Many choices. A few options here. For bone involvement a na-f18 pet scan is the most sensitive along with MRI scans. Standard bone scan, imho, is outdated. Also, we find the measurement of ctc's (circulating tumor cells, very useful. Standard ct scan is good for lung and liver disease. Last, MRI with iron nanoparticles is great for lymph node + disease evaluation. Prostatscint is not so useful anymore.
Psa. Bone scan is best but very low chance if psa not above 20.
Imaging and PSA. Most patients with metastatic prostate cancer have psa levels above 10 ng/ml. Depending on the location of the metastases, which are usually in the bone, bone scan can detect mets.
Dad has advanced prostate cancer with bone metastasis. After orchirectomy, psa down from 270 to 10. Shall he start zometa or xgeva (denosumab)? Which is better?
See Below. Use of bisphosphanates for your dad can be controversial. Here is an excerpt from a recent review article on www. Cancernetwork. Com which you can use to discuss with your father's doctor to decide what is best for your dad. Http://www. Cancernetwork. Com/bone-metastases/content/article/10165/105118.
Either. Xgeva (denosumab) does have some advantages over zometa: quicker administration and no kidney side effects. It is associated with fewer bone complications from cancer than zometa. On the other hand, zometa is now generic, meaning that is a lot cheaper. Neither is a curative treatment for prostate cancer and they are both considered adjunct treatments. Thes small differences may or may not justify its use.
Bones. Xgeva (denosumab) has less side effect profile in my opinion.
Off label. Neither zoledronate nor Denosumab is approved for disease that has not progressed on initial hormonal therapy. I would recommend waiting until disease progression and thus avoid potential side effects from these treatments.
My dad is 68 years old. Recently, he was dignosed with advanced prostate cancer with skeletal bone metastasis. What kind of hormone therapy shall he use? Is orchiectomy ok?
Yes. Orchiectomy is nearly instantly effective in reducing testosterone levels and can be done as an outpatient. Alternatives include injections (lhrh agonists) to reduce testosterone levels. These are relatively expensive over the long term, but preserve the testicles which is why many men prefer this option. Surgery is permanent whereas shots can be withheld, but permanent may be best with bone mets.
Disagree... As mentioned orchiectomy is permanent. There are other chemical options, including estrogen therapy as well as drugs which de-stimulate the pituitary from making lh and fsh. No direct proof confirms that testosterone per se is a cause. It may more be 5-dht. Men who lack 5-a-reductase do not get bald or prostate ca. Therefore drugs that block conversion to 5-dht may be used in tandem.
D/W your oncologist. Many options available for metastatic prostate ca- medical and surgical therapy. Orchiectomy can be done and will be for sure decrease testosterone permanently. Anti androgen tx like- Lupron (leuprolide) injection, oral casodex- or the newer oral agents that are more sensitive like x-tandi, abiraterone- are available. Not too forget- vaccine & chemo are available as well. Pls d/w oncologist in detail.
Orchiectomy OK but. The standard of care is an lhrh agonist (such as lupron, zoladex) injection combined with a drug taken by mouth called casodex. The Casodex should be used for a minimum of 1 month and then can be stopped. The advantage is that these injections can be as little as once every 6 months. Alternatively, a drug called Firmagon (degarelix) (an lhrh antagonist) can be given monthly without the casodex.
Prostate cancer. The most common metastatic site would be bones-although it also can go to other sites- lymph glands, lung, liver etc. Symptoms will depend on the location of metastases. Bone pain, fractures would be the symptoms of bony mets. If spread to the adjacent area such as bladder area- blood in urine, lower abdomen pain, prob wi/ urination, obstruction can happen. Weight loss, weakness are common too.
Pain. Pain would be the most common symptom of metastasis, as bone involvement is common in advanced prostate cancer.
Every 3 months. The ususal timeframe to check for prostate cancer recurrence and monitoring is about every 3 to 4 months. The frequency can change depending on the actual number, however.
Usually each visit. Psa has high sensitivity for detecting recurrence after radical prostatectomy, but is less sensitive in detecting recurrence after radiation therapy. For monitoring hormone treatment, psa provides a sensitive tool with which to verify treatment response and detect tumor recurrence;.Serial measurements provide reliable evidence.
Psa. I check psa every 3 monthd.
Every 6 mos for 10yr. We check every 6 months if all looks good for ten years. If something looks suspicious or concerning I will check every three months for a short interim until the problem declares itself one way or another.