difference between young and old patients in the fight against cancer

@copyman Yes, prostate cancer that hits in your 40s or 50s, like the original poster's, is more likely to be aggressive and fast-moving, and many cases are already advanced on first diagnosis.

In my case, I was diagnosed with de-novo stage 4 oligometastatic prostate cancer in 2021 at age 56. There is no research yet demonstrating that it's safe for me to go off ADT with metastatic prostate cancer (exactly the opposite so far), but the LIBERTAS trial currently underway is testing whether, with the advent of second-generation ARSIs (the -lutamides), it might be possible for exceptional responders with mCSPC to drop the ADT and continue with just Apalutamide. Preliminary results should be due out in a few months.

I'll be watching closely, but when my current regime of Orgovyx+Apalutamide is keeping my PSA undetectable and produces no intolerable side-effects, the stakes are very high for making a change. It's like a cliff-hanger in old movies or TV shows, with the car balanced half over the edge of a cliff: do I really want to try shifting around?

@graybeard46
Have you even considered getting an implant so you can get an erection?

They have an almost 90% satisfaction rate.

You and your wife could both benefit

I’m 78 had an AUS installed less than a month ago. I’ll be 79 this year. The implant is just as easy to install, though you do have to be put under and it’s surgery.

I am so sorry to hear that you are struggling with dark thoughts : ((( but they are understandable. It is tremendously hard to deal with cancer diagnosis, no matter the age or type of cancer - the suffering is the same. The suffering is the same for old person as it it is for a young one. As you can read in previous post man in his almost eighties is in anguish over ED. However there are man who just do not dwell on that part at all. For them physical changes cause trauma (shrinking of testicles or other changes in appearance), for others it is onset of diabetes, for some man it is muscle weakening - and NONE are the worse or better than the other. Suffering is a suffering, it is very important for all of us to know that.

Now, after we acknowledge that it is normal feeling we have to also acknowledge that life is beautiful and worth fighting for no matter what and that there are many ways to combat those dark thoughts. Different methods work for different people and you have to slowly find what works for you - it could be counseling, anti depressive medications, meditation, prayer, exercise or ALL of the above combined !

Since you major complaint is muscle pain and weakening I have to ask you - do you exercise every day ? Do you do weight training and aerobic exercise ? Do you eat enough of protein ( you need at least 100 g a day) and do you take supplements ?

PS: just as a biological fact side-note - cell division rates naturally begin to slow down significantly around middle age (between ages 40 and 60), so yes, you are young for PC but not so young biologically speaking ; ) and also, aggressive cancer divides the same speed at ANY age, no difference there : (((

PPS: HUGSSSSSSS !!!! No giving up !!!! 💗 Tomorrow there might be a new drug or treatment announced that eradicates PC , or one that has zero side effects !!! You can do this ! You are successfully doing it for 2 years !!!

@jeffmarc I definitely looked into implants but since the few times I had a medium erection for sex I have no feeling or sensation . My doctor agrees an implant won’t bring me any satisfaction if I can’t feel anything, my nerves must have been damaged more than my surgeon admitted to . I would give anything for an implant to work but the surgery isn’t worth being further discouraged.

Lots of good advice here, so I won’t repeat what others have said. I will only add that there is no shame in seeking counseling or taking antidepressants. I went through a difficult patch, unrelated to cancer, in my late 40s and was helped tremendously by therapy and antidepressants, and was eventually able to manage comfortably without them. When the cancer appeared 20 years later, I had the tools to help me deal with the emotional trauma I experienced. That said, I nevertheless needed the help of counseling as the side effects of ADT took their toll. I think I spent the first two or three sessions just crying as we talked. My wife has been incredibly loving and supportive, but with the therapist I could just be and feel without worrying about her pain. Having that outlet also relieved some of the burden from my wife. It was good for both of us.
I’ve also been a long-time practitioner of yoga and meditation. Both can help with perspective, flexibility, and pain management. Given your physical limitations, you might want to try a gentle or chair yoga class. You’ll probably be the youngest one there, but in my experience, you’ll find a warm and nonjudgmental community.
Is life perfect? Do I not get depressed and angry? No, but these approaches help me keep things in perspective.

Thanks everyone, guys, for yours advice and support!

I stood up and took control.

I'm really looking forward to the results of LIBERTAS

With great respect to everyone who wrote in this thread, Denis.

1. Advice/recommendations for older people (over 70 and up) won't always work for us, young.
2) Age is one factor in cancer control strategy that must be taken into account. Now the main question is: what other advantages do we, young people, have, and what can we use before we die

Well, I beg to disagree

I was diagnosed at age 57, high risk, one daughter in high school, another starting college, eight years until "65" and "retirement, though I finally retired at 70.". Treatment choices were binary, surgery, brachytherapy. I chose surgery, maybe I'm an outlier, no incontinence, erectile function returned and within a month I was travelling, exercising...

Alas, it was not a cure, 12+ years later, SRT, Triplet Therapy and Doublet Therapy.

Yet here I am.

A lot of living has gone on in those 12+ years, vacations, graduations, anniversaries, birthdays...more to come

How have I "managed my PCa at 57 versus 70...? Not any differently.

I control the things I can:

Diet
Exercise
Managing stress

I choose my medical team well, it's a privilege to be on my medical team, not a right.

I also have rules for myself and my medical team...

Once I make an informed decision and carried it out, I never look back. Well, that is not entirely true, I look for lessons learned from that decision. The path is always forward: I continue to learn about PCa and always look ahead. What counts is today and what lies in the future.

Yesterday is gone, so forget it, well, learn from it.

I educate myself as completely as possible and took the time I needed, I always know that no matter the outcome of a particular choice, I made the best possible decision. That knowledge that I have thought my decisions through carefully is what is really important—and may be more important than the decision itself.

I am in charge. Not my doctor. They need to be consulted and their opinions and ideas should carry weight as I make my decisions. But I never forget: it is my life, my today, and my future. I have made the best possible, fully educated decisions that makes sense for me, with the focus on long life.

Don’t Walk In Cold to an Appointment. To make sure I do the best thing for my individual prostate cancer, I need to educate myself.

Knowledge will empower my BS detector. When several urologists told me ADT monotherapy is what I needed and did not want to talk about imagining and combining other therapies such as radiation and chemotherapy, I didn’t just have to accept their advice on faith.

I walk in the door ready to start the conversation at a different level. I don’t have to spend time talking about the basics, things like Gleason grade and clinical stage and what they mean. I already know. I can have an intelligent discussion about the merits of a particularly treatment for my cancer, my likelihood of being cured, and risk of side effects.

I won’t blindly accept the opinion of a non-specialist – I know that my cancer requires a team approach.

Rules for my Medical Team

Know your stuff. As part of my medical team, you must have a thorough knowledge of my cancer and of the latest developments in research, and be ready to formulate a plan of attack. If what I ask about based on my research is not familiar with you, then admit it, say you will look into it and discuss on my next consult. Better yet, you will call me!

Do your homework. I expect you to have reviewed my medical records prior to my appointment, talked with other doctors I have seen that day.... You’ve looked at my x-rays; you have my pathology report, labs. I can tell when you're looking at my clinical data from tests for the first time !

Respect my point of view. Listen to all sides thoughtfully before reaching a conclusion. With patience and finesse, I’m sure you can help me to feel confident about the plan you and I have shaped for me.

Don’t close your mind to new hypotheses and don’t ignore clues that might lead you toward the best results. Rid yourself of the temptation to make your day easier by delivering perfunctory care.

When it’s decision time, please decide! Care for me with a dogged determination to get me healthy

Follow up on promises and follow through on tasks. I can tell you with absolute certainty that there is no greater disappointment than realizing that you cannot rely on your doctor.

Please talk to me. I need your advice, comfort, and expertise; I am scared and discouraged—are you willing to take a seat, look me in the face, and answer my questions?

And yes, the front desk is key, sets the tone, pleasant, efficient on check in and scheduling on the way out...a kind word, smile...and don't call me "honey." You have my records, I am ok with you calling me by my first name or Mr.___

Yes, I am fortunate, of these 12 years, three have been on treatment, the rest off. While on treatment, was life any different? Yes, I experience the side effects, fatigue, muscle and joint stiffness, genitalia shrinkage, weight gain...But, didn't change my life, only how I felt doing it. I went skiing with friends in Colorado, did the Bataan Memorial March with my sister, travelled the Ring Road in Iceland with my wife, attended my daughter's college graduation, went to a Willie Nelson concert with my wife...I continued working, often travelling, my colleagues knew when I was on treatment and had no issues with my work,

My original treatment decision was curative, since then, treatment decision have been about managing my PCa, knowing a cure is no longer possible. I make my decision in concert with my medical team. We have decision criteria in doing so, we treat for defined periods using hybrid decisions that combine the guidelines from NCCN, AUA, with results emerging from clinical trials into mainstream clinical practice and my clinical data. We have decision criteria for de-intensification.

So, from my perspective, the underlying concepts and principles behind managing one's PCa at younger versus older may not be different. The mind is a powerful X factor in this. Yeah, when I got the call, it floored me, I had my pity party, then picked myself up off the floor and set about he business of living.

Kevin

@kujhawk1978 Great post, Kevin, as always…Best,
Phil

Thanks for all the hugs , today was one of those dark days with my wife flipping out over a very small issue but acted like I did something horrible, I don’t need that when I wake up down

First I’m so sorry about what you are going through, I have questions, have you talked with your oncologist? Have you had a second opinion with another oncologist? Have you tried different meds? Most of the time is medication available for side effects, all the cancer center have support groups, pickup the phone as soon as possible and call your oncologist team and say you need help, you know do you are only 49 it’s 100’s of medical trials going on right now if you need to change oncologist do it, what ever it takes but NEVER GIVE UP God loves remember that ( even if you are not a believer) Now go make that call my friend