ADT effectiveness duration for 80 plus age ?

[Tinkudi]

For how long have those over 80 years with mets to bones , been able to keep their psa low with just ADT treatment ?

[God_Loves_Me]

What is current PSA and T-score ?

[Tinkudi in reply to God_Loves_Me]

Psa 18. What is t- score ? Don’t know that

[God_Loves_Me in reply to Tinkudi]

I mean testosterone levels. In india it is common to do orchiectomy. So you can go for it.

[Tinkudi in reply to God_Loves_Me]

Yes most likely will do that

[God_Loves_Me in reply to Tinkudi]

check your PM as well. do it..

[God_Loves_Me in reply to God_Loves_Me]

I agree with your doctor treatment plan.

I did copied from your bio.

100 mg and day and take lupron every 3 months.

[Gearhead]

5 years.

[Tinkudi in reply to Gearhead]

Thanks. How old are you ? Did your pains or numbness reduce with ADT or you took spot radiation too ?

[Gearhead in reply to Tinkudi]

I'm now 81.5. I've had no radiation or chemotherapy. I didn't have and don't have much pains or numbness. But I have almost all the side effects associated with 5 years of Lupron and abiraterone. I've gotten used to most SEs except fatigue, which seems to be cumulative (and affected to some extent by just getting older). I try to combat fatigue and muscle loss by going to the gym every other day. But now, fatigue sets in, and I can't exercise nearly as much as I could 4 years ago. Also, I had periods of high very BP. I managed to lower my BP somewhat by switching frpm prednisone to dexamethasone to go with the abiraterone (at least I think that was the applicable cause/effect). Hope this isn't too much information.

[Tinkudi in reply to Gearhead]

5 years on just adt and with bone mets seems encouraging. Wish you continued good luck

[Doctorsceptic]

I am going to look at your question in a different way (I am 78 with mets, not taking treatment). The real question (at least to me) is whether taking medication at "our respective ages" makes a blind bit of difference to outcome. After all, death is just around the corner and will come whatever we do. What matters is our quality of life (and quality of dying) between now and the inevitable outcome. ADT has a lot of side effects (vary a lot between individuals but I found them intolerable). ADT has side effects (weight gain, metabolic syndrome, cognitive decline, osteoporosis, sarcopenia etc etc) which just like cancer reduces life expectancy. You might be better off monitoring your mental health, weight, and physical fitness as markers of health rather than blood PSA. Take your pick!

So does the PSA really matter? It is only a surrogate marker of tumour load and tells you nothing about your health overall.

We are all in the proverbial "waiting room" and I guess it is not death that I fear, it is the mode of death. I want it to be quick, and if slow then easy.........

Perhaps that does not answer your question, or maybe it does??

[Tinkudi in reply to Doctorsceptic]

I totally understand your view and respect it. But what does one do when there are symptoms. My dad has some leg pain as he has mets to some pelvic bones and femur. He is finding it tough to put much weight on one leg. In that case I would think if ADT can help shrink the Tumor and relieve him of pain that would be good no?

I understand that as long as there are no symptoms one can get away with doing nothing but what when it starts bothering ?

[Doctorsceptic in reply to Tinkudi]

In this situation, when symptoms become a problem, a conversation has to be had with the oncologist and dad (it may be difficult) and ALL the options for symptom managment have to be on the table. That should be the focus.

I can think of a few management options - local radiotherapy to a painful deposit, surgical stabilisation of a fracture, maybe more systemic therapy, opiod analgesia - but what ever choice is made there will be trade offs and your oncologist must be very honest about the pros and cons of each.

From the sound of it your dad's situation is not good. I am no longer a doctor and fully retired, but if it were me I would be saying 'stuff it', please please just make sure I am as pain free and as comfortable as possible - in the mean time let me enjoy life as much as I can.

That may not be what you want to hear or indeed discuss with your dad. But sooner or later the conversation has to be had. Prolonged futile medical intervention can make life more miserable rather than better. I am very sorry and my heart goes out to you and your dad.

PS Sooner rather than later I will be facing the same issue......

[Tinkudi in reply to Doctorsceptic]

I pray for you too 🙏🏻

Actually dad is otherwise a very healthy 83 year old. And doctors are surprised at how all his other medical work up is so good at his age.

I am hoping the one focal spot on the upper leg which troubles him will be helped maybe by radiation.

Btw what do you mean by more systemic therapy

I am just curious if you would know why so many seem to do quite ok on ADT or orchiectomy but you say you had a tough time.

[Doctorsceptic in reply to Tinkudi]

The main problem enzalutamide with ADT gave me was a syndrome calledPRES - worst ever headache after several weeks of increasing headache, plus severe hypertension. BP systolic 190. Resolved after drug withdrawal. On apalutamide plus ADT rapid weight gain, raised triglycerides , more headaches, cognitive problems (stupid mistake, memory declined and visuospatial abnormalities resulting in clipping a parked car; loss of physical stamina etc) - stopped the lot.

Might consider ADT alone in future but nothing at present.

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

When practicing, you must have been some fucking doctor........ the kind I like.......

Good Luck, Good Health and Good Humor.

j-o-h-n

[Grandpa4 in reply to Doctorsceptic]

that sounds very reasonable for you. It makes the most sense if you have a slowly growing tumor. I did not notice a huge drop in quality of life on ADT and abiraterone. I had no fatigue just a funny muscle fatigue that slowed me down on the bike. My brother is also on them. He did even better than I did. It is really a choice we must each make based on the tumor growth rate and our side effects.

[Roxysdad in reply to Doctorsceptic]

PSA doesn’t matter to me….QOL is my main objective….Your post was well spoken…

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

Give Roxy a patting for me..........behind the ears....... they love that....(I do too)....

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Roxy’s not here right now, she’s coming home from the Bronx…..😂

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

If it's from the south Bronx, she's lucky she made it.

I was born and raised in the south Bronx fairly close to Crotona Park (Morrisania section).

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Tell those Yankees to take it easy on my Padres this weekend…..🙏

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

Of course...... I'm an old Brooklyn Dodger fan and (boy, did I hear it from my friends, called me a turncoat)...

Good Luck, Good Health and Good Humor.

j-o-h-n

[vintage42]

On the other hand, I am almost 82 and healthy except for the Stage IV cancer. I would normally live to 90+, but need the help of ADT to get there now. And the ADT is not causing me any discomfort.

[Tinkudi in reply to vintage42]

Which one do you take

[vintage42 in reply to Tinkudi]

I am taking Orgovyx, and Abiraterone (generic Zytiga) with the required Prednisone.

[Gearhead in reply to vintage42]

I hope you understand how blessed you are if, "ADT is not causing me any discomfort".

[vintage42 in reply to Gearhead]

My blessings are mixed. Radiation in 2021 failed, leaving cancer in prostate to spread, and ADT was not started until after spread. On the other hand, radiation caused me no discomfort, and Orgovyx came along which is a lot easier than Lupron would have been in 2021..

[Doctorsceptic in reply to vintage42]

I think you mean you hope to live to 90+? There is no "normally" for any of us. For myself living to 90+ is not the goal. My goal is to be as fit and happy for as long as possible and then drop dead. 😀

Crack on with whatever you want to use - if ADT does it for you, who can argue with that!