My dad was diagnosed w stage 4 ductal prostate cancer that has spread to his bones all over, hasn't spread to his organs or lymph nodes.
He was hospitalized about a month ago(when they found it) w a psa of 482.It's now down to a psa of 11 as of today. Currently he is only taking Orgovyx but was just prescribed today darolutamide and starts chemo(docetaxoel) in 2 weeks. Every 21 days for 6 treatments. He has come a long way in the month in terms of eating, stamina, fatigue, and pain. Before he didn't eat much and could barely walk up a set of stairs and he is back to eating normally and is in therapy(for a knee replacement) and his most recent session did the full hour without needing a break.
Not sure exactly what I'm asking other than any tips, words of encouragement, wisdom that anyone in a similar situation might have that would help. I've spent a ton of time on Google but that's hard as medicine and studies have come a long way in a short time. Also, maybe how long you have being going through this, quality of life, prognosis, etc.
Thanks for any advice in advance
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DWall85
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Wishing the best for your dad. I'm in a very similar situation when my father was diagnosed with stage 4 prostate cancer with mets on multiple bones and lymph nodes. His psa was at 574 when diagnosed six weeks ago and he will have his first of six rounds of docetaxel tomorrow.He has been on Degarelix (80mg shot every month) and Abiraterone for 6 weeks now and his last psa test came back to be 20. His bone pain has gotten significantly better too and he's much more mobile.
This community has been helpful to know that we aren't alone in this journey. I'm still new to the community, but both our fathers are on very similar journeys and let me know if I can be of any help and answer questions that I can.
My husband has been on a similar journey- diagnosed in Aug 2017. You can look in my profile for details. Wishing similar results for both your fathers💙
I will add that we would have done triplet therapy at the start if it had been a thing back then. Doublet therapy was new when my husband was diagnosed, and we were happy we could hit it hard.
It has been a week now and he doesn't have any major side effects minus some fatigue. His taste seems to have been affected. No major hair loss yet either. The Dr did mention that he plans to ramp up the dosage, so unsure if it'll continue to stay this way for the other rounds.Good luck to you dad
Triplet therapy Orgovyx+docetaxel(chemo)+Nubeqa is best treatment he can get. I had dx in august 2023. PSA 2500 ,P-AFOS 2600 .Metastases in bones all over ,metastases in lymph nodes. Lots of pain ,weight loss 20 kg ... I had triplet therapy (still in Orgovyx and Nubeqa) and all pains are gone,weight have come back.So ,just now ,I feel great. So your dad will live good ,active life for many years.
I was diagnosed with similar conditions, albeit not ductal and not as high a PSA, but nevertheless similar. That was 7 years ago. You can read my bio. With the treatment your dad's on / going to have, he'll likely do very well also. Stay positive.
I went through quickly your profile and you have a good institution treating you. I was just wondering how did you decide about avodart? I asked my MO about adding avodart but he said that avodart is not a cancer medication. I have a cancer in my prostate and I was considering avodart but I don't have a gutts to insist on avodart because I am afraid of making my cancer in my prostate more aggressive.
Hi Seasid. When I was diagnosed with PC, it was determined that my prostate was huge… like 6-7 times larger than normal. After about a year of pc treatment it had reduced in size but was still three times normal size. My psa had reduced significantly, but never down to undetectable so I asked my MO if that could be partly because of my enlarged prostate and if I were to add dutasteride to my other meds would that give me a truer psa reading. She agreed that it might.
At the same time, in my research I came across info that indicated that adding dutasteride to abiraterone might prove beneficial in blocking the production of DHT via the ‘backdoor pathway’ of abiraterone’s mechanism of action that can lead to resistance. I talked to her about this as well.
For these two reasons she was happy to prescribe dutasteride and I’ve been taking it for several years. It did lower my psa marginally (not as much as I had thought it might) and possibly it helped stave off resistance for a longer period. In any case there have been no negative effects that I’m aware of so I am happy to continue taking it.
I think the combination has been shown in trials to be positive not negative.
Did you notice any further reduction of the size of your prostate since you started taking dutasteride?
I would do the same in order to reduce the DHT in my prostate because I may still have some radiation resistant cancer left in my prostate after the SBRT irradiation, but I am too scared to insist and my MO said that dutasteride is not a cancer medication.
Do you have any information about the combined beneficial effects of dutasteride plus abiraterone? I could ask ChatGPT and DeepSeek.
I was thinking about dutasteride adding to Abiraterone because my next medication after the present Bicalutamide plus degarelix injections could be Abiraterone plus prednisolone.
Unfortunately I am too scared that the cancer could start producing it's own DHT when pushed with dutasteride practically breading out an aggressive cancer with the use of dutasteride. Is any clinical trial analysing the combination of dutasteride plus abiraterone plus prednisolone?
I know that EdBar is using dutasteride with Enzalutamide and it was introduced by the American oncologist Snuffy Mayer and Sartor let him to continue Enzalutamide plus dutasteride.
I asked DeepSeek about the above and here is the answer from the AI.:
AI (DeepSeek) said:
**Answer to Seasid's Concerns and Questions:**
1. **Prostate Size Reduction with Dutasteride:**
Dutasteride, as a 5-alpha-reductase inhibitor, reduces prostate size by blocking DHT production. While individual responses vary, studies (e.g., REDUCE trial) show it can shrink the prostate by ~20–30% over 1–2 years. In hansjd’s case, the PSA reduction was modest, suggesting partial contribution from prostate shrinkage.
2. **Combination of Dutasteride + Abiraterone:**
- **Mechanism:** Abiraterone inhibits CYP17A1 to block androgen synthesis, but residual DHT may still be produced via "backdoor pathways" (e.g., from adrenal precursors). Dutasteride inhibits 5-alpha-reductase, potentially blocking this escape route.
- **Clinical Evidence:**
- A **phase 2 trial (NCT01393730)** tested abiraterone ± dutasteride in metastatic castration-resistant prostate cancer (mCRPC). Results suggested improved PSA responses and progression-free survival with the combination.
- Preclinical studies support synergistic effects, but larger phase 3 trials are needed for confirmation.
3. **Safety Concerns (Aggressive Cancer):**
- The REDUCE trial initially raised concerns about high-grade cancer risk with dutasteride, but subsequent analyses attributed this to improved detection (due to prostate shrinkage) rather than true biological aggression.
- In the context of **active treatment** (e.g., abiraterone/prednisolone), adding dutasteride is unlikely to "breed" aggressive cancer. Instead, it may delay resistance by closing DHT production pathways.
4. **Expert Opinions and Cases:**
- **Snuffy Myers and Oliver Sartor** have advocated for combinations like enzalutamide + dutasteride to maximize androgen blockade. Their approach aligns with the rationale of targeting multiple androgen pathways simultaneously.
- Real-world cases (e.g., EdBar) suggest tolerability and potential benefit, though individual responses vary.
5. **Practical Recommendations:**
- **Discuss with Your MO:** Share the phase 2 trial data (NCT01393730) and emphasize the mechanistic rationale for dual blockade. Highlight that dutasteride is not a standalone cancer drug but may enhance abiraterone’s efficacy.
- **Second Opinion:** Consider consulting a specialist familiar with combination therapies (e.g., a prostate cancer oncologist at a major center).
- **Monitoring:** If prescribed, track PSA, imaging, and symptoms closely to assess response.
**Conclusion:** While dutasteride is not a primary cancer therapy, emerging evidence and expert practices support its use in combination with abiraterone to target residual DHT pathways. The theoretical risk of aggressive cancer is mitigated in the context of active treatment, and clinical data suggest potential benefits. Advocate for a detailed discussion with your MO using the evidence provided.
I was diagnosed with wide spread bone Mets and multiple abdominal lymph nodes. PSA 32. That was in 7/22. Hopkins gave me 3 months. Saw Dr Smith at Harvard then Dr Aparacio at MDA. I had same treatment as your dad. I had a severe staph infection which I am still recovering from. I had two (7/22) nephrostomy tubes. Oh I now have collapsed l 3 l4 discs. Attitude is the proverbially everything. Be kind when he is not. Don’t hover give him space. He can survive and will survive knowing he is loved.
How old is your dear Dad and where is he located (city/state) and where is he being treated? Please update his bio because it will help him and help us too. Keep posting, you've come to a great site for information and comradery. Thank you and regards to your Dad (and to you).
I'm in a similar situation. I am on triplet therapy since September 2025 and just completed my 6th chemo (each was 3 weeks apart). You might read my bio if you have time. I'm doing very well considering where I started and hope he responds well too.
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