Father with Stage 4 prostate cancer in 8 bones.

[lgutman]

On 10/25/22 I took my dad (79 at the time) to the ER at the VA for escalating back pain and we walked out with a stage 4 prostate cancer diagnosis. When I brought him to the ER I expected them to tell me he had lung cancer as he is a lifelong smoker.  Additionally,  I had been worried about him all year. He had lost about 40 pounds and had run random fevers, and I had tried repeatedly to get him to talk more to his doctor about the fevers. I was still shocked when the doctor told us. His PSA was 137 at the time. He had asked his primary care about three years earlier for a PSA test and she said at his age they did not test anymore. We saw an oncologist a few weeks later who started him on bicalutamide and ran a PET scan.  The scan came back with cancer in 8 different bones.  He did ten sessions of radiation and a few weeks later he fell (using a cane) and broke a hip on his 80th birthday.  The surgeon said his hip had a lot of cancer in it and they were able to get a good biopsy. 

The first drug worked for about 7 months before his PSA started rising. During this time my dad continued to lose weight and became more and more frail.  The oncologist started him on Xantdi as the second drug, bypassing a second one that has a steroid that you needed to take.  He has been on Xantdi for about six months and his PSA, while low, doubled from .3 to .76 on the latest blood test and the oncologist mentioned that when Xandti stops working we will need to deal with the side effects of the additional medicines as we didn't have other options. He also gets a shot every six months of another hormone. 

My dad has an amazing attitude about not worrying about shit you can't control. I have tried to adopt that but as his POA I try to keep up with all the stuff that seems to be going on.  My dad is very frail. At some point last summer he lost a lot of his mobility and his balance. He had a brain scan and they believe he had a minor stroke at some point and has vascular dementia. On top of this, he is having urinary incontinence several times per week.

Additionally, he is blind in one eye from glaucoma and limited vision in the other eye. This is the reason he has tried to avoid steroids, but I have explained to him that we will need to take steroids on the next medication because the alternative is dying (which he is not ready to do yet.) Additionally, his blood pressure is through the roof, which he swears is due to the hormones. 

My sister and I are moving him to assisted living in two weeks because he has had several falls and can't really take care of himself all that well.  It is a great place that has a mix of independent and assisted living and the interaction with others will help on the social side.

First, I want to say to everyone here, I am sorry for your journey. Cancer is messed up.  I don't know what to expect in the coming months. Originally his palliative care doctor told us he had about 2-3 years left in his life depending on how he does. His oncologist told us that had we not gotten treatment when we did my dad would have most likely died by his first Christmas and he was very relieved when the first scan did not show it hit an organ.

I am trying to educate myself on what happens next. I am worried about his PSA doubling that the second drug is not working, and I am not sure what will happen next. He is so frail and has fallen multiple times I am not sure chemo is the best option. Originally, he said he didn't want it, but 15 months later he has reconsidered. But at 81, and frail, is it a smart or an option at all? I noticed that my dad's RBC counts are low. 

I would love some advice and guidance. Thank you in advance.

We don't have a Gleason score as my Dad was diagnosed at stage 4 as an initial diagnosis.  He went from about 210 pounds at 6'3" to 160 pounds, shorter than me (5'5".)