP or hospital clinic will need some warning to order the Zoladex and (if the GP practice) to ensure that the appointment is with a nurse who knows how to use Zoladex depots.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Feb 2022 at 22:31

Thanks Lyn, that’s massively reassuring. We have the Zoladex and intention is to do at GP. Getting appointment booked tomorrow.  Thanks again

User
Posted 06 Feb 2022 at 09:40

Hi all,

Back again with another question. My dad has been doing some research and is looking at potentially referring privately to the Marsden for the oncologist appointment and treatment plan thereafter. As it stands, all his diagnostics have been done through NHS (save PSMA which we did privately to expedite). 

The reason for going private is that he wants to be treated at the Marsden (we have had a couple of family members go there and it’s been excellent), and his private work insurance will cover him to do this. The negatives from my perspective are that we aren’t really close (approx 1.5 hours), so logistically for treatment it won’t be the easiest, and I have read several places that private for cancer isn’t really the be end and end all. 

I’d be really grateful for anyones shared experience, I completely understand why he wants to go to Marsden (+ our hospital hasn’t been fantastic if I’m honest), but is there anything we should be aware of? Can he actually be referred to the Marsden as NHS? Or could he at some point switch back to NHS whilst at the Marsden?

Thanks as ever,

Sam

User
Posted 06 Feb 2022 at 11:41
I don't think it would be a good idea to jump away from your hospital right now - wait and see whether they are going to offer SABR to the hotspot first (many hospitals wouldn't so the fact that it has been mentioned to your dad is hopeful).

Anyone can ask for a referral anywhere for a second opinion on the NHS but if he has private health he may as well use it. He can ask to see an oncologist at the RM without having to commit to moving his care there.

In all honesty, there may be very little benefit in going private for advanced cancer. The standard approach would be hormone therapy, probably with early chemo or apalutimide, and then when the hormone stops working add another one. Treatment plan with a private provider will be exactly the same but you will be sure of seeing the consultant every few months rather than a registrar.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Feb 2022 at 12:32

Hi Sam,

My husband got referred to RM on NHS and we live in Manchester. It was a urology referral though as he was going to have the op. As it turned out the waiting times were longer than we expected so we ended up paying private with the same surgeon but at LBH. We stayed in an apartment in London for 3 weeks around surgery (which was great for us) but I realise this wouldn’t be a good option for everyone and logistics have to be considered before making such a big decision. There is a lot to be said about being happy with your hospital and consultant though, it made such a difference to us. So as Lyn said you could still get the second opinion without committing to treatment there.

We initially paid for a private second opinion at the RM as our local hospital MDT confirmed bone met in his pelvis. All his scans were sent to RM MDT and they disagreed with original diagnosis…he had the G68 PSMA pet scan at this point which sided with the RM MDT. (Thankfully)

We had already prepared ourselves for the advanced diagnosis but we still wanted to go down the radical treatment path and then deal with the bone met later. I had received information about the Atlanta trial where one of the arms was what we wanted but of course you can’t choose. I did often feel like I was clutching at straws but I was constantly looking for a route with curable intent as I had the belief that anything was possible.

Best of luck with whatever decision he makes.

Elaine

User
Posted 06 Feb 2022 at 13:18

Thank you Elaine and Lyn, both incredibly helpful as always. So is best approach perhaps to go for a second opinion at the RM, and also meet with Onco at current hospital? 

Also Elaine - Atlanta trial is something we have looked into and will mention to Onco, but as you say there’s a chance he’s in the control group, and also it’s clearly speculative and v.unlikely to be curative! Looking at all options but really appreciate the guidance.

He’s had his 6th hormone tablet and doing well, no side effects to report but obviously aware it’s v.early days and he hasn’t had Zoladex depot as yet.

 

Sam

User
Posted 06 Feb 2022 at 17:01

Originally Posted by: Online Community Member

Thank you Elaine and Lyn, both incredibly helpful as always. So is best approach perhaps to go for a second opinion at the RM, and also meet with Onco at current hospital? 

Sam

Yes, that is what I would do. Contact the urology nurse and let him/her know that you would like a 2nd opinion. Your private health provider may want a letter from the GP and your preferred onco at RM may also want a referral letter from the GP or from hospital urology department. It will work out quite well if you see the RM first snd then the local oncologist as you will have an idea in your head of what the RM might offer privately or on the NHS and can make a comparison. 

Whatever treatment plan your dad is offered, it is unlikely to be curative. SABR to the bone met will slow that tumour, stabilise the bone and reduce any pain or other symptoms but it won't treat the microscopic spread that has probably already happened

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Feb 2022 at 17:06

PS if he was to be offered the Atlanta trial, don't discount it. Even the control arm is a better standard of treatment than he is likely to get on the NHS and with the benefit of much closer monitoring

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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