Urinary incontinence in mCRPC

[lgutman]

I am looking for help for my 81-year-old father who is mCRPC. He was diagnosed at stage 4 about 18 months ago with mets to 8+ bones including the skull. Summary of the following treatments:

Bicalutamide this drug failed in July 2023 and the patient transitioned to

Xtandi started in September 2023. PSA began to rise in January 2024 with a doubling time of 3.5 weeks, metastasis increased, pain increased, and urinary incontinence presented.

Moved to Zytiga in March 2024 with 5 mg prednisone twice daily

Lupron injections every six months.

The problem right now is the urinary incontinence. My father never had a prostate biopsy and at this point doesn't want one as he says too much could go wrong with that. His primary care doctor put him on Tamsulosin HCL .4 MG about six months ago and doubled it about two months ago. Now nothing seems to be working and he is very bothered by it and says he needs new medication. His primary care has said there isn't anything else and it is part of the cancer.

I am confident that the Zytiga is not fully working as he continues to have progression of pain, an increase of incontinence issues, and swelling recently in legs and ankles. He is sleeping about 15-16 hours a day and is very tired. We have our first blood draw in 10 days so should know more but he seems to be pretty symptomatic.

Any suggestions for urinary incontinence for him?

Thank you!

[Tall_Allen]

Has he had a cystoscopy?

[lgutman in reply to Tall_Allen]

He has not. I don't believe he would do it. I think if there was a different medication to use he would try it. My dad hasn't even seen a urologist as he was referred directly to an oncologist within days of his diagnosis. Because he was diagnosed at such and advanced stage we were told we were being sent straight to oncology. I can always ask for a referral back to urologist but that will take about a month. I honestly think that my dad doesn't have more than six months and I want him to have as much quality as possible. He came out of a skilled nursing facility last Thursday after a fall only to have fallen out of bed on Sunday. He was on the floor for 1-2 hours as he was not wearing his pendant at assisted living. He struggles to go from sitting to standing, sleeps about 15-16 hours a day, has no balance. His hands shake and tremble because there is something going on neurologically. His palliative care doctor and I decided to cancel the three hour cognitive test because it would only frustrate him and it would not help us with anything in terms of treatment. He is a very old 81 at this point. The past 18 months have been a steady decline down. Is there something easy he could do that is simple.. He does wear depends and that gives him confidence being it and about.

[Vegasman]

I believe Firmagon injections are better than Lupron. They are given monthly. Your Dad did everything wrong it seems, starting with not getting a Urologist who could direct his treatment. It appears to me that he Is ready for Hospice where they can keep him pain free.

[lgutman in reply to Vegasman]

I think hospice will start after Zytiga starts to fail. We do have palliative care. He did tell me last night he would consider chemo so I will ask the MO in two weeks when we are there if it is possible to add. Everything I read said it should be done with, not after. The year leading up to his diagnosis he ran random reverse lost about 40 pounds, and I kept asking him to talk to his doctor as something wasn't right. I honestly thought he had lung cancer as he is a lifelong smoker. We were told unless there was a plumbing issue a urologist wouldn't see him since the oncologist took immediate treatment. My dad did ask for a PSA test at 75 and they said it wasn't done at that age. It would have most likely caught it. I believe the studies that have come out since said this was flawed. My dad truly doesn't think he is going to die from this, and my sisters and I do. In fact I loaded all of his test results, case, PSA results, symptoms etc., into three different AI models and they all predicted the same thing. 6-9 months, Zytiga will fail quickly, etc.

[j-o-h-n]

Sad to say - but I feel his pain...... Depends, depends and depends.....We both are war time babies......I also was a depression one too....Give him my fondest regards.....

Good Luck, Good Health and Good Humor.

j-o-h-n

[garyjp9]

You should definitely ask the MO about the chemo since your father is open to it, but be prepared to hear that they won't do it because he may be too weak to tolerate it.

[lgutman in reply to garyjp9]

Thanks. He said last time we could try him on a reduced dose to see how he does. I think that also opens up other treatment options. He told us after the Zytiga fails we don't have many good options left.