University of Minnesota doctor

[Guest guest]

Hi,  My name is and I got lots of good help from you folks a year ago regarding my husband and his prostate cancer.    Now my dad has PCa and I'm looking for a good urologist, urologic oncologist or medical oncologist at the University of Minnesota (or anywhere else in the Twin Cities area).   Does anyone have any suggestions?   Also, I have some other questions regarding treatment below. 

Here's his data:   He's 91, has had elevated PSAs (a  year ago it was 38) for a number of years but negative biopsies.  I don't have any more information than that for his more distant past.  He had  a PSA of 500 in June and 300 in July, bone  scan negative for bone metastases, abdomen and lymph CT scan negative for lymp metastases.   He had a biopsy a couple  weeks ago and his  GS now is 5/4.   There was a large mass that could be seen by the biopsy ultrasound (at the base or top of the biopsy near the bladder).   The doctor took 5 samples from this mass (only these five- no others) and all were 90-100% positive.  That's all the data I have.  He was given a 3  month Eligard injection one week ago with no casodex and nothing  for bone loss.   He developed severe knee pain (or mild pre-existing pain suddenly got worse) the  following day along  with low back pain and was finally given Casodex 2 days ago.

The goal of treatment is quality rather than quantity of life.   Given he's 91 years old, my parents don't want to take aggressive means to prolong his life.  On the other hand, it's important to make sure he doesn't suffer unnecessarily.  

Here are some questions regarding treatment: 1.  If his pain is due to the Eligard with no casodex, are there things that could be done now to minimize damage besides starting casodex?    (This would warrant getting this checked into.   He's been seen by his PCP but not a specialist.)

2.  Are there problems  with giving older men (e.g. over 90) bone loss medications (e.g. boniva)?   I don't know why the doctor didn't prescribe something, given that one of the biggest dangers for older people is falling  and breaking bones, so I'm just guessing that maybe it was because of some bad side effects from these drugs.

3.  Are there any unique aspects of care for  older (over 85 or 90) men with prostate cancer that I should be aware of?4.   I hear that heart problems are a contraindication for Eligard.  My dad had a heart attack 20 years ago, has a pacemaker and has ventricular fibrillation.   The treating urologist said he's never seen any heart problems from Eligard with his patients.  Any thoughts on this?

5.  Could a testosterone flair from an LHRH agonist happen and cause damage to someone with no visible bone mets but with a large tumor (I guess you'd call it advanced, localized PCa)?   (The doctor's nurses say it's impossible to have complications from a testosterone flair if the bone scan is negative for bone mets.)

This is why I'm  looking for a different doctor:- no casodex before or even at the time of the Eligard injection- no bone loss medication-  Eligard given with known history of heart disease

-  little concern for back pain post Eligard injectionThank you in advance for any suggestions or thoughts.