Hi all,
I’m looking for some advice about my Dad who has advanced Prostate cancer. Apologies if I’ve got some of the details wrong.
In terms of background, he was diagnosed with non-operable locally advanced prostate cancer just under 6 years and is now 75 and it is now advanced and terminal.
He has previously had radiation therapy and all the available forms of hormone therapy (abiraterone worked for a while, but sadly Enzalutamide wasn’t effective). He has also previously had two rounds of Docetaxel (they tried him on Cabazitaxel the second time but he had an adverse reaction this so they went with more Docetaxel). The first course was shortly after diagnosis and worked well – keeping his PSA down for a long time (in combination with hormone therapy). The other (around a year ago) worked well when he was on it but his PSA started to rise again almost as soon as it was over.
Earlier this year he volunteered for a clinical trial testing a new form of medication (and was getting regular tests/scans) and that seemed to be working for a couple of months (his PSA went down a bit) but he's now off the trial.
This was as his PSA has now climbed rapidly to over 3000 and the scans showed significant spread/growth within his lymph nodes. The disease is also in his bones, but there seemed to be less concern about this by the medical staff (apparently the growth there is stable) in comparison to the growth within his lymph nodes.
He consequently has pretty much exhausted his treatment options, although his consultant has suggested a third round of chemotherapy (using mitoxantrone) may be an option. Understandably, medical staff have been pretty vague about how long he might have left – other than to say the evidence suggested months not years.
He isn't in any pain, but has been more fatigued in the last few months (taking to his bed more frequently) and can’t walk or stand for as long as he used to, but he still gets out and about. does some gardening and has a high quality of life.
I had put a lot of hope that the trial would be a game changer, but recognise that I should have been more realistic. I realise that many men with cancer don’t survive as long as he has already, but I’m still finding it very hard to come to terms with the fact that this will very likely be his last Christmas.
I was consequently wondering if anyone might be able to offer advice about the following questions:
1) Has anyone undergone (or know people who have undergone) treatment with mitoxantrone as a third line chemotherapy option? If so, did it provide a significant reduction in PSA/growth and were the side effects manageable? I ask, as it is my understanding that repeated courses of chemotherapy tend to have diminishing returns. My Dad seems to be undecided about whether to go for it as it is unclear about how much benefit it will give him (in terms of potential longer survival versus how much the side effects would detract from his time left.
2) Does anyone know of the current status of the approval for Lutetium (177Lu) on the NHS (he’s in Scotland if that makes a difference). I’ve looked online and I’m a bit confused as to what is happening. I recognise though that even if it gets approval, it will probably be too late for him.
3) At what point does it tend to be clear that the end is nearing in patients with cancer of this type (i.e. with significant lymph node involvement) – i.e. how much warning do you tend to have that things are going downhill?