Newly diagnosed prostate cancer and heart failure

User

Posted 12 Jun 2026 at 08:02

Hello everyone I am new to the community.

A bit of background: my dad is 67 and was diagnosed in April with advanced prostate cancer Gleason 10 with spread to pelvis and 2 rib nodules. A week following this, he was was admitted to hospital and diagnosed with heart failure EF16%. We are just shocked. He is a very active man, works a manual labour job and continues to do so full time with both diagnoses. Looking at him, you would not believe he has the diagnoses he does.

He was started on bicalutamide and then prostrap for the prostate cancer and is now on heart failure meds too. The oncologist still hasn’t even seen him face to face 2 months down the line, just one phone call appointment on Tuesday where they said he is not eligible for chemotherapy due to his heart. We are just devastated. We feel like if they could see go well he is managing then they would be more willing to help us.

My question is, do any of you also have heart failure? What options have you been given? Is it worth us exploring second opinions and how would we go about this?

User

Posted 12 Jun 2026 at 09:52

For a first post this one is an absolute doozy. Leaving aside the stage 4 Metastatic PCa. Your dad's heart failure, with as you say, an ejection fraction (EF) of 16, and still undertaking physical labour is truly astounding. A normal EF is in the range of 50 to 70. A borderline EF lies between 40 to 49 with associated shortness of breath (SOB) with activity. An EF of below 40 is associated with SOB at rest. Even sleeping is associated with paroxysmal nocturnal dysponea. So for a person engaging in physical labour when their heart is only pumping about 30 % of the body's requirement for homo stasis, is really a medical marvel worthy of a Lancet article. Surely the EF threshold is incorrect?

To a degree (it does vary somewhat twixt pharma) but all forms of ADT can interact unfavourably with heart failure. Not surprisingly the risk increases as the heart failure progresses. Most physicians would be of the view that there would be little point in seeking to control PCa Stage 4 mets in this scenario.

User

Posted 12 Jun 2026 at 11:30

That’s why we are also completely shocked and confused. No oedema or anything, and managing with a 16% EF on top of the stage 4 cancer is very confusing to us. I know that hormone therapy can have an effect on heart function but he was only on the hormone therapy for a week prior to the HF diagnosis so I would be very shocked if this is correlated.

I think we will have to go back to cardiology and ask for repeating testing, as he is now missing out on chemotherapy due to the EF, despite being as active as he is.

User

Posted 12 Jun 2026 at 12:12

Hello JCAT

Indeed there is something inconsistent with this story. The 16% EF makes no sense - your father would have trouble just walking around. So this needs to be confirmed immediately.

Starting your father on bicalutamide and prostrap makes sense - as it should stop the cancer from spreading further - at least in the short term - so you have a little time to investigate the best possible treatment. However whatever treatment is decided upon really is conditional on the status of his heart.

Courage!

Crispin

User

Posted 12 Jun 2026 at 13:17

Hello,

Thankyou for your response. It’s urging us to request a review as none of this is adding up

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