Hey lafc, I just finished IMRT (5weeks, 5X/day) at Sloan in Commack. My RO was Dr Andrew Barsky. I had salvage radiation, which is treatment due to failure of previous prostate removal so my situation is different from your dad’s.
However, I did question Dr Barsky about my radiation target and he said the Sloan protocol is to treat the prostate and pelvic lymph nodes as well; it is a source of confusion since a lot of RO’s don’t go into any great detail about their treatment protocol.
As jeffmarc pointed out, really get into the nitty gritty about combined radiation therapies - SBRT (cyberknife 5 tx) with IMRT (prostate/pelvic nodes) to possibly cut down on treatment time - IF it’s possible in Dad’s case.
I can’t speak to the advanced ADT regimen - since I was only on Orgovyx for 6 mos- but some of these can take care of the pelvic bone metastasis as well.
As you correctly point out, your father is at an advanced age, and not to sound like an actuary but at 88 yrs old something is going to get him sooner rather than later. IMO, Quality of life should be at the top of the list at his age; aggressive treatments should be for much younger men who can withstand it so maybe one day they will REACH 88, not for someone who already did. I know that’s a loaded statement and the counter argument would be that with aggressive treatment he could live to be 100….but in what condition?
But the word aggressive is relative, after all, so it is really something to discuss with your DRS and your Dad. My father, age 74 was suffering from Stage 4 mesothelioma - totally incurable. One doctor wanted to put him through a new experimental form of chemo because in his words “your father is a strong specimen”.
When I heard that cold blooded statement, I advised my father to just enjoy what time he had left as best he could and not seek further treatment. He hugged me because I told him what he already knew was the right answer.
Best of luck with whatever decision you and Dad make!
Phil