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Posted 03 Sep 2022 at 21:21

Hi all,


Its been a while since I was on the forum for support! but here we are again.  Quick recap: Dad diagnosed Gleason 8 (age 70) in 2010 was told contained to prostate, had prostatectomy in Feb 2011 but psa started to rise later that year. On Casodex intermittently until 2017 when psa started rising again. 2 spots appeared on rib so put on zoladex and it reduced.  2020, started getting chest ache had X-ray - originally said shadow on lung and wanted ct, then changed their mind and said it was from known shadow off rib so didn't do ct. 2021, with zoladex, psa started rising again. Was told would treat when reading over 2, but somehow bloods weren't picked up and acted on in March. They are now over 5.  Based on reading, he was put back on casodex and in the meantime had a ct and bone scan. He got a call out of the blue (4 weeks after scan to say they had mdt meeting day before) which has shown lymph node involvement and in lungs (according to Dad, although really need letter from hospital to confirm as he doesn't always pick up what they say and not sure what lymph node area) They now want more bloods and a chest xray. He has never had radiotherapy or chemo, just removal, casodex and zoladex. What, if any is the next likely treatment (if any) considering he is now 82 and suffering atrial fibrillation and possible heart failure too.  I have read enzalutamide as a possibility but wondered if anyone could assist until this letter comes through. You try and call the secretaries and they never pick up or return calls so I'm a bit in the dark and just going by what my Dad said. Thanks very much.

User
Posted 03 Sep 2022 at 23:34
They may leave him on casodex for a while to see if it helps the zoladex to be more effective, and then stop the casodex in the hope of getting an anti-androgen withdrawal response. After that, enzalutimide, abiraterone or apalutimide are likely next step - there is very little to choose between them but I think if my dad was given the choice, I would probably go for apalutimide as it is the newest. Be aware though that these second line HTs all have the potential to make his heart disease worse - the onco may be concerned about prescribing or it may be agreed that he will be closely monitored.

Some oncos would opt for chemotherapy before abi / enza / apa but I suspect that with your dad's heart problems, chemo is better left on the shelf for now.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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