Advanced PC with a 90 years old

[TN1932]

Hello all. My father got diagnosed in Oct. 2019. His case has been summarized in the profile. He's castration sensitive. After some readings, I'm not sure if the decision to switch from Bicalutamide to Enzalutamide is the right decision. Should he stay with Bicalutamide? Should he take Trelstar shot only (without Bicalutamide or Enzalutamide)? When he becomes castration resistant in the future, I'm afraid he won't have many options because of his age and health condition. With castration resistance, is ADT and another AR inhibitor or CYP17 inhibitor still a treatment option for him? For example, if he becomes castration resistant with Enzalutamide, can he get Apalutamide or Darolutamide or Zytiga? Other options like Pluvicto or Xofigo or Jevtana seems to be too much for him to handle. Thank you in advance for your inputs.

[Tall_Allen]

Take it one step at a time. He's doing fine with Trelstar and enzalutamide, so why argue with success?

[TN1932 in reply to Tall_Allen]

I've just read a comment of yours written 2 years ago about the choice of Xtandi vs Bicalutamide. It helps me feel better about the choice we've made. Thank you.

[HopingForTheBest1]

It does sound like he is on the right track. Although, I agree with you that he needs to now be treated by a genitourinary MO.

It is also Important to keep in mind the potential side effects for any treatment options, as quality of life for a 90 year old should be a main consideration.

[thudson1965]

Please think more of the Quality of Life for your father over the quantity.

[Miccoman]

My father was put on Eligard at 88. It really destroyed his Quality of Life (QOL). My sister, an oncology nurse was livid, and when I started taking care of my parents I took him off it. And you know what? No one cared what his PSA was when he passed at 98. BUT I do believe that his final years would have had a better QOL, even if a year or two shorter, without the ADT (the last couple of years he wasn't all there).

Now, my father was a very active man who drove from upstate New York to Florida and back via Indiana every year until he was 92. He loved to work on engines and tools and build things. The lack of energy and body changes were hard on that old man.

[Ggpa in reply to Miccoman]

I am glad you posted as I will be 88 in a few months and for several years before Covid the Doc at Mayo in FL wanted to start me on Lupron and I said NO as I had read the side affects posted by the people on this site--not anything I wanted to deal with. PSA last fall was 11.6--will have it checked again in Oct. at my annual physical checkup. I do not feel any different than ten years ago when my PSA was 5.1. Don't sweat it, enjoy each day that you have left.