Hi,
You are correct you have been doing AS for ten years without realising it. The finasteride does confuse matters, but I think we will go with the generally accepted wisdom that real PSA is about double the measured PSA when on finasteride.
With AS the objective is to keep monitoring until some threshold is reached and then to move to a more aggressive treatment. I think the consultant would argue that threshold has now been reached.
The fact this cancer has been progressing slowly over the last decade suggests an extra few weeks(months, years?) to decide will not be a great risk to his survival.
I did not have many side effects from HT: no libido, and impotency (not a problem when you have no libido), dry orgasm, some hot sweats but not many (perhaps once or twice a month and they only lasted a few minutes), a more emotional personality, perhaps a little more irratable (none of these were massive changes in my personality but I think they were because of HT), not much change in weight, perhaps a little less muscle mass and a little more fat, but not much either way. I have been off HT for about 3 months now, I would not say I have made much of a recovery yet, I hope that over the next year things will improve. The statistics for RT and HT together are quite impressive, the major benefit of the HT is in the few months before and after RT the second year of HT may not be adding that much to your dad's chances of survival, so maybe he should just stop it early if he doesn't like it.
If the cancer becomes advanced then HT can become a lifelong treatment, I would not like to be in that position.
You will find a few people on this site who have had treatments which have failed and have now decided that Quality Of Life (QOL) is more important than pursuing an extra few years of life.
The following is an interesting tool from the NHS it takes a bit of playing with, and at the bottom you will see the results can be displayed as "Curves" and you will want to tick the "Radical" box to see all information:
https://prostate.predict.nhs.uk/tool
For your dad's details (I have had to guess a few things) it says your dad's chances of surviving 15 year (i.e. to age 92) would be about 28% if he had never been diagnosed with cancer, 21% if you did not opt for any treatment, and 24% if you opted for radical treatment (surgery, or RT outcomes are about the same).
Another way of looking at this is to look at the curves and see how many years until 50% of people currently your dad's age will die, this is what would normally be called life expectancy. If your dad had never been diagnosed with cancer his life expectancy would be another 12 years, if you do nothing his life expectancy would be about 10.5 years (the last year or two may be painful), if you go for radical treatment his life expectancy is about 11 years (and probably only painful for the last few months).
I don't know how accurate the NHS tool is and everybody is different. I think I would advice your dad to take up motorcycling and parachute jumping both will increase his chances of dying from something other than prostate cancer.
Edited by member 17 Jul 2020 at 11:56
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