Treatments past 80 yrs.

[Wgly]

Am I limited in options because of my age? Scans, drug holidays, meds..? Agism? Not that I've run into it, yet (I think), but discourage from changes to get rid of bad ADT side effects, such as weakening, fatigue, ...

[Derf4223]

You are only going to be as limited as your ability to self-educate what options are available before you meet with oncologists. (Or have an educated advocate present.) Study up on trials -- eg LATITUDE, CHARTED, PEACE, etc. Use your doctor's language and they will not be as likely to assume you are ignorant and dismiss spurious concerns.

A doctor's time is very limited. You owe it to yourself to walk into appointments with reasoned questions written out.

[Wgly in reply to Derf4223]

That's what I'm trying. If there is an age factor, this shouldn't be an unplowed field.

[dhccpa in reply to Derf4223]

That does seem to make a difference, however imperfectly. But some doctors are still tough nuts to crack.

[Tall_Allen]

Treatments are based on "performance status" and "physiological age," not chronological age. It is true that recovery is slower as we age, and anesthesia can be difficult. It is also true that some drugs are more potent in older men. But if performance status is good, I can't think of any treatments, other than prostatectomy, that can't be used on older men. Sadly, ageism is rampant and some oncologists don't give men the treatments that would, in the end, help them avoid painful and crippling metastases.

[Wgly in reply to Tall_Allen]

I hadn't thought the end will (or could) be driven by metastases avoidance. Good reference point.

[Doctorsceptic]

The basic question is always what is my goal? Quantity or quality?

You sound fed up with the debilitating effects of ADT and not to forget the hidden effects on the body - bones, lipids, cardiovascular risk, type2 diabetes . Time lost from living life by travelling to clinics, scans blood tests and the rest.

I know nothing about your general health but in stark terms does prostate therapy make any difference whatever to life span at age 85? If it does at what personal cost?

These are questions only you can answer. Be blunt with your oncologist and ask him the hard questions. Does he really understand what you want?

[Wgly in reply to Doctorsceptic]

It is. Always, and it changes

Used Chat GPT to list side effects of Lupron, Xgeva, Zytiga and Prednisone alone and in combination. Quite a lot, and I have quite a few of them. My PSA and T are below measurable. Strength, fatigue, ambition, sleep and memory are worst. Also, a recently infected tooth, now cured, but expected to return. So, now on Xgeva 3 month+ holiday for extraction in about two weeks, with another delay of maybe three months after. Now many of the other less serious SE's have surfaced, perhaps masked by Xgeva, but awareness, desire to exercise and feel better are back. This damned election is keeping me intellectually busy, but for better or worse that will end soon.

I've been on 1/2 dose of Zytiga since Feb 23, and now off Xgeva, so my first intent is to explore adjusting the current regime, reduce Prednisone, replace Lupron, or a drug holiday.

My Onc. will say it's working, so leave it alone - is that because of my age; are there substitutes that will less affect an old guy? BTW my dad lived to 100, and except for his last few years did well. Before this I was doing very well too.

[Doctorsceptic in reply to Wgly]

Let me shoot an arrow in the dark. The loss of energy, fitness, cognitive decline all predictable

You obviously can’t stop pred instantly but you do have the option of stopping the lot given that your psa is unmeasurable. Take a really good drug holiday that’s what I would do anyway. Make sure you really take lots of time slowly reducing pred. Alternate day regime s are good.

You could then simply observe what happens to psa and its rate of change over at least 6-12 months. What is there to lose?

[Wgly in reply to Doctorsceptic]

I'm certainly willing to try it. Are there alternative drugs for this ADT soup with less SE's as a backup alternative? At least one could be to halve the Prednisone. Or just change my Onc?

[Doctorsceptic in reply to Wgly]

Just for_suggests Bicalutamide which is a good option if you want to stay with something suppressive but not too aggressive. To be honest the prednisolone bothers me and I am not quite sure why you are on it??? Are you able/willing to say?

Anyway, I would still be inclined to have a good break off therapy, and start plotting your PSA 3mthly on a graph - time on horizontal axis and PSA on a vertical log scale ie 0.01, 0.1, 1.0 ng/ml etc. You will then get a much better idea of where things are going over the next months and can make a rational decision when and if to start therapy again.

My very very personal view: I am not quite 80 and at the moment I am not prepared to trade good QOL for a suboptimal life of troublesome symptoms.

[Wgly in reply to Doctorsceptic]

"Zytiga blocks the production of cortisol from your adrenal glands. Prednisone helps to replace the lost cortisol that can cause side effects such as low blood potassium levels, fluid buildup (edema), high blood pressure or irregular heartbeats. Some of these side effects can be life-threatening"

Dr. says so. The standard is 5 mg 2 x daily with1,000 mg Zytiga. I take 500 mg daily.

[Doctorsceptic in reply to Wgly]

Thanks I did not know the trade name Zytiga - must be a US name?

[Wgly in reply to Doctorsceptic]

Abiraterone, All I know

[Doctorsceptic in reply to Wgly]

Yup got it thanks

[Justfor_]

Don't underestimate the potency of good, old, no SE except gynaecomastia, safe, inexpensive, Bicalutamide.

[Wgly in reply to Justfor_]

Casodex

[Justfor_ in reply to Wgly]

Yes. You can check the documentation of my N=1 experiment with it here:

healthunlocked.com/prostate...

The sensitivity to this drug varies 10 fold from person to person. I found out that I am very sensitive.

[Wgly in reply to Justfor_]

Shouldn't there be a calculator for everyone who is willing to adjust doses for optimum steady state level, ie. steady min dose for steady min PSA? Given good baseline data, for any drug? Reduction in costs and adverse effects.

[Justfor_ in reply to Wgly]

Too much effort for docs. "One dose fits all", rules. The BS that is served along is that the standard dosage is "optimal". My foot! If I were in the UK and been prescribed 150 mg/day I would had been overdosed by 30X.

[j-o-h-n]

Viagra, Cialis sex toys and any other necessary paraphernalia....

Good Luck, Good Health and Good Humor.

j-o-h-n

[Derf4223 in reply to j-o-h-n]

Paraphernalia Diddy