First off, though my husband was diagnosed with aggressive cancer in 08/2023, Gleason 9, PSA 46.6, based on MRI and PSMA PET scan, the cancer is localized. I have been posting in Advanced Prostate Cancer, given it was assumed that the cancer was systemic at diagnosis due to high PSA. But perhaps more appropriate to post on the Prostate Cancer Network site.
In fall of 2023, we decided that he would add Zytiga /prednisone for two years , based on the Stampede trial protocols for high risk PCa with PSA over 40. He is 74.
In the interim he was diagnosed with Chronic Fatigue Syndrome, an increasing Aortic Root Dilation of 4.6 cm (at 5cm surgery is a consideration), an ongoing Klebisella Pneumonaie infection over a year and a half, Radiation Proctitis with rectal bleeding and a high Cardiac Calcium score in the LAD ( the widow maker).
He was diagnosed with bladder cancer in 2020, and will have a Cystoscopy in February 2025, which if there is no evidence of cancer should be his last .
His fatigue is significant. One of the symptoms of Chronic Fatigue Syndrome, is fatigue becoming worse with physical exertion. He has been going to a gym but has to pace himself carefully or he'll be bed bound for several days afterwards. He is at risk for sarcopenia at this point.
We are increasingly thinking that he is at a higher risk of dying from heart problems than Prostate Cancer. He will have a monitoring ECHO tomorrow, and will follow up with the cardiologist the day before the MO follow up.
We are considering discussing the following with the MO in two weeks:
-Requesting the Decipher test to gives a better idea about his metastatic risk.
-Based on the results, reducing his ADT (Orgovyx) from 24 months or more, to 18 months.
-Going off of the Zytiga, titrating off the Prednisone
Any thoughts or recommendations? Would he be playing with fire to be less aggressive with treatment? We will discuss pros and cons with his providers of course.