Urology/pca

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QUESTION: doc, i have stage 4 pca, psa64,gleason 9(4+5) 51 yrs.old getting ready to have ent. beam rad. in week or so. the issue i'm writing you about is i have pain in penis(uretha) and muscle spamism in it? not sure why? as u might know i'm having all kinds of pain and aches with the cancer. your thoughts if any? thanx, paul

ANSWER: Paul:

By definition, stage 4 cancer and Gleason 9 disease is pretty bad.  External beam radiation therapy may not help with disease that has spread as is typical with stage 4 disease.

Pain in the penis is almost always due to issues related to the prostate.  The radiation and possibly hormonal therapy may help with this.  Very sorry to hear about having such bad disease at such a young age.

---------- FOLLOW-UP ----------

QUESTION: ok, done with 40 tx of imrt 2 weeks ago. still having lots of pain, taking pain meds. heres my questions.
how long after imrt will it take to show up in bone wide scale? also,how will i know when sliding to the end of life? also how rare is it to be in all three lyphnodes (internal, external and common lilac)?? thanx doc and have happy hoilday! f.y.i. i also have satge 4 copd...

Answer
Paul:

Hormonal therapy might help with the pain.  Talk to an oncologist if you haven't already.  Also, you might benefit from a visit to a pain specialist.

I don't understand the question about how long after IMRT it takes to "show up in bone wide scale".  If you have positive bone mets, then you should not have gotten the IMRT.  Since you did get the full dose IMRT, I can only assume you did not have stage 4 disease, but only stage 2 or stage 3.  You may want to ask about this.

It is not rare in extensive, high grade disease, to have involvment of all the local lymph nodes.

End of life issues usually are predicted from the stage and grade of the tumor, comorbidities, lymph node status, PSA levels and tumor growth rate.  In generaly, when we see a PSA doubling time of less than 6 months after using all available treatments, that would be a poor prognostic sign.

For now, you have just received a treatment and haven't even started hormonal therapy.  new treatments like abiraterone and Provenge are available now that were not available just a few years ago.  Hormonal therapy alone can usually provide roughly 2 years of cancer remission.

I strongly advise you to consult a medical oncologist to help you with these issues.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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