Dad dx with metastatic prostate cancer

Wow, I'm so sorry to hear about your dad, that's never the news you want to hear - either as the person getting it or family. The biopsy will determine the grade of his cancer and what his options are for dealing with it. It's hard to tell from the description but are you certain of prostate cancer? A PSE test will tell you for sure. A high PSA doesn't guarantee prostate cancer, just as a low one doesn't guarantee no cancer either. The biopsy and PSE will absolutely solve the riddle if you don't know for certain and from there you can get a Decipher test to help determine if it's even more serious than the biopsy says it is.

Nobody wants a biopsy, nobody. My wife's 90 year old father was just told he is likely in our little club here, and at his age it's unlikely they'll do much more than ADT to just stop the growth. At your dads age it's still treatable and ADT is a good first step.

Did you discussed Pluvicto with the doctors,? I suspect you did, and it also was too much for him. If not at least ask the doctors, it treats the whole body and works quite well for some people.

You are correct doing a biopsy makes little sense since it wouldn’t change the treatment. Ask the doctor what benefit it would have considering how advanced the case.

Hormone therapy will probably make him weaker. He needs to exercise. That is the only way to get around the fatigue from hormone therapy. Going to the gym, a couple of times a week for an hour and walking every day would help with the fatigue. I am 77 and do more than that.

Is it possible for him to do something to improve his health so he can handle these treatments?

Better than hormone therapy, it would make sense for him to look into the patch study. The patch trial Completed in England recently and showed that estradiol worked just the same as ADT, but had many fewer side effects. It easy easier on your cardiovascular system, On your bones (osteoporosis), causes fewer hot flashes and less brain fog. If your doctor has not heard of the patch trial, there is a lot of information about it so come back and we can help you.

Even with his case there is hope that the existing drugs work, they usually do. If ADT alone doesn’t work Darolutamide has the least side effects of the next level drugs, I’ve been using it for 1.5 years and it’s kept me undetectable after 15 years with PC. You can ask your doctor about it when the time comes.

timber, I'm thinking he could have a PSMA/PET and skip the biopsy. What was the contrast in the CT?
Immunotherapy might be available for you dad. https://www.cancerresearch.org/cancer-types/prostate-cancer
https://www.cancerresearch.org/blog/june-2016/difference-cancer-immunotherapy-and-chemotherapy
Glad you are with him.
Biopsy could make a difference in treatment options. At first glance I'd be thinking they'd remove the prostate gland. But if it is only a small tumor in the prostate, it might be possible to use radiation. I'd wish he have the biopsy more for the genetic testing of the tumor's mutations, that for the gleason score. Still, I admire his spirit.
Better answers will follow, but I did want to wish you and your dad well.

You can also biopsy one of the metastases rather than the prostate itself -- that's what they did for me (the lesion was on my spine, and they didn't know the origin). There's no need to determine a Gleason score when it's already metastasised, since it's an 8 or 9 pretty-much by definition, and a needle biopsy elsewhere -- if one of the tumours is large enough and accessible -- can confirm prostatic origin without the extra risks and discomfort associated with a prostate biopsy.

@timber2002 Sorry about your Dad. It is scary stuff but good for you for coming here and looking for answers.

If it were me, I would take @gently suggestions to get a clearer picture of internals with a PSMA/Pet Scan. If your Dad chooses radiation, come back here to talk about the type of radiation machine as some have real time, built in MRI and some don't, so side effects and quality of life can be more, or less, depending on that choice.

It also would not hurt to have a telehealth opinion from a center of excellence like Mayo. Doctors are dedicated but not infallible.

Thank you for your response. They seem pretty certain it’s prostate cancer. Both the urologist and oncologist have stated it’s prostate cancer. In his medical chart, they have listed: adenocarcinoma prostate, cancer metastatic to bone, and cancer metastatic to retroperitoneal LN.

Thank you for your response.I have not heard of Pluvicto and his oncologist did not mention it to us. It’s been a whirlwind the last few weeks and I’m learning more about prostate cancer and treatments every day. I will definitely ask the doctor about it when we meet again at the end of May (and also the patch study). His doctor did bring up the importance of exercise and that he needs to be more active. He has been walking with his walker every day and seems to be gaining some strength back. He went downhill fast from January to April to where he could barely walk because of the pain he was in. He went to his PCP doctor in February. They did a chest x-ray, but they didn’t see anything on it. Diagnosed him with Gerd. They have him on pain meds that are helping considerably so we hope he will gain back some strength.

Thank you for your information and well wishes for my dad. It just says they did the CT scan with intravenous contrast. I don’t know anything more beyond that. The immunotherapy sounds like a great treatment option. The oncologist said that hormonal therapy was the best option for him at this point. maybe if he regains some strength and his general health improves other options would be on the table. I’m sure we’ll find out more moving forward. Thanks again.

That’s great information, thank you. I had no idea they could biopsy an area that’s metastasized. That makes sense that the Gleason score would be so high if it’s already metastasized. I’m on board with my dad‘s decision to not do a prostate biopsy especially if it won’t make a difference in how they treat it. Maybe it would for some patients but not all.

Thank you! The oncologist did mention that they might want to do targeted radiation on his spine to help alleviate pain down the road. I will come back and ask more questions about that before he does that. Quality of life is our main focus. Thank you.