Treatment options for older patient (Stage 4 with Polymetastatic bone involvement)

User

Posted 23 Sep 2026 at 10:15

Hi all,

My Dad was diagnosed with Stage 4 prostate cancer with polymetastatic bone involvement.

He is in his mid 80s and has some heart conditions that are serious (aneurysms, minor heart failure), though currently under control. He is probably more like a man of mid 70s given his fitness and what he's able to do. He has been described as 'very fit' (performance status of 0) on correspondence.

We had a meeting with his consultant who was very helpful, and is balancing his quality of life with the treatment he has available.

His consultant's approach at the moment is ADT in the form of the 3 month Zoladex injection (with Bicalutamide to counteract the testosterone spike caused by the Zoladex).

It seems his consultant is currently steering us away from either doublet or triplet therapy. Chemotherapy is probably not a good idea for a man of his age, but I'm not convinced he couldn't try one of the newer second generation treatments like Darolutamide. I asked about this due to its favourable side effects on the heart compared to similar options. The consultant referenced Darolutamide saying 'do you want to be on a drug that no one else is really on?' - which leads me to think there isn't much uptake in his patients, or he doesn't have familiarity with it.

His consultant considers his heart conditions to be the more serious risk, so given this and his age it explains the conservative approach. My Dad has lived with his aneurysms for a long time now and since his blood pressure is under control they have not progressed in size. His heart failure is minor and he is actually looking in to an ablation procedure to see if it can be fixed. To put it one way, he is 'game' for trying things while he can.

We have looked in to a private second opinion, and my Dad is currently on the fence with this. He does think 'maybe I'll be kicking myself 6 months down the line' but I don't see the harm in being able to take something back to his consultant if there's any difference of opinion. I think he might be concerned with causing offence to his current team given he had a bad experience in the past with a second opinion for a different condition.

Any advice on different treatment options and the second opinion would be much appreciated.

Edited by member 23 Sep 2026 at 10:35 | Reason: Not specified

User

Posted 23 Sep 2026 at 10:55

L , I am 75 and on decapeptyl injections and half the normal dose of apalutamide (120 instead of 240). The full dose was creating to much fatigue, the hot sweats were an inconvenience but not a major issue. My blood pressure went out of control and even at half dose it is an average of 170 /90 despite being on 4 BP tablets, it does occasionally get to 195/110.

Choosing quality of life or quality of life is always difficult. I told my GP I would sooner die of a heart attack that a long drawn out death from the cancer. Worst case scenario would be a stroke.

Thanks Chris

User

Posted 23 Sep 2026 at 14:36

Originally Posted by: Online Community Member

The consultant referenced Darolutamide saying 'do you want to be on a drug that no one else is really on?'

I think your consultant is not up-to-date with treatments.

You don't need to go privately for a second opinion, you can ask for that on the NHS. If you can access one of the specialist cancer centres, that would be a good option, but it might not be nearby. You could talk with your GP about it.

Regarding chemo, generally speaking, the further you are over 70, and the more comorbidities you have, the less likely you are going to get it. The ARPI meds (such as Darolutamide) are generally a better bet for someone of that age.

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User

Posted 23 Sep 2026 at 10:55

Choosing quality of life or quality of life is always difficult. I told my GP I would sooner die of a heart attack that a long drawn out death from the cancer. Worst case scenario would be a stroke.

Thanks Chris

User

Posted 23 Sep 2026 at 14:36

Originally Posted by: Online Community Member

The consultant referenced Darolutamide saying 'do you want to be on a drug that no one else is really on?'

I think your consultant is not up-to-date with treatments.

User

Posted 23 Sep 2026 at 15:39

Thanks Chris, Andy.

We are aware the quality of life is a big factor in any decision, and every treatment choice will have some impact on QOL.

The reason for the private second opinion is basically the speed at which it will get done. We were looking at The Christie in Manchester for it, whereas now he is at less specialised hospital.

We were still impressed by the consultant's knowledge and experience, and there seemed to be a good dialogue with him, but I note your concern Andy that he may not have that much experience with newer drugs. He also seemed worried with long term data regarding Darolutamide, and mentioned Apalutamide and Enzalutamide as drugs he has more familiarity with. From what I've read Darolutamide has fewer side effects due to not crossing the blood brain barrier and also seems safer on the heart.

I guess we're just looking at his options at this stage and what the tradeoffs will be

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