I have posted a few times about my dad. Stage 4, mets to 8+ bones at time of diagnosis, PSA at 137 (10/22.) Lupron twice a year, Bicalutamide, failed at 7 months, Xtandi failed at 4 months, currently on Zytiga.
We met with my dad’s oncologist on 4/24. My Dad’s PSA dropped from 2.47-1.46 and pain has been improving. MO said that my dad is very symptomatic even with low PSA, and that treatment options have to also take into consideration quality of life. My dad was hospitalized in February for uncontrollable cancer pain when his PSA was only around 2.5 so the decision was made to move him from Xtandi to Zytiga. He talked with my dad about how for some patients he would let the PSA rise a bit more while staying on Xtandi to get a few more months out of the drug, but that sometimes it is not just about quantity.
I was very direct with the MO and said “How long will Zytiga last given my dad’s previous failures?” He said his usual statement, it could last weeks, months, years, or not work at all. My father always hears “years.” I stopped him and said, “Dr. A, do not tell my dad he has years because, with each drug failure, he gets disappointed and tells me he thought he would get more time with this drug.” I then explained I ran my dad’s entire history into three different AI language models and got varying numbers of Zytiga working for his specific case for 3-6 months, and some had concerns that perhaps not at all.” So I need to know not what happens with Zytiga, but what happens next. My dad was not happy with this direct question. But the MO knew why I was asking.
The MO finally had a direct conversation with my Dad and said if he was 50 and walked into his office with advanced cancer my dad had, he would have said five years was reasonable. But at his age each time the cancer comes back it punches harder at him because of his age. Add to that the additional health issues my dad has, the continued falls and hospitalizations, that five years was not reasonable, and that my number for Zytiga failure would be about average in my dad’s case, but we can’t really say until we see how his body reacts.
He talked about what comes next, ADT will still be there and it will continue to block a certain amount of the cancer, but the percentage it blocks will decline. He thinks my dad would do well on Pluvicto, but to get to it we would need to try chemo and fail. He shared that failure can be, not tolerating side effects, response, etc. But we would need to try it and it could be a lesser dose. The MO shared with me privately that the chemo would be harsh on my dad and the GI issues with someone like him could be difficult. My dad has no balance and is dependent on his walker. The MO also shared with me that he sees my dad wanting to exhaust all treatment options.
Zytiga has given my dad an extra pep in his step (I think because of the prednisone.) However, I can see the cancer starting to come back. The urinary incontinence issues are slowly creeping back, he has had some back pain, and shoulder pain where there are significant mets. This is usually his MO and PSA doesn’t seem to correlate with this any more. We moved my dad into Assisted Living in mid Feb and he loves the place, has a great routine, has made a lot of friends, is very involved with the activities, and is honestly more active here than in the last 2+ years.
My question is whether chemo/pluvicto seem reasonable to try. But how long do these last?
Making the Best CHOICE for Daddy. What to do next.....
Alkaline Phos and Hemoglobin 
Brain metastasis treatment options?
Zytiga and Firmagon 
