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Is treatment for 88-year old Dad too aggressive for his age?
Hello all. I am learning so much from your posts! They are informative, and heartfelt. This is a compassionate group.
I would love to hear your comments on my dad's journey. We - as his children - are torn about his treatment suggestions.
My dad was diagnosed with Stage 4 oligometastatic prostate cancer back in November. Gleason 9/aggressive/entire prostate has cancer, as well as lymphnodes, some perineural invasion, and bone mets in one spot: pelvic bone.
He is being treated at Sloan. He started Orgovyx in early December. Now, his oncologist wants to start Abiraterone 250mg 4 times per day, with Prednisone 5mg once per day. We are meeting with the Sloan radiation oncologist on Tuesday to discuss radiation treatment. (As a side note, we met with another radiation oncologist who said 5 weeks of IMRT to the prostate - not the lymphnodes and not the pelvic met - which surprised me). Radiation will start in approx. 3 months.
Our concern is this: my dad is 88 years old. He is relatively healthy except for a Foley Catheter needed to eliminate urine ( which may resolve if the cancer shrinks from treatment), minor seizure a few years ago for which he is taking meds, and they are working. His heart is good. He is thin - 132 lbs. His mind is still active, and he loves to eat! He wants to LIVE! He loves his life.
He has fatigue which started before the cancer treatment. So we are not sure if his present fatigue is due to the Orgovyx. He has had one hot flash. We worry about starting the abiraterone since this could bring on liver problems, and heart problems. He now has neither.
Are we being too aggressive for his age? We love him, and want him around for a longer time. Oncologist says survival rates are better with 2 meds simultaneously in the beginning. I would appreciate your thoughts! Thank you!!
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As seriously Advanced as his cancer is the treatment makes sense. Keep a close eye on his blood pressure, abiraterone Can really aggravate it.
You should ask the doctor if it’s possible to do some SBRT to the prostate, so you do not need as many IMRT sessions. 26 is not a lot, Are they doing the whole prostate bed?
Getting a second opinion would be a good idea.
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1 ReactionI thought Zytiga/Arbiterone with 5mg. Of prednisone was considered ADT.?????? that’s what s going away. The Trelstar/ Lupron 3 monthly injection is going to happen but whether the MO is going to make it chronic- I just don’t know yet???
Lupron is ADT, it reduces your testosterone below 20. That will keep most of the side effects of Zytiga continuing since Zytiga just reduces your testosterone down even lower.
Zytiga is considered an ARPI An Androgen receptor pathway inhibitor and ARSI Androgen receptor, signaling inhibitor. The same things
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1 ReactionThe treatment itself sounds excellent and his results so far are very encouraging. Only YOU really know if your father is up for 26 radiation treatments. The treatments themselves are easy - 10 mins on the table; it’s the bladder and bowel prep that can be a challenge.
You need a very full bladder and sometimes they run behind schedule and you need to hold it for a longer time. If Dad can do that ( not wearing pads or diapers now or has some incontinence) he’ll be fine. The bowel prep is just a ‘no gas’ diet that was a challenge for me (love my fiber!) but maybe not for your father.
The drugs are probably the biggest wild card, as they do have side effects. The Orgovyx not so much but the other two need to be watched very carefully.
Nobody has a crystal ball, but Dad may have 10 more years in him and treatment will give him that. Or maybe he would live another 10 with no treatment - blasphemy to even say that🤫- but we’re all different.
My friend’s father passed recently (in his80’s) and he was very active. One day he had a pain and then was dead a week later. The docs told my friend that his dad had cancer everywhere - every organ, every bone, you name it. Never even tried to figure out what kind of cancer it was.
My friend was at peace with this turn of events because his father was never subjected to any medical treatment, lived a great life, and then passed peacefully in a week on pain meds.
You, my friend, are not as lucky because you KNOW your Dad has a problem and now it’s up to you to decide…. “TAG, YOU’RE IT!!”🫣
Thanks. Thus side effects continue.
lafc, I came across this the other day: presumably it's the provider whose report I offered to you before through a link expounding on the research he had presented there:
https://www.urotoday.com/video-lectures/localized-prostate-cancer/video/4525-overtreatment-of-prostate-cancer-persists-in-men-with-limited-life-expectancy-timothy-daskivich.html.
I haven't viewed the video myself, and I repeat that I'm not endorsing the contents nor the presenter - I don't know him at all, but present this for your consideration, as I believe it addresses what you had originally posted.
Good article, the crux being that men with life expectancies of 5 yrs or less are being treated more than ever, mostly with radiation.
But “life expectation” is the wild card and some 88 yr olds will reach 100, while some 60 yr olds will not reach 65. It’s always gonna be a roll of the dice, especially when the 88 yr old is active, alert and otherwise healthy.
At his age; quality of life is likely the most important thing. God bless him for having a long and healthy life.
Best to you and your family.
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