Phil,
I was diagnosed with stage 4 prostate cancer de novo July 27, 2022 - I am 61 years old now. I started out with terrible pain in my back that ultimately turned out to be from bone metastases in my spin and ribs. At first I thought it was my gall bladder and unaware I had cancer had emergency surgery to have it removed. After I was released from the hospital the pain in my back continued. It was the worst pain I had felt in my life and I could not sleep laying down. My doctors ordered an MRI which revealed bone metastases in my spin. Later a bone scan revealed bone metastases to my spin, ribs, and hips. The cancer only traveled to bone. Because the pain was so bad my Oncologist ordered palliative radiation to the spin (10 cycles) and ribs (5 cycles). I too did triplet therapy like your father: Eligard (ADT), Darolutamide, and 10 cycles of Chemotherapy (Docetaxel). My PSA initially dropped to 0.238 at the end of chemo and continued to drop after Chemotherapy. I am now undetectable. What I want to share with you is that after radiation I had no more pain and I still do not have any pain. I also think that me getting radiation first to bone metastases shrunk and damaged the DNA of the cancer cells. I believe the 10 cycles of Docetaxel Chemo did even more damage to the cancer and just knocked the hell out of the cancer. I was very aggressive in my treatment. I agreed to 10 cycles of chemo but had my doctors allowed it I would have done 12 cycles. My wife just found a study that shows Darolutamide continues to enhance the chemotherapy death cycle (apoptosis). That should encourage your father as well.

I am also getting Zometa infusions every month. After every infusion I experience some bone and muscle discomfort - not pain. During Chemo I ran to the ER worried the cancer was spreading because I felt some discomfort in my back - only to find out it was pain and discomfort from Zometa. Every time the CT scans came back stabilized metastatic disease. I did this 2 times and my doctor had to sit me down and tell me that not every pain is not from or is (in my case) from the cancer. Everyone with this disease is different and reacts differently to treatment. Regardless, every PSA check is stressful and scary for all of us. But I am encouraged your father received triplet therapy and responded well to the treatment. You should know, Men are living longer with the disease. Some do have more struggles if they have genetic or genomic markers (i.e., BRAC1 and BRAC2). Those of us that received triplet therapy based on the ARSENS trial are being watched closely - because there has been great success with triplet therapy. There is hope. Trust in Jesus.

As a final note my oncologist will not tell me how much time I have because she does not know. Everyone is different. Initially I did get a second opinion at Hopkins and that doctors said the average is 7 to 8 years but that does not mean I would die is 7 to 8 years. He said he many patients that have been living with stage 4 prostate cancer 10, 15, and 20+ years. He said this before triplet therapy was approved as the standard of treatment. So be encouraged.