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What is the best treatment for prostate cancer with metastasis in ribs and femur?

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Oncologist, Surgical
Practicing since : 1986
Answered : 59 Questions
Hi! My dad, who is 74, was just diagnosed with stage IV prostate cancer; with a metastasis to the ribs and femur. Thank God there is no lymph involvement. I am wondering how the prostate cancer could travel to the bones without going through the lymphatic system? Also, what is the best treatment for him? Can Radiation still help him, and be administered, even after the cancer cells have been released from the capsule? Will his spots on his ribs and femur diminish and be completely eradicated with hormonal treatment? Does hormonal treatment loose its' effectiveness over a period of time? Does hormonal treatment sometimes not work for people? Thanks!
Posted Mon, 17 Feb 2014 in Cancer
Answered by Dr. K. Harish 11 days later
Brief Answer: Radiation could still help him Detailed Answer: Prostate cancer can spread to bones through venous system. Prostate is encompassed by a large venous plexus. Once the cancer accesses these veins, the tumor can spread to lungs and other organs via blood. Peculiarly, these venous plexus have direct communication with vertebral veins and hence the cancer can spread to spine and other bones. Lymphatic spread is thus NOT a pre-requisite for bone spread. His treatment would involve hormonal therapy and radiation. Your doctor would be the best to advise you on that. Rarely he may require chemotherapy. Radiation can still help him to alleviate pain and control disease in critical areas like spine. This as you understand itself is stage IV. Hence you should not expect eradication of disease. Instead the aim would be control disease and alleviate pain and other sufferings. Hormonal treatment can loose its efficacy over a period of time. The tumor can be refractory to therapy. But it takes time. There is a small possibility that hormonal therapy may not be effective in some depending on the character of the primary disease.
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Follow-up: What is the best treatment for prostate cancer with metastasis in ribs and femur? 15 hours later
Dr. XXXXXXX Thanks for your response. Do you think my dad can have radiation therapy, once his PSA lowers with Lupron, to try to attack the primary tumors in the prostate gland? Do you recommend Castrax with the Lupron? XXXXXXX
Answered by Dr. K. Harish 2 hours later
Brief Answer: Check with your doctor Detailed Answer: In my earlier reply I have made it clear that the disease is stage IV. Hence treatment would only be palliative (meaning symptom control or prevention of a possible symptom). Once this is understood, radiation to gland or to bone etc would depend on the symptoms. It has to be understood that the treatment is NOT for cure. In fact if the patient has blockage of urine, chanelling of urethra by removal of some tumor through cystoscope may also be required to relieve obstruction. Again, this depends whether or not the patient has urinary blockade. There are various levels of hormonal block. Single or combination of drugs and sequencing of drugs would be the choice of the treating doctor and his assessment of the patient. In addition, standby drugs (when the tumor becomes refractory) also needs to be kept in mind.
Above answer was peer-reviewed by
Follow-up: What is the best treatment for prostate cancer with metastasis in ribs and femur? 7 hours later
Dr. XXXXXXX Hi! Thanks for your response. I understand what you have mentioned about Stage IV. My dad's MD, Urologist, feels that the raditation may better control the primary tumor from coming back more aggressively. Do you know of anyone who is doing well, in Stage IV, with just hormones, for many years? XXXXXXX
Answered by Dr. K. Harish 5 hours later
Brief Answer: Yes and No Detailed Answer: Radiation is local form of treatment and could definitely help. However, hormones also act on the same tissue. It is a matter of individual experience, type of tumor and areas of spread. Your doctor would be best to decide on what is best. I think you should follow his advice. All forms of therapy in cancer are complimentary and not substitute for each other.
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