@heal623 , I am sorry your father has received this unwanted news. The first recommendation I have is for you both to stay as positive as possible and remain patient. Educate yourself as much as possible . The Prostate Cancer Foundation (pcf.org) has a very good free patient guide (available in print or as a download) and suspect other organizations do as well.

Starting out with metastatic cancer and a PSA of 38 is indeed scary but is not necessarily life threatening at this time. About four years ago (January 2019),when i was 72, I started with a PSA of 197. By the time I saw a urologist it was 541. Treatment progression was bicalutimide followed by Eligard (Lupron) injections every six months. 44 external beam radiation treatments, nzoleddronic acid injections every three months, enzalutimide for a year (PSA came down reasonably well then started back up). Started radium223 for five treatments. Then five docetaxel treatments. PSA came down to 27 at the end of July 2022. We felt good. Then it started back up. Tried enzalutimide hut I did not tolerate it well this go-arounf. Last PSA check on 10/19/2022 was 1011. We just gompleted a round of scans (bone, CT and MRI). I get the results at 9 am today and we will develop a new treatment plan for the future.

Why so much detail? I think it is important to remember that while we all have prostate cancer, we all have our own prostate cancer. Each case is unique and needs to be treated according. Please do your research so you can ask good questions and you can understand what is being proped. Don't be afraid to question and seek clarifications. Don't be afraid to seek a second opinion. Be sure you are comfortable with you team (PCP, urologist, oncology, radiation oncologist) and know who is the principle play called and who is the quarterback. You are an integral member of the team. Ideally you are the quarterback.

This a long journey you are starting, stay positive, stay patient, educate yourself. Continue to do things that bring enjoyment and are fulfilling. Go to your coffee club, work on your craft projects, travel if you enjoy it, rely on friends and family. I find prayer to be very powerful

Goof luck on this journey. You have NOT, in my opinion, received an immediate death sentence. There can be many beautiful years ahead. Take care of yourself as a caregiver and take care of your father the patient.

I hope this is of some help.

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