So, my father is 91. He has had stage 4 prostate cancer since 2016, he's had lupron, xtandi, radiation, bicalutamide. His prostate cancer was under control until July 5 of 2023 when he had severe headaches. We were told not to worry, it rarely ever moves to the brain....he had a CT then MRI and one large dural mass with lepto enhancement surrounding it. They offered him whole brain radiation at that time which he did...it was BRUTAL, by the 10th dose he was stumbling, couldnt walk, a week later his ears had 3rd degree burns and were bleeding and the back of his head, he was sleeping nonstop and nauseated and lost over 50lbs, could barely talk, lots of confusion. That lasted 2.5-3 months. Fast forward the scan after that showed stability, no decrease, the scan after that same thing, the scan after that a little growth in the tumor, now last week which will be 15 months post diagnoses he has a reduction in tumor size on both ends of the tumor and stable lepto. He does mumble a bit with forming sentences, uses his walker but legs are weak and sleeps alot, plus he's 91. He's still on xtandi to maintain control of the bone mets because they are so painful if one starts to grow, he's had radiation on a few. His psa is moving up a little but not significant for him but his brain tumor is reacted now to the radiation last year they said, which is good, no headaches. The rad onc dept called and wants to do a PET PSMA and if the brain tumor has psma on it, do Pluvicto. I really dont want dad going through any more radiation side effects, he doesnt have the best quality of life now but at least he's starting to get his appetite back and stay awake longer watching his football and spending time with mom who is 90, they both live independently still. I have to make the decision.....I will feel bad if it could help alot but if he has side effects and because he is stable now, my opinion is not to do it or put him through more, he's satisfied with how he feels now and really doesnt want to do more radiation type treatments, opinions on Pluvicto? Can it even cross the brain-blood barrier ?
Pluvicto: So, my father is 91. He has... - Advanced Prostate...
Pluvicto
A tough decision. We all want to ive but is the QOL worth the pain and suffering? To live is not the same as to breath.
This article indicates it does improve BM. ncbi.nlm.nih.gov/pmc/articl...
I'm sure there are lots of men for whom Pluvicto was a good option. For my husband not so much. It kept him confined to a monthly trip out of town for treatment and all that entails and after 4 treatments, his bone marrow failed. I'm not complaining because it's what he wanted to do but given the side effects, I would have preferred to enjoy his remaining time on earth. He would have died eventually but the treatments didn't help.
I'm so sorry for your loss and appreciate for your input. Dad, after whole brain radiation was a mess, so sick, weak, miserable for almost 3 months, it did take away the headaches but he said never again. He is finally eating and feeling pretty good at he's 91, he says he doesnt want to do more radiation or any more scans than are absolutely necessary. They told us if he gets headaches again, he can go back on dexamethasone which helps so I told them yesterday, lets just hold off on the pluvicto for now and let him enjoy feeling well.
You will probably get push back from people who are at a different point in the process. I personally wanted my husband not to do the Pluvicto. His oncologist really encouraged him & of course the Theragnostics department, so he wanted to try. I had done extensive research and was opposed given his age, metastases and his previous treatments. It’s different for everyone. The treatments themselves are painless except for the insertion of the IV, but the later side effects for my husband weren’t worth it. Good luck
I appreciate your input. Dad had so much nausea from whole brain radiation, no meds seemed to take the edge off, he lost a ton of weight and doesnt want to do anything that is going to make him sick to his stomach again. He is finally feeling pretty good. Sorry your husband had such bad side effects, a friend of mine's father had alot of vomiting from it and even after they stopped it for several months, everyone is different on how they respond but were not going to take that chance right now. Dad would rather feel good than prolong his life at 91 he says.
It's heartbreaking to see my father-in-law, who’s now 93, struggling after a lifetime of good health. He’s in a nursing home, and his beloved wife of 73 years is there too, but she’s battling dementia and no longer recognizes him. They built an incredible family together: 6 children, 18 grandchildren, and 55 great-grandchildren—a true legacy of love. They’re cherished and visited often, but for Dad, these visits are bittersweet.
He’s been very open with us about how difficult it is to face each new day, especially now that Mum no longer knows who he is. He often tells us he wishes he could simply take a pill and not to wake the next morning, because he doesn’t want to continue in this painful (mental not physical) state. He’s lived a long, wonderful life, and he feels ready to leave us, knowing he has loved and been loved in return. While we may not fully grasp his perspective, we do respect it and support him as best we can.
I’m sharing this because your dad is 91. It’s worth considering whether another round of treatment is something he truly wants, or whether it might just make what time he has left even harder. These are such tough questions to grapple with, but they’re important ones.
We’re all sending you our kind thoughts as you navigate this difficult journey. Whatever decision you and your dad make, we hope it brings peace and comfort to you both. All the very best.
Your situation sounds sad too. My dad is pretty done with life as well, we talked yesterday and he says no more treatment. He says he will go to his standard appointments and take his usual meds but no more radiation. I understand and I'm not sure I would want to prolong my life if I just sat in a chair everyday and felt like him.
My mom is 90 and she helps take care of him, they both love their home and want to remain there as long as possible and I understand that.
Best of luck to you as you navigate your situation as well. Thanks.
Helen
I had radiation to my cervical spine that was equally brutal to your father's experience and didn't have a big effect on the cancer.
I did Pluvicto and, with steroids to tamp down any side effects, it was not bad at all. Some fatigue but the steroids compensated for any "rebound pain" from the treatment and kept the fatigue to a minimum. Also: Pluvicto works well for only 30% of the patients.
So: irridation and radio ligand therapy both involve radiation. BUT radio ligand therapy involves a shot that is like a very quick infusion and it does not produce burns.
As to the PSMA PET scan, if he can deal with scans, is not a bad experience: you go in and they give you the shot, then you wait an hour and then they run you through a scanner. Then you are to stay away from pregnant women, children and small animals for 3 hours. That's it.
So, I would lean toward the PET scan to see if the brain tumor is prostate cancer as that information could be useful.
As for Pluvicto -- if you think it will improve his QOL, then that's a positive; but even if it works it is a 9 month commitment and it might gain him 36 months. And that's only if the brain tumor is effected by it.
All things considered, how does he and his wife feel about continued treatments? Does he have a palliative care doctor who could contribute to the conversation?
As always: YMMV
Thank you for all of this information! Dad is 91 and mom is 90, he's not looking to extend his life he says just to stay headache free. I do think the PET scan might be of good use because they (radiation oncology) Say its prostate ca to the brain. The neurologist says he thinks its a type 2 Meningioma due to the fact that its only in one location and he says it doesnt look like what normal mets look like, so there's a conflict in diagnoses. They radiation team says well he has lepto enhancement around the tumor but the neuro says he's seen that in meningiomas and its only around the tumor and hasnt spread in 15 months. I wonder if the PET could distinguish between the two. His medical oncologist says he's not seen a case like this and turned him over to the radiation team for brain issues.
I completely understand where your father is coming from. QOL is foremost and a break from doctors and scans and all that is good for the soul. I have to fight to keep my doctors into one "doctor month" so I can just do what I want and not think about cancer the rest of the time.
When he is feeling better, I do think the PET scan would be good just to get the info as it is not a big deal. And the PSMA part will only glom onto prostate cancer, even very small amounts of PC, so it will definitely tell you if the brain tumor is PC.
Now the 5 hours required to go through from start to end of high radioactivity can be kind of boring. I suppose you could amuse yourselves after they let you go (after about 2 hours) driving around to see if you can trip a radiation sensor somewhere! LOL Seriously, a 3 hour drive through the countryside could be a really nice way to follow the scan.
I was caregiver for my parents until they passed in their late 90s, so please take care of yourself, you'll be better for it, and them, if you do.
Thank you for the great info! I'm sure you get tired of the doctor visits too and the stress of waiting on labs and scans is intense.
I think we'll go ahead with the PET so that they know exactly what it is and hold off on the pluvicto. He does need a break from the scans and appointments and lab sticks!
A long drive sounds great, it can be overwhelming emotionally sometimes for me working full time and taking care of my parents but I love them to the moon and back and wouldnt have it any other way. My brother found out two years ago that he had it too so Ive been his advocate as well, his has been more well controlled found in stage 1 but gleason was 10/10!! It spread to the capsule, dads was found in stage 4 so its been a fight to keep it controlled.
Take care of yourself as well!
what does your Dad want? Seems like it should be his decision if he is capable.
He always leaves that up to me since I am in the medical field, always wants me to decide, but knowing him and we have talked about this recently, he just wants to not have to go to alot of appointments and scans and he doesnt want to feel crappy with radiation so I told him I would tell the rad onc which I did yesterday. I think since dads case is a bit strange they are intrigued by him but I told her that the last bout of radiation was awful on him although in the long run it helped with headaches and since he is not just stable but has improved, lets just put this aside for now.
Successful Pluvicto Treatment
Update on my daddy- 8 years stage four 
Jevtana prescribed until Pluvicto available to him
Update to Pluvicto Consult, and Question
