Daddy recently diagnosed APC

I have hormone resistant prostate cancer, the docs are now suggesting Zytiga.....Ive heard there is another drug besides prednizone that it can be taken with that doesnt hurt the immune system the way prednisone does........Im brand new to this network and still finding my way around so any help you can offer would be appreciated.....

thanks so much

TYTD

Kay

From the info you shared here I see the “baddy” in the metastases at spine and shoulder. Probably his clinical stage is T3NxM1b. The Gleason pattern 4 is also not good but the cancer is responding well to the hormonal treatment.
In any case; these diagnoses should be confirmed in the next bone scan. The worry is if we can consider false negative results from those scans. If the procedure is done at antiquated facilities/equipments.
I also would recommend him to get a MRI done in a Tesla 3 machine. (Get him into Europe if he cannot find a T3-MRI in Africa)

Does your dad trust the doctors and the hospital where he is consulting?
What about second opinions on the recommendations?

So far the procedures he has followed by his doctor are correct in my view. The only problem would be if his doctor got the proper tools to deliver the best treatment.

Unfortunately all treatments for prostate cancer have risks and cause side effects. It is the duty of the patient (and the family) to decide on a preference that is acceptable. Older patients sometimes are recommended palliative therapies so that they avoid the risks of radicals (surgery and radiation) with regards to the Quality of Life. 75 years old is usually the limit for radicals as recommended by NCCN guidelines. Your dad is a younger 73 full of energy and healthy. As you commented he feels OK and is ready for the challenge.

Brackytherapy is a treatment for localized diagnosis. This will care for the prostate gland alone. IMRT is wider and it includes the gland and close peripherals. Metastases at the spine and shoulder should also be included which turns the localized therapy inconclusive.
M1b cases (confirmed far metastases) are usually not treated with radicals. Doctors prefer to use focal radiation to the spots they find reserving other areas in bone for later attack to treat pain (typical of cancer symptom in bone). The reason is that radiation should not be directional to the same areas twice because it may cause fistulas.
Radiation is only applied to pre-defined targets with intent at cure. Full dosage and proper isodoseplanning is required. In a case like your father (M1b) Bracky would be considered debulking only (eliminate the biggest portion of cancer in the gland but not the whole).

Surely this way of treating is also feasible. It extends life but at a cost of quality living. In such cases the radiologist should take into consideration QoL when deciding on the field to radiate. “Zipping” the most out without much destruction and no cure in the scope.

This is why proper image studies are important in the decision process. I recommend your dad to try getting the best scan he can afford.

Advanced prostate cancer patients are usually recommended to hormonal and chemo therapies. These do not provide cure but it can pin down the cancer for long periods of time (years). One starts with a first-line HT (your dad’s case) with leuprolide acetate (Lucrin, Lupron, Eligard, etc) RHLH agonists plus antiandrogens (Casodex, Cyproterone, etc) and then moves to a second line HT when the drugs become ineffective. Before chemo there are still immunological treatments which overall extends the life of a patient considerably. Many reach the 15 year mark.

I think that your dad is taking Flomax and Valdoxane to counter the effects from hypogonadism. HT is not free of symptoms either, but they may be more amiable than problems of incontinence, bowel colitis or fistulas.

Your dad will need a series of other tests to control the progress of his case. Testosterone is very important in HT and so it is a dexa scan to look for osteopenia/osteoporosis (induced by HT and cancer). He may need taking a bisphosphonate. ECG for heart health should also make part of the routine as well as any other image study. The lipids need to be checked to look for diabetes and to verify for interaction of the medications. Care with Anemia.

Being active and changes in diet and in the way we do things may become required to counter the effects too. Here is a booklet for your reference;

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

I like to see you so involved in his care. You are wonderful and he his very fortunate for having such daugthers.

Best wishes in his journey.

VGama