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Elder diagnosis choosing no treatment

Posted 26 Dec 2018 at 19:54

I am writing about my father who is in his late 80's and has advanced prostate cancer with bone mets. He has decided to not pursue treatment. He has had a catheter since July due to prostate enlargement. He had a CT scan at the end of October that reveled widspread cancer to his bones. There is a lot of involvement in his lower spine and tailbone as well as his pelvis. He recently started having pain in his legs and his feet. He is very stiff in the morning or when he first gets up, but he also has extensive arthritis in his hips that has been painful for a long time, so hard to tell what the true cause of the pain is.  I am seeing lots of posts for people who are receiving treatment, but not a lot of people in my father's situation. Would love to hear people's experiences in this similar situation. What to expect and what to prepare for are the biggest questions I guess. He has been designated as a hospice patient. My Mother is still living and he is being cared for at home by her and  family along with Home Health staff a few hours a week. I am concerned that he may be starting to have some spinal compression symptoms. 

Posted 26 Dec 2018 at 20:12
Hi, my father-in-law was 79 at diagnosis and declined hormone treatment but he was thought to be localised so slightly different to your dad. He lived for 4 years. My dad is 82 and has had a recurrence of prostate cancer but is also declining treatment at the moment.

The difference between my dads and your dad is the bone involvement. I can understand why he might not value HT as a treatment to stop the cancer but I am amazed that his doctors haven't explained to him how important HT could be to reducing his pain. Men don't die of bone mets but the pain becomes excruciating and cannot be totally eradicated by pain relief meds so the normal ending is that thy slip away to a coma induced by the ever-increasing levels of morphine. It is different for men with soft tissue mets who are more likely to have organ failure and not necessarily much pain.

If you believe he has SCC, you should phone an ambulance without delay.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 27 Dec 2018 at 09:44
I think it’s entirely appropriate that your Dad should decide whether or not to endure ‘treatment’, as in these late stages they tend to be ‘kill or cure’. But if hormone therapy could help, why not? I don’t suppose he would be too bothered about growing ‘moobs’ if it provided some pain relief.

It is good that a hospice is involved, and let’s hope they can do a decent job with him in terms of palliative care.

Best of luck to you all.

Cheers, John.

Posted 27 Dec 2018 at 18:41

Thank you both for your replies. He had been taking Lupron and bicalutamide, but they were not effective. 

I have spoken with Home Health and they are preparing for care at a respite house once it is too much for my mother at home. They feel we are looking at weeks to a couple of months at this point.

Posted 27 Dec 2018 at 19:17
Ah sorry - I read it that he had recently been diagnosed and had refused treatment. Deciding to stop treatment is a different matter.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 27 Dec 2018 at 20:30

The bone involvement was recent. I may not have been clear. He only agreed to the hormone treatments after the prostate enlarged to the point he had to have an on board catheter. That was stopped when the CT showed that he had bone mets and placed on hospice care. Talked to my Mother at lunchtime and he fell getting out of his recliner, taking her down with him. They are both ok overall. Just anther sign he is getting weaker. Home Health was in for a regular visit shortly after. I have not spoken with them yet since his fall.

Posted 27 Dec 2018 at 20:51
It is still very unusual - many men stay on the hormones right up to the end because it reduces the worst of the symptoms. On the other hand, hospice teams are usually much better than hospital staff at getting the pain relief balanced well so you have good reason to hope he is in good hands.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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