My dad has Gleason 4+5 prostate cancer. He is newly diagnosed and he started ADT one month ago. According to CT it is widely metastatic in lymph nodes. Bone scan is clear. He will start apalutamide but they said that no radiation and no cytostatic treatment. I am horrified because I thought at least they will start some kind of radiation. He is 74 years old and does not have any symptoms.
Does anyone have similar experiences? Is it time for a second opinion?
Whole pelvic radiation may be curative, along with 2 years of hormone therapy. Maybe he should sign up for this clinical trial:
clinicaltrials.gov/ct2/show...
Is your advice of whole pelvic radiation still valid although there are metastases in his para-aortic lymph nodes as well and also one suspected distant lymph node near clavicle?
no. The clavicular node is outside of the pelvis.
Where are the lymph nodes located?
There are plenty of para-aortical lymph nodes and also para-iliac lymph nodes. Also one near clavicle.
Is it really possible that even chemo is impossible alternative if there are many distant lymph nodes affected? Sounds weird to me. Or is it possible that they have decided that chemo is not best alternative right now and they want to start with ADT and apalutamide. It is possible that I understood something wrong… My dad”s overall health is ok so it is not reason to avoid any kind of treatment.
Adt / erleada.....is a succesfull protocol....as a 2 tier approach....i have been on it 6 yrs...psa <1...... i believe ta and the likes of him like to add doxcatel into the mix.....i was in good health too..b4 apc.....did not get memo to EXCERSISE.....so here is.....ADT .....will destroy your muscle...spinach wont help.....
Since there is cancer beyond (above) the pelvis in clavicle and pare aortic nodes then he is metastatic de novo (at diagnosis). Best treatment he own is Triplet Therapy, adding docetaxel right from the start along with The ADT and apalutamide or darolutamide. Reassess after completion of the docetaxel 6 cycles, in a few months. That is just my opinion from the clinical trial results in this setting. Good luck.
I always think a 2nd opinion is a good idea. Preferably at a large regional cancer center.
Treatment post ADT failure?
Will Medicare pay for ADT treatment? 
Effectiveness of ADT treatments 
The three ADT treatments.
Proton Treatment - When to start the ADT relative to simulation and CT of the prostate 
