This article says ALP flare initially... - Advanced Prostate...
This article says ALP flare initially may mean more aggressive therapy should be done
That's a 28 year old article so at the time the flare may have been the only way to determine who had bone metastases. Today that would be revealed by early imaging and the standard care would be to begin with triplet therapy, which is definitely more aggressive therapy than what was available when the article was written.
Hi again. 😊
Dad is 83 so the MO’s not advising chemo upfront. But Tall Allen says that’s the best to do. Keeps me so conflicted as the doctors here just dismiss it and say doublet therapy is enough. One MO said at this age forget chemo and another MO said it would be overkill.
I would agree with TA. I wish my dad did chemo up front as that was when he was strong enough. I know I have shared my dad's story but 18 months after widespread metastatic prostate cancer at initial diagnosis he is really frail and ADT is no longer working and now chemo isn't a great option.
Hi again 🤗
Sorry to hear about the very hard time you are going through. It is heart breaking to just read it. How old is your dad ?
Are you planning to do any of the lu-177 etc ?
My dad is 81. Was 79 when diagnosed. We are meeting with oncologist and palliative care over the next ten days and will have a psma scan. I am not thrilled with any of the choices and Pluvicto doesn't seem to be all that it is cracked up to be. Additionally, I read that for over 75 the average number of doses are 2-4 before it is stopped. The question is with my dad is he better off staying on Zytiga and blocking some of the cancer, but not all, that will be the conversation, but looking at how frail ADT and if course the cancer made my dad I wish we did something different at the start.
🙁
Your MO had not offered the chemo option ? Was he in decent health when he was diagnosed ? He has been on xtandi I think and is now on Zytiga ?
My dad's case was a little unique. He was diagnosed in the ER with stage 4. The oncologist started him immediately on bicalutamide and lupron telling us that he hoped to have it work for 6-12 months before moving on to next ADT. He then started Xtandi a d failed that quickly. He was due to start Zytiga at first but because it came with the steroid the pharmacist oncologist changed the order as my dad has galcoma and is legally blind in one eye and limited vision in the other. He later told us that my dad would have died by Christmas had we not started original therapy when we did. But outside of the debilitating back pain had we done a triple therapy at the start it would have been when my dad was strongest. At some point we believe my dad had a small stroke, and was diagnosed with vascular dementia, he has mild cognitive impairment. For most patients they will never be as strong as they are today. But quality of life should have been a discussion up front and wasn't. Read "Being Mortal" chapters 5-8 right away.
It depends on if your father is healthy enough to tolerate and benefit from chemo. No one here can determine that. Two oncologists have said that it is not appropriate for him. That carries a lot of weight.
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