Should 80yr old have aggressive treatment for metasisized cancer?

My father died at 88 Of prostate cancer. I remember when he told me Lupron stopped working, That was the only drug available at the time. He had his teeth ground down and crowned without Novacaine, And came home and had dinner with us when I was a teenager, He had that much pain tolerance. The last few weeks before he died, he was on so much morphine he couldn’t communicate. The pain was so severe..

You can decide not to have treatment, It may be worse than treatment.

I’m 78 (79 this year) and I’ve been on ADT for eight years. Had a lot of hot flashes in the beginning don’t have many now. I never had fatigue from it. It doesn’t affect everybody..

I know a lot of people in their 80s that are just on Nubeqa Alone. It is keeping some people with very severe prostate cancer cases from having it progress. It has very few side effects, For most people, it has none. In my case after 16 years of prostate cancer and 4 reoccurrences Nubeqa Has kept me undetectable for the last 31 months. I have BRCA2, which makes it very aggressive. I am on Orgovyx and Nubeqa Since I don’t have problems with day-to-day life being on ADT.

Getting radiation treatment in your 80s can stop the cancer, and then stay on the drug to keep it under control. Do you have major health problems that would make you not have another 10 or 15 years? Radiation treatment isn’t too problematic, For most people, it just causes some urinary issues for a short time. I had around 40 sessions of radiation after my prostatectomy and didn’t notice it at all no side effects.

Just some things to think about and to discuss with your doctor.

It is your decision how aggressively or even if you want to treat the prostate cancer but do not assume that no treatment will give you the best quality of life until you die. There is a middle ground between aggressive and no treatment. Prostate cancer tends to metastasize to bones and that will be very painful. Stage 4 untreated about 1/3 die within 30 months and another 1/3 within 5 years. Best quality of life may be to take Nubeqa as long as it works and get some SBRT radiation if there are a few spots on your bones to keep pain free and mobile (spine seems to be a place it shows up) as long as possible. Except for the radiation and current drugs being better this is what doctors use to do a few years ago for palliative care since stage 4 prostate cancer had no good treatments.

The aggressive systemic treatments for prostate cancer include a couple rounds of chemo, Xifogo if only in bone, and Pluvicto. Could also include ADT in addition to the ARSI (Nubeqa) and a lot more radiation. These all tend to have more side effects.

My two cents: Agree with the previous comments. Orgovyx + Nubeqa can check the cancer with minimal side effects, if any. With a Medicare drug plan with $0 premium, after paying $2000 the meds are free for the rest of the year….so there is little to lose.

If you are prescribed Orgovyx, if you don't want to continue to tolerate whatever side effects it gives you, you can stop. Its a daily pill as opposed to an injection that lasts a much longer time.

Just got a metastasis on my spine zapped a few weeks back. Prior to that, it was becoming increasingly painful. Not to the point of being debilitating yet, but certainly to the point of not letting me sleep. I couldn't imagine having to live with the ever-increasing pain that skipping treatment would have caused. As Jeff said and I can attest, metastatic prostate cancer to the bone hurts. I would strongly suggest you avoid it if you could.

@mjp0512 palliative care would include pain management. .

The cancer has metasisized to the bone already. Decisions to be made. The only one we have made is no adt hormone therapy.

I am an 83 yo in excellent health with gleason 8. PSMA shows spread to seminal vesticle and pelvic lymph node. It has been recomended that I start 6 weeks of radiation and 2 years of ADT. Like meem65 I am cosidering not to treat.

@meem65 - Palliative care is not limited to pain management. SBRT to accessible bone metastases and IMRT to prostate can be considered palliative as well (at least that's what it says on my treatment summaries).

I understand your reluctance to go on ADT and that certainly is a personal decision. I would suggest a discussion with your doctor regarding an ARSI, such as Nubeqa, that may slow progression down with very low incidence of side effects. If you click on my name, it will take you to my profile so you can see if we are similar in diagnosis.

I'm not about to tell you what to do but I'm 63 and just finished 5 rounds of SBRT radiation on the marrow of my humerus bone in my right arm that had an SUV of 28. The pain is already subsiding some. I can't imagine it being all over well I can to some degree as I also have 14 screws and hardware in my spine with failed lumbar fusion and need more spine work. As far as side effects from the radiation I had some slight discoloration on the skin after one round and only mild fatigue no other side effects. As of right now my RO is pushing me to stay off ADT.

Anyway if they told me at that age that it would help with the pain I believe I would go through with it. I was with my Dad 24/7 the last week of his life with stage 4 pancreatic cancer. Myself and my SIL gave him his oral morphine and it helped some but not much and one year before at age 83 he was the strongest man over 80 I ever knew. I hope if I ever get to that point someone will just accidently give me too much. I know someone that is 46 yo and it looks like he is nearing the end with colorectal cancer. The plan right now is to start radiation to help him with the pain as it's in multiple bones now. He's been in several trials but nothing has worked sadly he has the type colorectal cancer that only about 2-3% get.