Connect
Newly diagnosed stage 4, how long on ADT before adding ARSI?
My dad (83 and otherwise relatively healthy) was recently diagnosed with stage 4 prostate cancer that's spread to his bladder, urethrae, possibly rectum, pelvic lymph nodes, thoracic lymph nodes, pelvis (bone), and spine. PSA is 24 (up from 4 a year ago), 12/12 cores, and gleason score 9.
We had our first meeting with the oncologist today who is starting him on Orgovyx but no ARSIs. I was expecting the combination to start immediately given his stage and what I've previously read. He referenced adjusting to the ADT and potential side effects as reasons to delay, but also didn't provide a timeline for adding in an ARSI. We have our next appointment in 2 weeks so I'm trying to gather information on the initial ramp up of treatments as perhaps this is common practice? I've definitely read cases of people starting both at the same time and is stated as such by the prostate cancer research institute which has me confused. Just looking for people's initial experiences being prescribed ADT and ARSI combos so I can be prepared for our next appointment.
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
I've heard elsewhere that one rule of thumb for aggressive treatment is to recommend it only if the patient otherwise would have an expectation of at least 10 years of good-quality life without the cancer.
Obviously, individual patients might choose differently (for example, an extra 2 years might be worth chemo for some patients), but since the majority of 83 year olds don't expect another 10 good years, there's a good chance that's where the doctor is defaulting to.
There's been a lot of push-back against over-treatment of advanced cancer in the elderly in recent years, so doctors might be a little more hestitant, but if your dad wants aggressive treatment and makes it clear to them that he wants that, then he should be able to get it somewhere.
Again, best of luck. Unfortunately, we have to be our own advocates — I must have asked for everything I wanted at least 5× (stubbornly but politely).
I am also stage 4 (spread to 3 lymph nodes) and Gleason 9, currently on Eligard every 3 months. Just started proton radiation and wondered if/what side effects you had. I have the expected fatigue but also dealing with nausea which was not a side effect I expected. Anyone else have nausea from radiation treatments?