Ask the doctor: Prostate cancer and lymphoma

Three years ago, my husband was diagnosed with prostate cancer and non-Hodgkin’s lymphoma (NHL). He had a radical prostatectomy followed by radiation, but his PSA has continued to rise; it is now 2.9 ng/ml. He was given the drug rituximab (Rituxan) for the NHL, but he had an allergic reaction to it. What should we try next?

William DeWolf, M.D., chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:

Although there is no known relationship between prostate cancer and NHL, your situation is not rare. I have cared for several patients with both conditions during my career. Unfortunately, there’s no one correct course of action.

Lymphoma is the name for a group of cancers that start in the lymphatic system, which is part of the body’s immune system. White blood cells called lymphocytes (see “Lymphocytes: Critical immune system players”), which usually protect against infection, change to lymphoma cells. These cells pile up and form masses in the lymph nodes and other parts of the body, such as the lungs, liver, or bones. Rituximab is one of several drugs typically used to treat NHL.

At this point, I think you need to seek the advice of a hematologist, urologist, or medical oncologist — or even all three — to determine the best course of action. It would be helpful to know which condition the specialists consider more threatening. The treatment for each condition is different. Given the potential side effects — vomiting, diarrhea, constipation, nausea, weakness, and fatigue are most common — your husband may not be able to tolerate treating both conditions at the same time. Opt to treat the one that is more severe.

If you want to treat the prostate cancer first, ask if your husband is a candidate for hormone therapy. Patients generally try hormones before chemotherapy.

You should also ask about clinical trials, which assess new drugs or treatments, in your area. Several Web sites list clinical trials and/or match patients to appropriate trials based on the type of cancer they have, previous treatments, and other factors. Two to try are www.clinicaltrials.gov, the U.S. government’s listing service for about 55,000 trials around the world, and www.cancer.org, operated by the American Cancer Society.