Father diagnosed with stage 4 metastatic prostate cancer

scared88

My father, who is 88 years old, was diagnosed on Wednesday with stage 4 prostate cancer with metastases to the bones. His most recent psa is 90. His gleason score is 9. For the past 10 years his psa levels have been going up from 4 to 10 to 13 to 30 to 40. They only performed a biopsy the week before last because an xray showed cancer in his bones. I think they have basically written him off because of his age. He is really mad, and so are we, that they didn't do a biopsy 10 years ago. The doctor has recommended some drugs something called lupitor and zytic (i am not quite sure about the names) and prednisone. He doesn't want to take the meds because he figures it will only extend his life a little and it is not worth it and he doesn't want to pay the high cost of one of the meds. The doctor just sent him home with a description of the meds, but no instructions on how to take the meds. They didn't even tell him that he should start taking the meds before his upcoming ct scan. 

Does anyone have any advice on how to cope? Would these drugs help my dad? Should he get radiation? 

 

This has been a punch in the gut. 

 

VascodaGama

NCCN guidelines recommend palliative approach to aged patients

Scared,

Welcome to the board. Unfortunately, there is no recommended therapy with the intent of cure to patients with widely spread metastases. The age of your dad also imposes some restrictions on protocols. I think that his doctor has recommended hormonal treatment (ADT) with Lupron shots plus Zytiga (with prednisone), which are the best for similar situations. Apart from ADT one can also opt for chemotherapy but this involves nasty side effects. ADT's side effects are milder. Radiation is usually spared for pain management in bone, when required.

In any case, ADT got a wide arsenal of weaponry to fight the disease so that your dad can try different drugs cheaper than Zytiga. The common protocol is Lupron plus Casodex (bicalutamide). These drugs will cause hypogonadism which condition leads to the many side effects one experiences, similar to menaupose. The purpose of Lupron is to stop the testis from producing testosterone (chemical castration) as the bandit survives with the stuff. Casodex will prohibit the cancerous cells from absorbing testosterone. Instead of Lupron many guys have an orchiectomy, in particular aged patients. This protocol would be probably recommendable to your dad so that I suggest that you discuss the matter with his doctor.
In any case, the CT scan and other exams (DEXA scan) will add more info on his case so that other medications may be added to the protocol. For instance; Prolia that would **** bone loss.

Can you share more details on your dad's health? Is he taking any medication for other illness? Did he go for second opinions from other specialists?

Here are links with more details for you to read;

https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/

https://www.cancer.ca/en/cancer-information/cancer-type/prostate/treatment/metastatic/?region=on

https://www.mayoclinic.org/tests-procedures/hormone-therapy-for-prostate-cancer/about/pac-20384737

Best wishes and luck in his journey.

VGama 

scared88

VascodaGama said:

NCCN guidelines recommend palliative approach to aged patients

Scared,

Welcome to the board. Unfortunately, there is no recommended therapy with the intent of cure to patients with widely spread metastases. The age of your dad also imposes some restrictions on protocols. I think that his doctor has recommended hormonal treatment (ADT) with Lupron shots plus Zytiga (with prednisone), which are the best for similar situations. Apart from ADT one can also opt for chemotherapy but this involves nasty side effects. ADT's side effects are milder. Radiation is usually spared for pain management in bone, when required.

In any case, ADT got a wide arsenal of weaponry to fight the disease so that your dad can try different drugs cheaper than Zytiga. The common protocol is Lupron plus Casodex (bicalutamide). These drugs will cause hypogonadism which condition leads to the many side effects one experiences, similar to menaupose. The purpose of Lupron is to stop the testis from producing testosterone (chemical castration) as the bandit survives with the stuff. Casodex will prohibit the cancerous cells from absorbing testosterone. Instead of Lupron many guys have an orchiectomy, in particular aged patients. This protocol would be probably recommendable to your dad so that I suggest that you discuss the matter with his doctor.
In any case, the CT scan and other exams (DEXA scan) will add more info on his case so that other medications may be added to the protocol. For instance; Prolia that would **** bone loss.

Can you share more details on your dad's health? Is he taking any medication for other illness? Did he go for second opinions from other specialists?

Here are links with more details for you to read;

https://www.pcf.org/about-prostate-cancer/prostate-cancer-treatment/

https://www.cancer.ca/en/cancer-information/cancer-type/prostate/treatment/metastatic/?region=on

https://www.mayoclinic.org/tests-procedures/hormone-therapy-for-prostate-cancer/about/pac-20384737

Best wishes and luck in his journey.

VGama 

Father's overall health

Thank you vgama for replying. 

My dad has diabetes, overweigh, high blood pressure, a pacemaker and high cholesterol. All of which he has managed with medication. He is surprisingly fit for his age. He is cognitively as sharp as ever and I think that although he is overweight, what really helped him is that he was very phisically fit as a young man and is still very active.

The doctors have talked to him about taking the medications, side effects, contr indications. One of the meds costs $200, which doesn't seem that expensive to me, but I think he has pretty much given up.

He has not gotten a second opinion. I don't think he wants to. He doesn't want us to talk to his doctor. 

Thank you again,

v.

 

 

 

VascodaGama

Some medications interact with PCa drugs

Your dad got several issues which seem common to a 88 years old. He should get the opinion of a medical oncologist as drugs for prostate cancer may interact with the medication he is taking. You may try accompanying him in his next consultation and inform about the issues. I wonder the real name of the drugs you describe above. Lipitor is taken to control the cholesterol and costs about $160 for 30 pills. Which drug costs $200?

Prostate cancer medication like Lupron 6-month shot costs about $700 and a box of Zytiga (120 pills) cost about $11,000. The Casodex is about $50 for a box of 30 pills.

Best wishes,

VG

 

scared88

More details on meds

I looked up the details of the medications they have recommended for my father:

Zytiga...this is the one he didn't want to pay for. Fortunately, his doctor has a grant which will pay for it.

Vitamin D3 and calcium

Prednisone 

Zoledronic acid for high calcium (we didn't quite understand why he would need more calcium if this drug is meant to reduce calcium).

Lupron

His biopsy lab results were as follows:

Right side:

Gleason 4+5 =9 grade group 5, 15% of total tissue volume on one of six cores (5% of total tissue)

Gleason grade 5 for 30% of tumor. 

No perineural invasion.

 

Left side:

Gleason 9, grade 5, approximately 35% of total tissue volume on six of six cores. Gleason 5 for 5% of tumor. + for perineural invasion.

 

I hope he will let me keep him company at his next appointment.

I did read that one of the drugs may interact with his diabetes medicine. 

 

 

 

VascodaGama

Free Zytiga is usually obtained in Clinical Trials

Hi again.

It seems to me that his doctor is recommending the best approach for the condition of your dad. Surely the CT scan will provide more details (lymph nodes involvement, etc) so that the doctor will adapt the findings to the protocol. I wonder why Zytiga is free of charge. Probably the doctor has set your dad into a clinical trial. Can you find which trial would that be?

Clinical trials are very good and safe. The treatment is free of charge and the patient is well looked after along the years/treatment. The only disadvantage is that the patient and the doctor cannot change the protocol while on trial. Surely one can stop it if any bad event occurs.
In such regard, I wonder if Lupron (leuprolide) could be substituted for Firmagon (degarelix) as your dad got heart issues. Firmagon is cardio vascular friendlier than Lupron. However, both Lupron and Firmagon may reduce the effectiveness of his medication for diabetes so that the blood glucose should be periodically tested.

Zoledronic acid (similar to Prolia) is used to help in the formation of bone (metabolism). It lowers the blood calcium levels, but old people need more calcium that the average so that the doctor has recommended calcium intakes. Bone metastases will cause bone loss which needs control and the body needs vitamin D to digest the stuff. Prednisone that is taken to pair with Zytiga (to avoid some side effects cause by this drug) also decreases bone formation. This is a game of interactions and counter actions.

From your info I assume that he got 7 positive cores out of 12 all with the Gleason rate 5 (S9) which is the highest aggressive. They also found perineural invasion (the gate for extraprostatic extensions) leading to a localized condition. Bone mets turn your dad's case into stage T4. I wonder the extent of bone lesions. Do you have the Bone scan results?

Treatments for prostate cancer deteriorate the quality of life of the patient. One needs to treat but we should try balancing things. The above palliative treatment will not cure but extend the life of your dad. I wonder what may be the best for a 88 years old man with several other health issues. Overall I think that your dad's wishes should be respected. You may try gathering the opinions from all family members keeping everybody informed of the situation.

Best wishes and luck.

VGama