Dad (68) recently diagnosed with metastatic PCa

Hi mag

I've just read your thread so playing catch up,I'm just going through my 2nd round of chemo and side effects seem to kick In a few days after injection then Peter off after a week leaving me about a week and half of pretty decent QOL I also have stomach injections for 5 days for white blood cells,it's great news to hear that your dad has responded well to chemo and hoping that his PSA remains undetectable for a long time,fingers crossed I follow the same route, oncology appointment next month so I'll see where I stand then.

Regards Phil 

Hi all,

First of all wanted to say a huge thanks as this forum has been a great resource in recent weeks as we've been coming to terms with all this. I wish you all the best. 

Yesterday my Dad's diagnosis of metastastic PCa was confirmed as he got his bone scan results back, showing it had spread all over his bones. Thankfully, it hasn't spread to his lymph nodes or visceral organs, at least. His PSA was only 15, but his Gleason score was 5+4 (in that order, sadly) - clearly aggressive, so I suppose not surprising it metastasised before it was ever discovered.

Treatment-wise, some good news in that he's getting the new 'triplet therapy' treatment that was recently approved by NICE for metastatic prostate cancer, which seemed to be quite promising in clinical trials: 

1) Androgen deprivation therapy (ADT) - the 3-monthly LHRH agonist injections (he had his first about 3 weeks ago)
2) A course of docetaxel chemotherapy - which he starts in a couple of weeks and should hopefully complete by December. 
3) Darolutamide tablets daily - which he'll start alongside docetaxel. 

Based on my brief foray into the medical journals, this seems like the right treatment regime for him, so I'm quite reassured by that. But no doubt, the Gleason score is scary. 

Naturally, we're all in shock as his only symptom (developed recently) was frequent urination. No bone pain or anything like that. He's otherwise very fit and healthy, generally full of energy for someone his age, swims 3 times a week, still perfectly able to do his manual labour job full time (he's off work at the moment due to a recent, unrelated hernia operation - frankly, he misses work!). 

He's mostly coping by staying busy and sociable, and living his normal day-to-day life - it's a lot more difficult for him when he's not occupied, so we're keen to keep him as busy as he wants to be, if we can. With that in mind, I had a few quick questions that I was wondering if anyone had any thoughts on:

1) The Docetaxel chemo seems to be more tolerable than most forms of chemo, but I'm guessing that he'd not be able to work during that treatment? (given the nature of his work, and the effects on e.g. immunity) Would he be likely to be able to return to work afterwards?

2) Similarly, would it be advisable to keep up the swimming during the docetaxel treatment? I get the sense exercise is beneficial with PCa, but again concerned about the immunity point. I suppose he may not have the energy anyway. 

3) Hugely grateful for any wider advice on how we can support him through his treatment and more broadly.

I can post updates of his journey here in case anyone's interested.

Thanks all!

I am on the exact same plan is your dad, just got in on the Darolutamide after is was approved for Advanced PC.

On the immunity front it's a hard battle to stay away from illness for the 5 or so months of the treatment, and on my first chemo I was brought down by Strep A 8 days later and was in the local hospital's acute ward for 5 days. After that my oncologist started adding the injection I can do myself which you inject into your belly fat 24 hours after chemo. I can't remember the name of it but it allows the white blood cells to come back to normal (or even high) levels during the 3 weeks gap. I'm not sure why this isn't given by default, but I had it every session after that and was fine with colds, and I had at least 3 of them during the 5 months. Might be an idea to ask for it from the get-go.

I think he might also be offered radiotherapy once the Chemo has finished, and that's where I am now. Had the spacer gel injected and the planning CT/MRI scans and start RT on Tuesday at a GenesisCare centre.

My job is working from home so I was able to continue it, but anything more than moving a mouse around I would have probably given myself the resting time away from work, the fatigue was pretty bad on a few of the days in the cycle and I found myself in bed a lot of the time on those days.