Patient's Query
Hello doctor,
My dad is a prostate cancer patient and underwent IGRT last year with a Gleason score 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. The doctor suggests 8 to 12 injections. He feels weak in spite of consuming vitamin tablets. He has been complaining of blood in his stool occasionally. He underwent a colonoscopy with gastroscopy, which revealed angiodysplasia of the left colon and mild hemorrhoids. The gastroenterologist suggested an APC.
Please help.
Hello,
Welcome to icliniq.com.
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 a half years of treatment.
The 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 a steroid enema is not tried, it can be tried prior to APC.
I hope this helps. Kindly revert so I can assist you further.
Patient's Query
Hello doctor,
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. He was prescribed Sucralfate suspension, which he consumed for a couple of days, but that apparently caused swelling under his eyes and in his 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, which was good. The doctor suggested once again to do the scan.
Is it necessary, and how frequently should that be done? Kindly help.
Hello,
Welcome back to icliniq.com.
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 three times. 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 and the body may be an allergic reaction to Sucralfate (not the same as a steroid). A steroid enema can be tried in a hospital setting with all precautions. I suggest an 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 this helps. Kindly revert so I can assist you further.
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Answered byDr. Andrew Chellakumar Fenn
Medically reviewed byiCliniq medical review team
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