93 year old dad: My dad had Prostate... - Advanced Prostate...

Advanced Prostate Cancer
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93 year old dad

My dad had Prostate surgery over 30 years ago..no follow up treatment needed. 2 years ago after having bladder issue from scar tissue his PSA levels increased. They started with monthly injections (I’m not listing meds as I don’t want to be wrong on the name). That helped until maybe 8 months when his levels began to increase again. At that time they put him on Xtandi. That helped for awhile until recently it metastasized into his bones. He’s actually doing really well. Some back pain. They are now putting him on a regimen of Zytiga, Steroids, zoledrinic acid IV, which he hasn’t started yet. I have been doing so much research on my own. I feel a lot of people talk about their “medical team” and all the support they receive. My family and I feel that we are the ones having to figure this all out on our own. We are looking into changing doctors. My dad is 93 years old, very young for his age, and before this he’s never had any problems. He is really dreading having to take this medication and possible side effects. Have any of you heard of or looked into alternative medicine? My dad has an appointment this afternoon with his doctor.

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I would recommend to take part in the Vision trial:

visionclinicaltrial.com/abo...

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It appears from the link that a patient must have already had taxane (e.g., docetaxel) based chemotherapy in order to qualify for the Vision Lu-177 trial. It looks like Francesca's Dad wouldn't qualify.

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You are right, Alan, I overlooked that somehow. However, according to this report, Lu177 works better without Chemo first:

jnm.snmjournals.org/content...

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That was interesting. It seems like our armory against prostate cancer keeps growing.

Alan

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It actually sounds to me like he is getting excellent care and is doing very well. Where is he being treated? He may wish to talk to his doctor about taking Celebrex along with Zometa.

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He is being treated at a local Cancer Center. I’m trying to get as much information as I can prior to this next appointment. I’m hoping he is getting excellent care...just not much conversation with doctors and nurses. I’ve had more questions answered from Specialty pharmacy and my own research.

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Sounds like he's going to the VA. I have the same problem with them. Best of luck for you dad.

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Thank you. He isn’t going to VA. Thankfully he had a much better appointment yesterday. The doctor listened to our concerns.

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Hello Francesca,

On the question of "alternative medicine", it's my view that none of the alternative treatments one sees promoted on the Internet help and some of them hurt. There are some diet and supplement recommendations that have been reviewed by the National Cancer Institute and you can see them at: cancer.gov/about-cancer/tre... They might do some good but they aren't going to stop the progress of the disease, maybe just slow it down a bit.

It sounds like your Dad has done very well to live this long and to have survived his first bout with prostate cancer for all these years. He's also lucky to have a daughter helping him out as you are.

The treatment that he is receiving sounds to me pretty much like the standard of care. I'm not a doctor but, from what I've learned over the years, I'd think that Zytiga is the best next step for holding down the cancer, prednisone will reduce side effects form the Zytiga, and the zoledronic acid should slow the spread of the cancer in the bones and reduce the likelihood of "skeletal events" - e.g., joint pain and bone breaks.

Currently, there is no known cure for metastatic prostate cancer. The best that can be done is to prolong life and to ameliorate symptoms. Some of the treatments that can prolong life may help ameliorate symptoms. Others may have difficult side effects of their own that may make your Dad feel worse and not help much. The Zytiga/prednisone/zoledronic acid protocol offered to your Dad is a pretty good drug combination for trying to get a good balance of life extension and preserved quality of life. Chemotherapy is another approach that can work but can also have rough side effects which, for some men, are too much.

There are experimental therapies that might help. The Lu-177 treatment suggested by GP24 is one, though it looks like your Dad won't qualify for that particular trial. Another possibility is immunotherapy. Provenge sometimes prolongs life for men and has relatively tolerable side effects. Keytruda has been used experimentally (that's the drug that saved Jimmy Carter from his melanoma) and has helped a small percentage of prostate cancer patients. It might be worth talking to someone about it.

I personally think that, at age 93, it makes sense to treat the disease a little differently than at age 63. I think it's a good idea to try more treatments, but maybe shy away from the very rough treatments and not to spend the rest of one's life running around from doctor to doctor, city to city, test to test, and treatment to treatment. There is still life to be enjoyed, memories to write down or record, time to spend with family and friends, and happiness to be experienced. I also think that you can help your Dad by checking out palliative care alternatives. If he reaches a point where he is sick, in pain, and in need of palliative care, does he want to be at home (that's where I think I'd want to be - though I'm not sure since I haven't gotten close to that stage yet), maybe with a palliative care nurse or a relative checking in to help him out from day to day. Or maybe he'll need care from a doctor or nursing home that specializes in pain management. I say that because I know that prostate cancer can cause tremendous pain but some docs and nursing homes are first rate at treating it. It's a good idea to know which are the good ones before you need them. If you call the local hospital social worker she or he may be able to put you in touch with the best palliative services and also give you good advice for how to prepare for the future.

If your Dad decides to get a second opinion, I recommend looking at one of the National Cancer Institute's "Designated Cancer Centers". They are teaching and research hospitals and clinics that keep up on the latest treatments. See: cancer.gov/research/nci-rol...

The last thought that I'll leave with you is that there may not be a lot that you can do from a medical point of view to help your Dad, but you may be able to help in other ways that are also very important - making him feel loved and cherished and as happy as it's possible for him to be. That's something that no doctor can do for him and it may be worth more than some of the pills and treatments. Some studies have shown that it may actually keep him alive longer too!

I wish the best of luck to your Dad, to you, and to the whole family.

Alan

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Thank you so very much for the supportive words. I actually live 4 hrs away from my parents and take part in all his appts via FaceTime. I’m traveling to visit tomorrow and trying to talk them into staying with me for awhile. I do have a brother that lives near them. I guess my concern is with side effects with the meds. Because he has never really been ill, this is all new to him and I can hear the frustration in his voice.

I hadn’t heard of palliative care until I started doing my own searching. That is something I will look into.

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Good work Francesca!

When you talk to your Dad you'll have to be sensitive and work hard to hear what he's telling you but also figure out what he's thinking but not telling you. He may want to stay with you for a while but he doesn't want to impose on you and so says he doesn't want to stay with you. But it's also possible that it's the other way around. He may not want to leave home but feels it will disappoint you if he doesn't come to your house.

They say medicine is an inexact science. I think that's true, but human feelings can be even harder to figure out. Still, I bet you'll do a good job at it.

Best.

Alan

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Well said, a person asked me the other day are ou doing this for your dad or for yourself. It’s a tough question but a real one . 🙏🙏

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All I can say is that he’s blessed ! Few of us here ever expect to reach the 90s!

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Yes he is! We are! My parents live a very independent life. He looks and feels at least 10 years younger...happy to have his genes! I think that’s why this is difficult..more annoying for him. He has lived an extremely healthy life.

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My parents lived til 87 and 94 . I hope to reach 80.

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Male USA life expectancy was 72 when I was younger, now is 78. I will be 69 this year. So like everything else in my life, they keep moving the goal posts. Now my dad was right on and made it to 71 only. But mom was 88 and both grandparents were in their 90's. (They lived on a farm on the South Dakota prairie.) So am guessing prostate cancer life expectancies are lies, damned lies and statistics.

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Our parents lived through the Great Depression and WWII yet had long lives. Go figure.

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😢😢 sorry to hear the monster is back. My 87 year old dad Is in the same fix as yours. He is now on Zytiga and prednisone, at his age and condition there’s not much they can do, they offered chemo and a couple other similar treatments but we didn’t feel he would survive the side effects . Good luck with your search. 🙏🙏🙏🙏

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May I ask how he is doing on Zytiga and Prednisone? Side effects? Helpful hints? I just really want comfort for my dad.

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I am not an "alternative medicine" champion, but I do believe complementary medicine strategies can be beneficial if chosen carefully based on data, including anecdotal accounts that can be trusted.

I have posted on this subject. Review these and message me. I will provide details for you to follow in helping your father.

healthunlocked.com/advanced...

healthunlocked.com/advanced...

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93, GOD BLESS HIM.... (and you too)...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 01/11/2019 4:51 PM EST

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Thank you!

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