New diagnosis at 50

MT - Very similar to my case . My father was diagnosed at 62 , and passed away when he was 67 . This was 28 years ago now. He went on ADT right away but it only helped for about a year or so . There was no other ADT drugs at the time... now many ADT drugs , some to over-lap , many modes of treatment . I had operation and then about 3 years later EBRT of 22 session at PSA of 0.14 ...this brought me down to 0.066 now . EBRT was 2.5 years ago . I see Jeff Michi participated in blog to you - wonderful source of information and research . A nice fellow as well ! Dont forget AS is a treatment plan , and monitoring plan . I was never on it had Gleason 3+4 from the get go ! I like you have problems with anxiety and stress, as I was the only caregiver for my father and spent hours and hours in the palliative care award during his difficult times. I miss my dad so much. He was a very smart man and an engineer, a chemical engineer, but didn't seem to get along with Dr as well and didn't trust the whole process. Prior to an overseas trip with my mother 28 years ago, he did get a PSA test and that's what gave him his diagnosis. I can't remember what his PSA was, but he was 62 at the time and just thinking about retirement. He left it too long for sure. You on the other hand are very proactive and this disease will not get away from you. I can tell. You have this, just be proactive and educate yourself on all the possible therapies. Have at least 2 to 3 doctors to consult with to bounce opinions off of. I will pray for you Sir . James on Vancouver Island .

@vancouverislandhiker Yes, it's so different now. When I was diagnosed with stage 4 oligometastatic PCa at age 56 back in 2021, they told me to expect basically what your unfortunate dad experienced, probably based on old SEER data.

But fortunately, they still put me on the new treatment modalities (which apparently only three Canadian cancer centres were using regularly back in 2021, all in Ontario, though they're more common now).

Over four years later, I've experienced no progression at all. Nada. We're watching one spot from the last MRI, but it's probably benign, related to my spinal surgery and fusion at that location. PSA remains < 0.01.

Not everyone will be as lucky — and my own story could change suddenly any day — but it's a whole new world out there for those of us with advanced prostate cancer in 2025.

@northoftheborder North , Geee thats luck ! You have done great ! What sort of ADT are you on? I hear it makes a difference ?, I have never been on those things . I hear some ADT is bothersome . But your Bang-On on the change of Landscape now. 25-28 years ago when my dad pass away , I was there . Not a nice way to go . Thye were using "Cobalt" on him in the end . Poor guy . Now we have all sorts of modalities and pills to try and some are very effective ! Just think in another 5-6 years ...there are some very good drugs in the pipeline ! Talk soon North ! James on Vancouver Island

@vancouverislandhiker I started on Firmagon, and am currently on Orgovyx, which wasn't yet available in Canada in 2021. They're both GnRH antagonists, so effectively the same thing, but I find the acute side-effects much lessened with a daily pill over a monthly injection (the chronic side-effects of testosterone deprivation are the same, of course).

I'm also on Erleada (Apalutamide), a second-generation ARSI. It used to be that they'd start you on just ADT and then introduce an ARSI only when that failed, but the big realisation (after TITAN, STAMPEDE, and other large trials) is that the outcomes are far better if you start both at the same time while the cancer is still castrate-sensitive. That's certainly been the case for me. I've remained castrate sensitive for over 4 years, while the expectation before was only 18-24 months.

Another change from the past is that they'll now radiate the prostate (and any metastases) with curative intent for oligometastatic prostate cancer. With stage 4, they used to think "why bother, he's dying anyway, just keep him comfortable" but it also turns that it makes huge difference acting as if you can cure oligometastatic prostate cancer, even if the jury's still out on whether it's possible.

Finally, I had that emergency debulking surgery to preserve my mobility. Normally they wouldn't do that, especially near the spine, since it was very high-risk surgery, but it was either that or life paralysed in a hospital bed. Since I didn't die on the operating table, I ended up with a significant reduction in tumour load before the post-op radiation, and that has probably also helped. I wouldn't recommend running that risk, though, unless it was a forced play like it was for me.

If I'd been diagnosed a couple of years earlier, or if I'd lived in a different city (or even had a different radiation oncologist), I might have just been treated palliatively, like they used to do for all stage-4 prostate cancer, and I'd could have been either very sick or deceased by now. My cancer centre, as I mentioned, was one of the few in Canada recognising "oligometasatic" as a separate category and treating it aggressively back in 2021, just like at Mayo. I'll never buy a lottery ticket, because I think I've already used up my full lifetime quota of luck.

@vancouverislandhiker I started on Firmagon, and am currently on Orgovyx, which wasn't yet available in Canada in 2021. They're both GnRH antagonists, so effectively the same thing, but I find the acute side-effects much lessened with a daily pill over a monthly injection (the chronic side-effects of testosterone deprivation are the same, of course).

I'm also on Erleada (Apalutamide), a second-generation ARSI. It used to be that they'd start you on just ADT and then introduce an ARSI only when that failed, but the big realisation (after TITAN, STAMPEDE, and other large trials) is that the outcomes are far better if you start both at the same time while the cancer is still castrate-sensitive. That's certainly been the case for me. I've remained castrate sensitive for over 4 years, while the expectation before was only 18-24 months.

Another change from the past is that they'll now radiate the prostate (and any metastases) with curative intent for oligometastatic prostate cancer. With stage 4, they used to think "why bother, he's dying anyway, just keep him comfortable" but it also turns that it makes huge difference acting as if you can cure oligometastatic prostate cancer, even if the jury's still out on whether it's possible.

Finally, I had that emergency debulking surgery to preserve my mobility. Normally they wouldn't do that, especially near the spine, since it was very high-risk surgery, but it was either that or life paralysed in a hospital bed. Since I didn't die on the operating table, I ended up with a significant reduction in tumour load before the post-op radiation, and that has probably also helped. I wouldn't recommend running that risk, though, unless it was a forced play like it was for me.

If I'd been diagnosed a couple of years earlier, or if I'd lived in a different city (or even had a different radiation oncologist), I might have just been treated palliatively, like they used to do for all stage-4 prostate cancer, and I'd could have been either very sick or deceased by now. My cancer centre, as I mentioned, was one of the few in Canada recognising "oligometasatic" as a separate category and treating it aggressively back in 2021, just like at Mayo. I'll never buy a lottery ticket, because I think I've already used up my full lifetime quota of luck.

@northoftheborder
An interesting change of medical advice. Rick Davis who runs ancan.org Always told people they should eventually treat the primary. He told people over and over that even though their case seemed to be extreme that they needed to get the primary treated at some point.

Then about two months ago, some new medical advice came out about this issue. Apparently, with people who had very advanced prostate cancer cases there was no benefit to treating the prostate. It had no effect on their survival. It was strange to see him change his tune, But he followed that advice and told people that he believed they should treat it unless the case was quite advanced.

@jeffmarc Thanks for sharing that.

It sounds like Rick Davis has decided to align himself with the STAMPEDE finding published in 2018, showing that there was a significant overall-survival improvement from radiating the primary/prostate for cancer with "low metastatic burden" (aka oligometastatic), but not with "high metastatic burden".

@northoftheborder Yes, you have to wonder how close to the end those patients with high metastatic burden really were.
I mean, people DO still die from PCa today even with all the drugs and treatments medicine has to offer, right?
So treating the primary source of cancer was probably a case of ‘too little, too late’ in those cases…
Phil