Dad dx with metastatic prostate cancer

Posted by timber2002 @timber2002, Apr 29 2:58pm

Hi all,
Sadly, my 78 year old dad went into the ER about three weeks ago with back and chest pain. CT scan revealed metastasized cancer on his ribs, sternum and spine PSA drawn in the ER was 160. Ferritin was >1800 but he is also mildly anemic. A few days later, they did a CT scan of his lower abdominal area and found a nodule on his prostate, mets to his hipbones and lots of lymph node involvement. He also has infiltration to the psoas muscle. He has had appointments with urologist and oncologist. Urologist wants to do a biopsy of his prostate, however, my dad does not want to do that. Are there any compelling reasons why he should have it done? He says he doesn’t see how doing that procedure will impact the outcome. Will it? Oncologist says chemo is not an option because of his weakened condition. He has started on hormone therapy.

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northoftheborder | @northoftheborder | Apr 30 12:29pm

In reply to @timber2002 "That’s great information, thank you. I had no idea they could biopsy an area that’s metastasized...." + (show)

A very-general rule of thumb some (not all) oncologists use is to avoid aggressive cancer interventions unless the patient would otherwise expect at least 10 years of reasonable-quality life. If your dad had outstanding health before the cancer, and had had a reasonable hope of living to 88 or beyond, then major interventions might make sense; if he already had serious comorbidities (like heart or kidney problems) that made that less likely, then aggressive interventions might just take away some of the good remaining years with the people he loves.

The alternative to aggressive treatments, so-called "palliative" care, just means lower doses and gentler treatments aimed at keeping him comfortable, but still slowing down the disease's progression where it's possible without tough side-effects.

It's not easy talking about this kind of thing, but it sounds like your dad knows what he's doing, and it's good you're supporting his decision. ❤️

gently | @gently | Apr 30 3:16pm

In reply to @timber2002 "Thank you for your information and well wishes for my dad. It just says they did..." + (show)

timber, there is a newer contrast agent pylarify https://www.pylarify.com/
It might be that you want to listen to the urologist and basically not treat the cancer. And that may be what your dad prefers (at this point). Quality of life is very important. And these decisions are quite personal.
With hormone treatment, it is considered that treatment has begun and it gives you time to get other opinions, which I think you need.
I can't think that it is of any advantage to wait to radiate the bones until the bones crumble before having radiation.
Your dad could have hormone resistant cancer. So, he could suffer all the effects of ADT (not our best quality of life control) without any advantage.
This diagnosis is usually unnerving. Your dad's initial response may turn into something more receptive. And , of course, it is his choice. If he saw the spectrum, he might not choose to treat with hormone alone.
You might gather his records and send them for a second opinion and ask for a referral to a radiation oncologist and a surgical oncologist.
When cancer invades the bones you end up with fractures. They are painful and will obviate any thoughts of "quality of life." The quality concept should include treatment because untreated cancer is not a good, or fast way to die.
Bless your struggle.