It is very likely that ADT alone will bring your PSA down to very low levels and adding an ARSI at this point may not be essential, yet. ADT It is pretty hard on the body and at 83. The doctor is thinking about that.

The thing is though, your father’s situation is what would normally call for triplet therapy. ADT plus an ARSI plus chemotherapy. What has your doctor discussed doing?

One alternative would be to use Pluvicto to try and eliminate the cancer in the whole body. The problem is, it has only very successful in about 1/3 of the patients.

You might talk to the doctor about using Darolutamide as the ARSI. It has the least side effects of all of the ARSI drugs, so it may work well if the doctor is concerned about side effects due to age. If your father has any heart issues, you do not want to go on Zytiga. I never had high blood pressure and Zytiga gave it to me, and many other people using it.

Both chemo and Pluvicto can be hard on the body, But they do give the best chance of eliminating most of the metastasis from his body. The thing is ADT can really cause a lot of fatigue for some people and then going on chemo or Pluvicto Ccn greatly increase that fatigue. As long as your father stays active and exercises fatigue May not be a major issue. I’m 77 and was on ADT for eight years, Had very few problems with fatigue.

Instead of ADT, you want to talk to the doctor about Estradiol patches instead of ADT. They work just as well as ADT as the patch study showed, but have many fewer side effects. Much better for the cardiovascular system fewer hot flashes, less brain fog, and less deterioration of your bones. Estradiol comes in patches as well as in a gel and other forms.