It is the first time that I write and I would like your opinions about my case:
I am the daughter of a 75 years old man with metastatic prostate cancer. It all started in 2002 when he underwent a radical prostatectomy with a gleason 6 pt2bn0m0. Until 2019 he has been on intermittent hormonal therapy, especially with bicalutamide 50 and 2 injections of eligard until in 2019 the psa gave 15. His urologist started with lupron until September that he dropped to 3 and decided to stop treatment but it was a mistake and in January 2020 gave him 39. Again he started with Lupron and went down in 24 but in July this year it has gone back up to 39 so I indicate him Casodex 150 + lupron and in 5 weeks it went down to 17. When the psa of 15 they made a pet hill and they saw 6 small points in the axial skeleton and one in the head of the femur ... the urologist has told us that later arbiraterone will come.
Could you please tell me what you think? Your opinions would seem very valuable to me. Thank you very much and good luck to all.
PS: Sorry about my English.
Written by
Izas
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I have to say I don't think much of the decisions your dad's doctors have made. Your dad is still hormone sensitive and the intermittent therapy is not working. At this point I hope new lines of cancer have not become resistant to Eligard and casodex. If so, he may have to move onto a new ADT drug like abiraterone or xtandi.
That's what I think. I think they should have been more aggressive but they told us that everything was under control and that surely he would not die of cancer ... but now I don't see anything clear. I don't know if it is resistant to castration but he told us that the response to Casodex 150 had been good ... how long could it last? or what would be the best sequence? Thank you very much for your answer.
If Eligard and casodex are no longer effective, abiraterone followed be xtandi could give him years of quality life. After that there are other newer drugs.
I know a patient who had a Gleason 6 at diagnosis and after twenty years he had bone metastases. He got a Lu177 therapy and this removed the bone metastases. You may ask the nuclear medicine departments at these hospitals regarding this therapy:
Thanks for answering me. In principle, the doctor treating my father is a specialist in uro-oncology. He is in charge of the uro-oncology area of the hospital where my father is being treated.
Difficult - my husband is being treated in Portugal - it is very SOC following STAMPEDE - I would look to the US guys for a more personalised approach.
He should be in Lupron or similar and abiraterone. There is data showing that prolong life in metastatic PC (castration sensitive and castration resistant) when compare with ADT (lupron) alone.
Yes I know...he is now lupron+ casodex 150 but I don't know how long will be efective and I don't know will be happen with my Daddy.Thank you very much.
ADT (Lupron) and enzalutamide offer a survival advantage over ADT and casodex. I believe it may be similar with ADT and abiraterone. Abiraterone may be better tolerated than enzalutamide, but both are valid treatments which have shown to prolong life.
I believe Lu 177 PSMA treatment is available in Spain.
This treatment has shown to prolong life even in patients with very advanced cancers. It is not the SOC but it may be effective and it will have few negative side effects. It is well tolerated unless there are a lot of bone metastases and significant bone marrow infiltration.
You could check Dr Sen's post about LU 177 on this site. She is based in India where the price is much more reasonable. I think a number of people from US visit her but maybe someone here could advise on this.
Do you have any prostate cancer specializing oncologists within a reasonable commute for you and your Dad? a larger city.....or even out-of-country? I question your current Doc's expertise re advanced PCa?? Unless there are other factors re your Dad that have led to this line of treatment?
One very important aspect of receiving medical care is being a part of the decision process and not just being dictated to, or told what to do.
As patients, we sometimes need to advocate for our own care, and sometimes too, this may be in contradiction with what a doctor wants to do, or is even familiar with doing. But if we do our own research and find data to support our decision and then want a particular treatment that may be more aggressive than what a doctor wants... They should submit to the patient want/needs rather than disregard a patient's desire. Of course considering there is benefit to the patient in what they want to do.
Most studies being used today are treatments with multi-drug modalities. But with progression to bone metastasis, a more aggressive therapy should be introduced. As noted, ADT & Zytiga and or ADT & Chemo...
I want to thank you a lot for this time that you have dedicated in answering my post. As for the treatments you mention, I totally agree but ... I have a problem ... and it is that my father does not want to know, he trusts his doctor and does not like to talk about what he has or the future ... He is fine, he has no pain and except for his leg, which is weaker due to a hernia operation, he is in very good health ... that is why my question is what you think because although I do not see him badly, I know that more could be done but not I know how to do it ... Thank you all very much! You are wonderful!
Your Daddy is like most of us men.....we do not like doctors (visits and etc). Tell you Daddy that if he does not take your advice (and of course his doctors) I will sic Eva on him.... Give him mucho besos.... You are a wonderful offspring....
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