My dad's cancer returned and now it’s stage 4 metastatic cancer

Had L2 radiated 1 inch out
Year later in T 6 7 and L1 L1 too close to L2 to radiate
On Xtandi a year then it failed
Now on 4th injection of Xofigio or Radium 223 with Xgeva for calcium plus 600 calcium daily
Still on Zolodex
PSA up from 1,1 to 16,1 over this time

If your Dad has only a single metastatic lesion in his spine he has what is termed oligo metastatic disease (i.e very limited). Current aggressive treatment is SBRT (usually 3 treatments at high dose) to that area with curative intent. Yes, ADT is part of that plan. I believe current standard is triplet therapy to try and eradicate as much micromets as possible with the radiation killing the tumor visible on the PET. If his PSA becomes and stays undetectable, some MO and RO will stop the ADT and follow the PSA. If another met or 2 pops up, rinse and repeat-whack a mole.

Just my experience.

Concern of mine is OS is only a few extra months Radium 223 says 18 months OS Overall survival Do have better info

These ADT type drugs are getting better and better each year . every 4-5 years seems like a new landscape for these drugs. Yes , usually very effective over long term. Ask about 5 months on 5 months off ADT at this point and see what they say . This methodology is getting some great reviews I see in a lot of publications. However, some PC profiles would not fit the treatment profile.

Ok, thanks . Gleason has some more aggressive cells in it at 4 , but 3's are very minor and dont change . Gleason is really subjective though, by viewer. It appears it was caught at the very start start. Ask about 5 on , 5 off ADT . There are many types of ADT , so maybe one will work and you can rotate on/off schedule . Most guys say this is better for them. yes, minor spots are usually pin-point attached through radiation. It should go well for your dad - keep him active and help him stay positive and his mind off PSA's / Prostate Cancer . Keep us informed of his progress please . Great son to help dad like this ! Excellent ! God Bless you all . James - Vancouver Island .

Hi @vancouverislandhiker - my dad is 67. His Gleason score a few years ago was 7 (4+3). I assume it’s same? Or does that change?

His current PSA level is 5.

Yes one spot was determined by pet scan. It was hard to find so missed it first time, but doctors re-reviewed and found it.

I did not include include hormone therapy for the rest of my life in my retirement plans. It, stage 4 advanced prostate cancer arrived shortly after my retirement. I am now 3.5 years into my cancer journey. The first year was horrible. I was a prisoner of the cancer wars going on inside me. Pain, misery, fear were my constant companions. Cancer Treatment waiting rooms were my only trips I made that year. No big vacations like I'd planned in my retirement years.

One day the craziness began. I started walking, aided by my walker, very slowly to a coffee shop and life, a good life returned to me. Soon I started infighting my cancer buddies in the waiting rooms out for coffee. That began the second phase of my cancer journey. Full of friends, walking, trying to eat right, library visits, more fiends, prior to my cancer life Quality of life were just words, Now they become words to live by.

I have friends on it for 20 years I am on for 7 yrs now My advice stay on it

They took me off after 2 years and my cancer metastases to bones

Since your dad’s prostate cancer metastasis is only to bone, have they recommended Xofigo (Radium-223)?
Here is information: https://www.bayer.com/en/news-stories/radium-223-prostate-cancer

Here is a technical description: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5593411/

How long does your doctor say you can be on zolodex . Can you go 6 months on 6 months off ?