I can't think of a good reason to make his life worse. PSA is just a
number; ADT is REAL. Ask him which is more valuable to him ... a few
more happy years now or a few extra crappy months a few years from now
IF he's that lucky.

He can always go on ADT if mets ruin his QOL, but at that age ADT will
hit harder than with a younger man and its SEs will be much more likely
to be irreversible should he decide they're not worth it.

Even for a much younger man, the timing of ADT -- right after initial
treatment, when PSA rises, or when mets appear -- is highly debatable.
The older we get, the farther that scale tips towards "if it ain't broke
..."

I.P.

On February 23, 3Putt wrote:

Two points:

First, pay no attention to Mr. I P Chicken-Little, who knows zero about
how ADT would affect any particular individual and whose personal
experience is limited at best. He beats his anti-ADT drum at every
opportunity.

Second, I do not believe that a uro should be involved in the friend's
treatment. A uro is a surgeon, no more. It is possible, though, that
this particular uro might be one of the rare breed who actually knows
what he's doing outside the OR.

I recommend that the friend see a true cancer specialist, a medical
oncologist; preferably one who is familiar with treatment of PCa. A list
of PCa specialists in various fields will be found via this web portal
of the encyclopedic site of the Prostate Cancer Research Institute:
http://prostate-cancer.org/resource/find-a-physician.html

For the link to the list, scroll down about half way.

If a particular expert is inconveniently located (though I know of men
who travel thousands of miles to get the best treatment), I understand
that they are willing to work with a local med onc.

Regards,

Steve J

"I believe it is a mistake for many urologists to be involved in the
endocrine therapy of prostate cancer.  Let me state why. Urologists are
surgeons and many times surgeons rush to a treatment without really
understanding what they are doing."
-- Stephen B. Strum, MD
Medical Oncologist
PCa Specialist

Yes.

Er, I mean no.

Oh, Hell.  I don't know.

Your friend is in a precarious position, but you do not know nearly enough
of his history and condition to formulate an opinion.

Depending on how fast his PSA is rising, he is very definitely in danger of
dying from PCa.  But, assuming he's been through initial treatment and/or
ADT and chemo and nothing is currently abating his cancer, then there are
few alternatives left in his war chest.  If he can somehow reduce his PSA
(i.e., cancer), I would certainly do so, given QOL constraints, etc.

I would make one observation that he might be better treated by an
oncologist and would be surprised if he was not already.