Dads recent diagnosis

Well that is a good response to treatment. I'm sure you've googled a lot by now. Once PCa has spread to bones it is considered incurable, but that does not mean it can't be treated and managed. There is no point in removing the prostate now, and targeted treatment of where it has spread to is probably pointless as by now it will be lurking in alsorts of places waiting to pop up. So the treatments are now systemic such as chemo, enzalutamide, ADT. They typically become ineffective after a few years, they can then try swapping him from one treatment to another. The chances of him living at least a year are quite high, the chances of him surviving five years are not very high, but we have people on here who have survived 15 years with advanced prostate cancer, so anything is possible. 

ADT stands for androgen deprivation therapy, which is another name for hormone therapy (or HT). The usual starting place for ADT is a four week course of tablets (bicalutamide) followed by either monthly or three monthly injections of a drug which stops the production of testosterone. If testosterone is stopped prostate cells become dormant. ADT costs the NHS about £1000 per year. 

Enzalutamide (Enzo) is a top of the range drug. I think it costs about £30,000 a year, so usually the NHS held this back as the last treatment. 

Thanks to covid men are getting enzalutamide instead of chemo, it is probably the better treatment. Hopefully it will carry on working for a number of years, and then if (when) it stops working they will try one of the other treatments. 

I don't know if anyone knows if in the long term starting with Enzo and then switching to the cheeper treatments will prolong life overall, as until covid no one has tested this approach of doing things backwards. Chemo suppresses the immune system so at present it is too risky. 

By the time Enzo stops working hopefully covid will be a distant memory and they can then try him on chemo or ADT. 

So yes as one treatment fails they will switch to another one. He could probably apply for a trial of a new treatment, once things get desperate, that is a gamble but when you have nothing to loose, so what. 

I can understand you wanting to see the consultant with him, and it would be a good idea. But I can see that a man may not want to talk about erections and sexual function, blood in semen, with his daughter in the room, and those topics do come up when dealing with prostate cancer. 

You may be able to come to an arrangement where you go to the consultation and agree to leave and wait outside the consultation after a few minutes and then be called in for the summing up. I have never tried this sort of arrangement myself. 

How old is your dad? I tend to take the view that if a man reaches 80 he has reached a reasonable age, and PCa is better than alzheimers. If he is under 70 he has been short changed in life and anywhere between 70 and 80 it's a bit of bad luck. 

Good luck. if I have missed anything important I hope another contributor will come along. Keep posting on here with any questions, or just to let us know how you are getting on and how he is getting on. 

Oh I’m so very pleased I came on here , thank you so very much for posting a reply to me with that info … I feel so much better now you have … I’m very poorly myself and I find it very difficult to get my head around but feel assured when I understand it all better. 
My dad is 73, he’s a very strong, stubborn  man who never complains and to try and get him diagnosed in the first place was really really stressful as I could see he was in excruciating pain and he would never ask or pester the doctors , they just thought it was constipation…  so I managed somehow to call 111 and speak to various doctors and finally get him seen… but it took months of nagging. 
Im glad he’s got the diagnosis and on correct treatment now but I hate to ask him lots of questions when he’s going through everything and trying to get his head around it all so coming on here and asking for this help is so much better as I’m really starting to understand things. 

Thank you so much again , it’s really appreciated. ( you will never know how much ) 

Hayley 

Fairly common attitude us men have. This disease sneaks up on us, no symptoms until it is quite advanced. It has probably been lurking in him for 10 years. Most men over 60 have got PCa, but it will grow so slowly they will die of something else long before it gets them. So your dad has probably saved himself 10 years of worry, possible incontinence and impotence, it may have shortened his life by five or even ten years, but to quote a comedian I heard on TV "those last few years are rubbish anyway".

I'm glad you are finding the site useful, ask any questions, and keep us updated good news or bad. I think a lot of us here will be interested to know how long the early Enzalutamide works for, let us hope it is many years.