← Return to Protocol over person -The Quiet Tyranny of Standardized Care

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@northoftheborder

That's really rough. I'm so sorry.

Co-morbidities like heart disease complicate cancer treatment, and the more of them there are, the less likely that there's a big body of reasearch covering precisely the patient's situation.

It that case, what does an oncology team do? The safe course is to undertreat the cancer and let it take its course, because they're unlikely to be sued for that. Taking more drastic action to try to extend the patient's life is risky, both for the patient and (litigation-wise) for the medical team, but can have a big payoff if it works out.

That's why it's so important to have a conversation about risk tolerance up front. The onco team should initiate it, but if they don't, you can. I told my onco team in 2021 that I wanted to fight (stage 4, age mid 50s) and was willing to take chances and put up with harsh side effects. That made them more willing to take chances, too, since my wishes were clear.

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Replies to "That's really rough. I'm so sorry. Co-morbidities like heart disease complicate cancer treatment, and the more..."

Yes, we wanted to be very aggressive when he started treatment for his prostate cancer … though stage 3 it was assumed to be micro metastatic with a PSA of 46.6 and Gleason 9 .
He had radiation and he was on Zytiga for a year, with Orgovyx, until his aortic root aneurysm started getting bigger and his BP became more unstable..
His oncologist is very neutral regarding treatment plan … I don’t think he expects a cure anyway.

Now he has a cardiac team at Mayo and he will be scheduled for open heart surgery sooner than later.
Cardio doctors don’t want to advise him re; ADT risks before, during and after surgery . Oncology doesn’t know enough about cardio impact of ADT to advise. No one recommended that he get off Zytiga… even the Oncology cardiology doc.
We made that decision.

At this point we think his heart will kill him before the prostate cancer.

We are also getting a second opinion with a different oncologist.