My dad is a prostate cancer patient and underwent IGRT last year with a Gleason of 3+4. I have three questions: He has already taken seven Zoladex injections and his PSA over the last two years has been less than 0.20 ng/mL, his last being 0.03 ng/mL. How many more doses does he need to take? The doctor suggests 8 to 12 injections. Is there a standard treatment for it? He feels weak in spite of consuming vitamin tablets. How can we improve that? He has been complaining of stool in his blood occasionally. He underwent a colonoscopy with gastroscopy, which reveals angiodysplasia of the left colon and mild hemorrhoids. The gastroenterologist suggested an APC. Any recommendations to address the issues in a more conservative way?
According to your query: Eight to twelve injections is the standard. For your dad, I suggest giving the same for three years (12 injections) of treatment. As testosterone levels drop, weakness sets in. This is a side effect of treatment If he is unable to tolerate the weakness, or if daily activities are hampered, then we could stop with two years or two and half years of treatment. APC (active protein C) test is quite conservative in my opinion. The more aggressive therapies are colostomy (colonic bag attached to stomach wall) and colectomy (removal of the diseased colon). If steroid enema is not tried, it can be tried prior to APC.
I hope I have cleared your doubts. Thank you.
Thank you for the clarification. He is doing well in terms of extreme weakness. He feels weak but is able to do his normal day-to-day chores so I think he can complete the 12 doses. Suggested Sucralfate suspension which he consumed for a couple of days but that apparently caused swelling under his eyes, and feet. Also, does APC solve the issue permanently or will it need to be redone every time a similar issue is encountered, and how soon does it heal? We had done a PSMA PET scan before and after the radiation therapy to confirm that the lesions had gone away and which was good. The doctor suggested once again to do the scan. Is it necessary and how frequently should that be done?
PSMA PET (prostate-specific membrane antigen positron emission tomography) patients with follow-up as well as blood PSA (prostate-specific antigen) are monitored every three months for up to five years. If cost is an issue, then PSA alone can be done monthly thrice. Remember that PSA escape is possible, where some tumors stop secreting PSA. So, the PSA test will be normal but the cancer will be spreading inside. To avoid this, we do the yearly scan. Swelling in the eyes, the body may be an allergic reaction to Sucralfate (not the same as a steroid). Steroid enema can be tried in a hospital setting with all precautions. I suggest Entofoam (topical treatment of ulcerative proctitis of the rectum) enema. APC (activated protein C) may be required repeatedly. Generally, the bleeding settles with one or two sittings. If it recurs repeatedly, he may be better off going for surgical removal of the diseased portion of the bowel, as a permanent solution. I hope I have cleared all your doubts.
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