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Suggest Treatment For Prostate Cancer

Posted on Wed, 26 Feb 2014

Question: I was informed by a Prostate XXXXXXX 9 , support member, that XXXXXXX 9's, with bone metastasis, need to not only be tested with PSA, but also four other blood tests (CEA-CarcinoEmryonic Antigen, CGA-ChromoGranin A), NSE (Neuron-Specific Enolase), and PAP (Prostatic Acid Phosphatase). I was wondering if people, on this thread, have their Oncologist's take this extra blood work. My dad had this sneaky cancer come out of no where! His PSA was always low, and his PSA just started to jump like crazy within 4 months. I believe that my dad's entire skeletal system had to have this cancer on it for years. I thereby feel that PSA alone, will not be a full indicator if it lowers to close to zero (I pray), but rather looking at the above mentioned bloodwork? Also, with stage IV, bone metastasis, is it concention to have radiation done, even after cancer had spread out of the prostate capsule? I was told, by a Urologist, that it is good to stop the possible, future spread to visceral organs? Is prostate cancer not as deadly as other types; even in its' aggressive form? Thanks!

Answered by Dr. K. Harish (1 hour later)

Brief Answer: Yes Detailed Answer: Hi In patients with high XXXXXXX score (more than 7 or 8) and who have low PSA, it is better to get these additional blood tests done. In these patients, the cells would be doing less of normal function and hence PSA may not be secreted by the cells. So, deceptively low levels of serum PSA would be estimated. Generally, PAP (only in these advanced cases) indicates that cancer could have spread beyond prostate, CGA indicates higher chances of spread to liver, lungs and bones. NSE and CEA indicate more aggressive type of prostate cancer. Radiation as therapy both for cure and palliation has to be planned by the attending clinician. He would have seen the progress of the disease and its potential areas of spread. He would be the right person to plan for treatment or for prevention of manifestation of disease. Generally prostate cancers are not very aggressive. But some forms are aggressive and could be life threatening. Apart from XXXXXXX score and other tumor markers, the attending clinician would be in a better position to comment on the aggressiveness. Hope it helps

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. K. Harish (5 hours later)

Dr. XXXXXXX How are you? Thanks for your responses!!!! Since my dad has extensive bone metastasis, as of a few weeks ago, with a bone scan, should he still have those 4 blood tests done? I am worried that it may have spread to lymph and/or organs. The CT scan did not show any other spread but to the bones. Also, I am wondering how long this cancer has been with my dad. Do you think it would take years, and not months, to see such a spread of disease throughout the skeletal system? Even with such spread throughout the bones, can this clinical picture, dictate more of an aggressive cancer, or do indolent prostate cancers, perhaps also spread to the bones? Thanks, XXXXXXX

Answered by Dr. K. Harish (11 hours later)

Brief Answer: yes Detailed Answer: As I had replied earlier, the blood tests are indicative of aggressiveness. These tests do not alter the course of the disease. These tests have been advised as you are apprehensive of lymph spread. There is no answer as to how long the cancer would have been present in the individual. Usually it would be months or years before they manifest. However, if the disease spreads in a short duration, then it indicates a very aggressive behavior of cancer. The very fact it has spread to bones indicates aggressive cancer. But if lymph nodes and visceral organs are involved, it indicates a very aggressive variety.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar