Hello My Father Is 99 Years Old And Was Diognised

Posted on Tue, 2 Jul 2019

Question: Hello
my father is 99 years old and was diognised in 2004 with local prostate cancer and since then he was on lupron or zoladex injection every 3 months and casodex was added in 2016 the last 12 months his psa started climbing from 23 al the way to 84 . His doctor suggested that he should go for another line pf hormone therapy either zytiga or xtandi but giving to the cercumstances of his major health a i have concerns against a second line of therapy, my father has heart desease and a border line of renal function and he is bed ridden since late 2017 and is on oxygen support when sleeping.
Is going for a second line of treatment at this age and this health condition helpful or it will do more harm than benifit? and if we decided to not go for the treatment what we should expect in the matter of pain and tumor progress and life expectancy?
Thank you
P.S he can not do any ct or bt scan due to his renal function

Follow up: Dr. Dr. P. T. Patil (0 minute later)

Hello
my father is 99 years old and was diognised in 2004 with local prostate cancer and since then he was on lupron or zoladex injection every 3 months and casodex was added in 2016 the last 12 months his psa started climbing from 23 al the way to 84 . His doctor suggested that he should go for another line pf hormone therapy either zytiga or xtandi but giving to the cercumstances of his major health a i have concerns against a second line of therapy, my father has heart desease and a border line of renal function and he is bed ridden since late 2017 and is on oxygen support when sleeping.
Is going for a second line of treatment at this age and this health condition helpful or it will do more harm than benifit? and if we decided to not go for the treatment what we should expect in the matter of pain and tumor progress and life expectancy?
Thank you
P.S he can not do any ct or bt scan due to his renal function

Answered by Dr. Dr. P. T. Patil (5 hours later)

Brief Answer:
I would suggest not to go for additional hormonal therapy.

Detailed Answer:
Hello
Thanks for query .

Based on the facts that you have posted your 99 years old father who has been diagnosed to have Prostate Cancer and is on hormonal therapy drugs like Lupron and Casodex since 2 years and have recently noticed his PSA showing rising trend .

In view of his age (99)years and other morbid conditions like poor renal function and cardiac problems that he has and the side effects these drugs have I would suggest not to initiate second hormonal therapy which is not going to help as far as arrest or progress of the cancer is concerned .
There will not be any noticeable effect in status of cancer even if you do not give him second line of therapy .

I would say that had he been my father I would not go for this second drug therapy which is not going to alter the progress of disease nor going to improve quality of life to appreciable extent .

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Raju A.T

Answered by Dr. Dr. P. T. Patil (0 minute later)

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. P. T. Patil (4 hours later)

Hello again Dr XXXXXXX

Thank you for your answer, but i have few questions if you allow me.
If we deside not to go for further treatments what should we expect in terms of symptoms and pain and life expectancy regarding the cancer? Would he have a good quality of life if left untreated?
Thank you again

Follow up: Dr. Dr. P. T. Patil (0 minute later)

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
He would have No major issues

Detailed Answer:
Hello
Thanks for follow up
There will not be much difference in quality of life irrespective of whether treated with second line of drug therapy or without it.

As regards pain it depends whether he has bone metastasis or not

Cancer of Prostate is very very slow growing cancer

I have not seen patient dying because of cancer of prostate itself per se Patient usually dies due to other conditions like Renal failure,myocardial infarction or liver failure or advanced age.
Thanks and Regards
DrPatil

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Dr. P. T. Patil (0 minute later)

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. P. T. Patil (42 minutes later)

Hello again Dr.
Thank you for your follow up,as far as now there is no pain at all and father seems to be in a good shape according to his health apart from some sense on burning in the beginning of urination, what im concerned of is that would his tumor turn to an aggressive one if no further treatments are given since his psa is climbing? And is his pattern of psa rise indicates that his tumor is getting aggressive?
Thank you again

Follow up: Dr. Dr. P. T. Patil (0 minute later)

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
Raising PSA suggests that his cancer is Metastatic Castrate Resistant

Detailed Answer:
Hello
Thanks for follow up .

The treatment of cancer prostate is very complex and challenging affair.Raising trend in PSA in spite of drugs being given itself suggests that it is Metastatic Castrate Resistant Prostate cancer (CRPC) .It is routine observation in managing Castrate Resistant Prostate Cancer(CRPC) with various combinations of these drug fail to arrest the growth and progress of the disease and offer permanent cure of the disease
,
At the end of the day we have to consider following factors in deciding or modifying line of treatment
1) Age of the patient .
2) Outcome of the treatment offered
3) Other co morbid conditions like liver ,renal function
4) Cardiac status of patient
5) Adverse side effects of these drugs which make life of the patient more miserable ,

Considering all these arguments Take decision which suits to your father who is 99 years old .

Thanks and Regards
Dr Patil.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Dr. P. T. Patil (0 minute later)

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. P. T. Patil (15 minutes later)

Thank you again
Im sorry for disturbing you Dr but you didn't answer my question about if we left it without treatment at this stage is there a chance the tumor turns into an aggressive one which spreads quickly or will it stay in the same way of growing the past years slowly?
Thank you again

Follow up: Dr. Dr. P. T. Patil (0 minute later)

Answered by Dr. Dr. P. T. Patil (1 hour later)

Brief Answer:
It is difficult to predict about the rate tumor will grow

Detailed Answer:
Hello

Thanks for follow up
As I have already stated earlier that Prostate cancer is slow growing as compared to cancer of other organs hence can predict about further growth of the cancer
Thanks and Regards
DrPatil

Above answer was peer-reviewed by : Dr. Nagamani Ng

Answered by Dr. Dr. P. T. Patil (0 minute later)

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Above answer was peer-reviewed by : Dr. Nagamani Ng