Dad to start Xtandi, does it work in later treatment times?

[Radtech40]

My father was diagnosed at 83 with stage 4 lymph nodes and lots of bone mets, psa 1204. Oncologist started him on 2 weeks casodex then lupron. Lupron alone kept psa to about 20 for 2 years, then started to go up (54) restarted casodex, that with continuing lupron lasted 2 years, then psa started to rise to 70 then down to 55 scans showed no new disease, stable. Oncologist stated he was in anti androgen withdrawal from going off of Casodex, this lasted a year, then psa up to 70, this scan showed no new disease, but one old met enlarging, he said he could try xtandi or radiation, dad opted for radiation. He did a short dose of pelvic radiation which stabilized his psa between 70-78 for almost another year still taking lupron, has never been off of that. We heading to year 6 and dads psa this week jumped from 74/4 months ago to 140. We meet with oncologist monday to discuss him starting Xtandi. Some articles I've read say it works better early on that later, but his oncologist wanted to save it for later he said, hoping it will work....he gets another scan before he starts it to see what is going on. Any experience with Xtandi being used later in treatment?

[Tall_Allen]

I would encourage your father to find a new oncologist. I don't know any of the details of his case, and maybe there is good reason for the treatments he received, but I suspect ageism. The elderly are often under-treated.

prostatecancer.news/2016/08...

It sounds like your father has been undertreated. Please, at least get a second opinion at a hospital of excellence. Where is he located? Maybe I can recommend someone.

[Radtech40 in reply to Tall_Allen]

St. Louis, MO. Thanks

[Radtech40 in reply to Tall_Allen]

My dads PCP told him at 68 years of age that his psa was 9 and he should get a biopsy, my dad said he didn't want to get one (my dad hates docs) so his PCP NEVER checked his psa again. Dad had a small stroke at 83, a hip x-ray found mets and that was how he was diagnosed

[Tall_Allen in reply to Radtech40]

You have Barnes Jewish in St Louis - some really excellent oncologists.

[Radtech40 in reply to Tall_Allen]

That is where we go, Barnes Jewish Siteman Cancer Center, the best they have here. Thank you for looking that up. I agree with the fact that due to age, some people do not get the appropriate treatment. Wish us luck Monday.

[Magnus1964]

Your father's treatments have been somewhat erratic. You might consider a second opinion. At this point I might suggest abiratorone instead of xtandi. If abiratorone fails, then try xtandi.

[Radtech40 in reply to Magnus1964]

Yes, they have been, ok thank you. We have an apt Monday with the oncologist. Looks like both are about the same in extreme cost.