Oncologist and prostate surgeon conflicting treatment

[Jbooopin]

Dad 73yrs has recurrent PC. 5 pelvic lymph nodes with hormone sensitive PC detected via rising PSA after 1.5yrs at undetectable then psma scan confirmed it was now in pelvic lymph nodes. He had his prostate removed a few years before, negative margins and just unlucky. In September last year Oncologist prescribed xtandi and lucrin for 2 years and radiation to the pelvic area. Since then PSA has dropped to the lowest it can be.Now out of the blue when my Dad was seeing the prostate surgeon for urinary issues which have resolved, the surgeon thinks my Dad should come off the therapy (10 months later) and see if his PSA should rise to 4. I'm not to happy about this I thought therspy is 18 months 2 years. Isn't that what the latest study says? Surgeon says he is concerned about the cancer mutating and becoming resistant.

He also thinks if he is to continue therapy he should switch to darolutamide for lower cognitive side effects. Dad doesn't really care about this. Again not sure if it's a bad idea.

Having conflicting advice is giving him great anxiety. He is seeing his oncologist in 2 days.

Any guidance appreciate

[Tall_Allen]

The surgeon has it backwards. By stopping his hormone therapy now, before all the cancer cells have been destroyed, he is selecting for the more resistant strains. A STAMPEDE trial showed that 3 years of ADT with 2 years of abiraterone and radiation among men who are with cancer only in pelvic lymph nodes (stage N1), can improve survival.

ncbi.nlm.nih.gov/pmc/articl...

IMO, it need not entail abiraterone - it can be enzalutamide, apalutamide or darolutamide - but some second generation hormonal agent appears to be necessary to get complete cell killing.

[Jbooopin in reply to Tall_Allen]

I agree with you TA and thanks for your comment.

The surgeon thinks being on xtandi so long will encourage the cancer to become resistant.

Is the reason why we don't stop treatment midway is because any cancer cells with partial resistance will proliferate? Correct me if I'm wrong?

Also is it okay to change xtandi to darolutamide mid course?

Thanks in advance.

[Tall_Allen in reply to Jbooopin]

I think it's ok to change enzalutamide for darolutamide.

[Magnus1964]

Stay the course. He's doing good, don't get talked into this. If his PSA starts to rise then think about other treatments.