Question: Dear Dr XXXXXXX

Thank you so much for your earlier advice to my thread
http://www.yyyyyyyy.com/AskDoctorInboxServlet?page=yyyyyyyyyyyyyy=238734

Our oncology doctor scheduled his next PSA test in April 2016, i.e. about 5 months after his last test in mid Nov.. Would it be too late, given his recent rapid rise?

I noticed that my father has recurrent blood bubbles in his month (which appear and subside quickly in a few days) (photo to be attached). Is this related to his low platelets or the ADT? Is it worrisome?

He did not have such conditions before ADT. His decline in Hgb and recurrence of blood bubbles arose early this year, just about 3 months after his first ADT shot. I wonder if these blood bubbles are related to ADT rather than low platelets entirely. If due to low platelets, he should have such condition before because his platelets has been low since late 2013. However, this problem as well as his sharp drop in Hgb arose not long after his ADT . It is such a coincidence in time that I wonder if all these problems are triggered by ADT? Do you have any idea? Have you come across with patients having similar conditions? Our doctors keep saying that these are unlikely due to ADT.

With the seemingly side effect of ADT on my father, I wonder whether we should go for radiation therapy so that he no longer needs to have ADT shots. But on the other hand, I am afraid that RT would suppress his bone marrow and trigger or worsen his bone marrow problem (if any now). Our oncologist said RT nowadays is very advanced and given that prostate is such a small organ, RT for PCa is tolerable to the elderly and side effects are minimal and manageable. We do not know any elderly PCa patients who can share with us their experience with RT. Doctor XXXXXXX from your experience and interaction with patients, do you think my father, given his medical background, could manage to complete RT? My father, though cannot be said to be very fit, is not very weak. His physiotherapist said his physical conditions are quite OK.

Is it possible that my father recourse back to RT if one day we do not wish to risk further side effects of ADT?

Another oncologist once said to us that it may not be necessary to take LHRH injection continuously and also it is possible to take antiandrogen pills only, rather than having LHRH injection. Is LHRH’s side effect of anemia more severe than antiandrogen pills? What do you think about taking antiandrogen pills only without LHRH injection? How long could pills alone keep PCa under control in general?

Thanks again in advance for your further professional advice.

Best regards,

Thanks Dr XXXXXXX for your prompt reply. I also worry that RT may worsen my father's marrow problem, although our doctors said the suppression on marrow, if any, is minimal. I intend to wait and watch for the PSA levels for the time being and when PSA rises to say close to 20, then give another ADT shot. What do you think about this approach, doctor?

Best regards,