Seeking advice for father (71) recently diagnosed with stage 4 PC.

[MJSAZA]

Hi everyone,

My father (71) was recently diagnosed with stage 4 PC, so far a single met to the Lung and 3 to the Kidney (2 nodes and 1 larger 3.5cm lesion) discovered. Nothing in the bones, lymph nodes or elsewhere discovered (yet).

A little bit of history:

- 7 months ago had a normal PSA test. Has been having them bi-annually as PC runs in the family (his father and brother both had it, but both caught early before any spread).

- About 4 months ago started needing to pee more frequently at night.

- About 2 months ago went to doc who examined prostate, said it was swollen. Follow up PSA came back at 6.8.

- Biopsy was ordered which came back with 6 out of 30 cores positive, I believe 2 were considered high risk, the rest mostly moderate. Gleeson 8 I believe.

- Further concern that the tumor was developing on the OUTSIDE of the prostate.

- At this point we had hoped it had been caught early and was contained. Those hopes were shattered when bone and CT scans came back showing mets to lung and kidney.

- He has began ADT, not sure of the exact drug.

- He lives in the UK, Dorset, so it is all being done through the NHS.

- Already seen the Lung specialist who feels they can hit that met with radiation, in her words she said it was still small and fluffy.

- Is going in for a kidney biopsy this week, but Urologist was certain it was cancer. Also scheduled for another PSA and a PET scan this week.

- Seeing his oncologist for the first time later this month, at which point we'll hopefully get a better picture of where we are at.

As many of you will intimately know, my family is in a complete state of shock and fear right now. My father is a wonderful and caring man, and the extent and speed of the spread has blindsided us all.

I guess my question is this, given the spread that has already occurred, what is the usual treatment process from here?

Also, are there any specific things I should be advocating for as his son at this time? Or do we just need to let the frontline therapies play out before pushing for things like genetic testing and inclusion on trials for Lu 177 for example?

Finally, if any of you in the UK have specific insight or experience of how to go through this process on the NHS, and what to look out for, that would much appreciated.

Thank you so much in advance for any insight or advice you can give. I'm so sorry for anyone who is having to go through this themselves or with a loved one. Sending prayers to all.

[Tall_Allen]

Assuming the spots on the lung and kidney are prostate cancer, the best course of therapy is to begin with docetaxel and either abiraterone or darolutamide. This is called "triplet therapy."

But first make sure that the lung and kidney lesions are prostate cancer. If ADT shrinks them, and if they show up on a PSMA PET scan, they are prostate cancer. If they don't shrink or if the PSMA PET scan is equivocal (it isn't very good for kidney metastases), a biopsy will give certainty.

[MJSAZA in reply to Tall_Allen]

Thank you for your reply Tall_Allen! Just for my clarity, by triplet do you mean radiation + plus chemo + ADT? Also, is the possibility of surgery to remove mets no longer indicated at stage 4? Thank you in advance.

[Tall_Allen in reply to MJSAZA]

Triplet, in this case, means (1) ADT and (2) docetaxel and (3) either abiraterone or darolutamide:

prostatecancer.news/2021/05...

Radiation to the prostate is a completely separate decision. However, it has been found that there is no benefit to radiating the prostate when there are visceral (organ) metastases:

jamanetwork.com/journals/ja...

Radiation of visceral metastases may provide a benefit if they are large and interfering with organ function. The triplet therapy will shrink them and will shrink the ones you can't see too. For every metastasis you can see, there are many more that are too small to be seen.

It is important to get a proper diagnosis of the visceral metastases.

[MJSAZA in reply to Tall_Allen]

Thank you very much, this is incredibly useful information that I will pass on to my parents.