Is treatment for 88-year old Dad too aggressive for his age?

My opinion is : I only take one Arbiterone with prednisone 5mg. With a low fat breakfast. This works for me. PSA < .01 for 25 months. Already had RT. Surprised their waiting so long to start RT. My cancer was in my pelvic lymph nodes, not the bone or spine. I m not 88, so my advise may not apply to an 88 year old dad. I M 76. Gleason score was 9 too with 13 biopsies way back on Feb. 2nd 2022

The problem is, he has pretty serious cancer, which could cause problems soon. Abiraterone may not be the best Drug for him. It will increase his side effects, Probably cause a little more fatigue, and will probably give him high blood pressure. I started taking abiraterone at 75, Never had high blood pressure, but I’m on three different medication’s now because of abiraterone.

Orgovyx Can definitely cause fatigue, it is one of the side effects that a lot of people have.

I am not a doctor but for years have Participate in weekly 2 hour. advanced prostate cancer user groups, And many of the people, including me, are on Nubeqa (Darolutamide) Because it is very effective and has very few side effects. If your father was younger Then abiraterone Would be a good place to start, But at his age Nubeqa Could work very well. Ask his doctor what he thinks.

Ecurb mentioned only taking one pill instead of four, which most people take. You may have misunderstood how abiraterone is taken. You take four 250 mg pills once a day on a stomach that has been empty for two hours. Taking one pill will have no impact at all on how you feel after taking the drug, It requires a special diet and gives you the same amount of drug In your system that you would get if you took four pills without that diet.

There are many different types of radiation treatments, and at his age it should do a lot of good. For someone who is oligometastatic you can easily have SBRT Radiation to get rid of metastasis and IMRT Or SBRT To treat the Prostate. Ask your doctors about that. I suspect they want to treat the prostate bed with IMRT. If they do SBRT On the prostate, they can Do fewer IMRT sessions.

I think you should consider getting a second opinion. Is there a Center of excellence available near you?

You should make sure you are working with a Genito urinary oncologist. They specialize in prostate cancer, unlike medical oncologist, who work with all different types of cancers, and can’t spend as much time finding out the latest treatments for prostate cancer.

Hey lafc, I just finished IMRT (5weeks, 5X/day) at Sloan in Commack. My RO was Dr Andrew Barsky. I had salvage radiation, which is treatment due to failure of previous prostate removal so my situation is different from your dad’s.
However, I did question Dr Barsky about my radiation target and he said the Sloan protocol is to treat the prostate and pelvic lymph nodes as well; it is a source of confusion since a lot of RO’s don’t go into any great detail about their treatment protocol.
As jeffmarc pointed out, really get into the nitty gritty about combined radiation therapies - SBRT (cyberknife 5 tx) with IMRT (prostate/pelvic nodes) to possibly cut down on treatment time - IF it’s possible in Dad’s case.
I can’t speak to the advanced ADT regimen - since I was only on Orgovyx for 6 mos- but some of these can take care of the pelvic bone metastasis as well.
As you correctly point out, your father is at an advanced age, and not to sound like an actuary but at 88 yrs old something is going to get him sooner rather than later. IMO, Quality of life should be at the top of the list at his age; aggressive treatments should be for much younger men who can withstand it so maybe one day they will REACH 88, not for someone who already did. I know that’s a loaded statement and the counter argument would be that with aggressive treatment he could live to be 100….but in what condition?
But the word aggressive is relative, after all, so it is really something to discuss with your DRS and your Dad. My father, age 74 was suffering from Stage 4 mesothelioma - totally incurable. One doctor wanted to put him through a new experimental form of chemo because in his words “your father is a strong specimen”.
When I heard that cold blooded statement, I advised my father to just enjoy what time he had left as best he could and not seek further treatment. He hugged me because I told him what he already knew was the right answer.
Best of luck with whatever decision you and Dad make!
Phil

I am happy that your treatment is working!

The one a day Abiraterone with low fat breakfast is interesting! We will look into this..

I am also surprised they are waiting so long for the radiation - we were told it takes time for the hormone therapy to "desensitize" the cancer cells, and get them ready for radiation. I will ask this question on Tuesday. Did they radiate your lymph nodes?

Hello, I am sorry to hear that the abiraterone was problematic for you! This is why I started this post.

You mention Nubeqa (Darolutamide). My concern is that it increases the risk of having a seizure, and my father had a minor seizure a few years back. He is on meds for this. Perhaps this is why the Sloan dr did not recommend it. We will check with him on this.

With regard to less abiraterone coupled with a special diet, this is definitely something to look into!

I will bring up your radiation suggestions at the Sloan appt on Tuesday. The first opinion was IMRT just to the prostate - not the lymphnodes or bone mets which surprised me.

RE: 2nd opinion: Sloan is our second opinion. I am assuming Sloan is a "center of excellence".
Yes, we are working with a Genitourinary oncologist at Sloan. He is certainly up on the latest research....since dad is in stage 4, I wouldn't have it any other way.

Hi Phil, yes we will get into the details re: the radiation as you suggested - at our appt with Sloan on Tuesday. You mentioned the Sloan protocol of radiating the lymphnodes - our 1st opinion was just to radiate the prostate which surprised me.

Your story about your dad was touching. He was probably relieved to have some quality of life rather than going down the rabbit hole of experimental treatment.

These decisions for those that we love are very difficult - as you said, it is a delicate balance between quality of life, and treating these diseases! We just want the best for them. I know that dad is advanced in age, and we will try to make the right decisions so that he is treated, but also keep his quality of life that he so enjoys!

Yes they radiated the lymph nodes too as well as the involved seminal vesicles. Their was a time gap between RT and ADT. I d have to research the archives. Forgot how long between therapy’s. One more thing….after the radiation a couple months later I felt something fall off the wall down there. Sounds stupid, but it had to have been the cancer growth becoming necrotic= absorbed by phagocytosis: the body taking care of dead cells from cancer. All this info is just my opinion. It’s not the documented analogy you find in doctors notes.

I understand what heavyphil is saying. I am sure he also knows that no two 88 years old are same metabolically. I am 89. I got a complete blood test from Function Health. It says my biological age is 74! I take it with a grain of salt.
No one knows how long I am going to stay healthy and live.

To ava11. I took a test too. I'm 84 and the result said I was biologically 73, so you're right. That gap, however, could narrow quickly as I age. Who knows.

Things to consider

Zytiga can also cause seizures.

Zytiga wasn’t just problematic for me, I have heard from many people that have experienced problems with their blood pressure when taking Zytiga.

The most common problem with Zytiga is fatigue. With some people it is really bad. It can be reduced by taking 10mg of prednisone rather than 5mg. Some doctors prescribe 10mg and others 5mg at the beginning , both are considered standard of care.