Stage IV Prostate Cancer: any realistic hope?

In My Humble Opinion
1

I am not seeking treatment advice; the subject is already being treated by probably the world’s best (MD Anderson). Rather, I want to determine if my guess as to the outcome is the most likely, and if there is even a slim chance of hope.

The subject is not me nor a blood relative, but someone I am close to. He is mid-40s.

The story so far: he was diagnosed right-off-the-bat as Stage IV prostate cancer about six months ago, after spending the previous few months complaining of upper-back pain. He has been undergoing hormone treatment, and experienced some relief of pain symptoms, but that fluctuates. He has been able to go to work as recently as two weeks ago.

PSA levels had gone down to low single-digits, but are rising again. They have determined the cancer has spread to his bladder and possibly kidney(s), in addition to the sites previously identified (scapula, for example).

On visiting him yesterday he seems quite weak, although part of that may be due to a procedure he had last week (invasive scope procedure to examine and biopsy kidney and/or bladder; sorry I don’t recall the name of the procedure).

His local oncologist has recommended immediately starting chemotherapy. He will likely meet with his MD Anderson oncologist at the end of this week to see if they concur, or if there is some clinical trial that may hold promise.

The questions:

  1. I would love for this story to have a happy ending; it’s heartbreaking. But from what I’ve read (a mix of lay and medical literature), and from my experience watching my mother die of cancer, my gut tells me this guy has 3 months to 1 year left. Would that be a realistic, mean life expectancy given these facts?

  2. Again, from my experience watching my mother: would chemotherapy have any significant, REAL benefit? If, say, someone has a year left without chemo, and chemo doubles that - is it a choice of a year being somewhat active (at times) and comfortable (at times), vs. two years of misery? In cases such as this, what is the goal of chemo, since “cure” isn’t really in the cards?

I ask the questions because I don’t think the family has really had frank discussions about the future (he has small children); they’re still in “hope” mode. I’m not going to be the guy to bring them out of that, but I can at least, if appropriate and timely, start some discussions around the fringes (his siblings, etc).

And while I don’t know his deepest feelings on the subject, IF he values quality of life over length, I don’t want to see him going through a lot of unnecessary agony for no payoff.

2

How close are you to the family? I don’t know how to say this gently, so I’ll go with bluntly: it’s not your call. It’s his call, and then it’s their call, unless he makes you the Power of Attorney for Health Care, and then it’s *still *not your call; the POA isn’t supposed to make the decisions the POA wants, but to communicate the decisions the patient wants when the patient reaches a point where he cannot communicate with his health care workers.

I’d encourage you to encourage him to fill out Advance Directives (Living Will, Power of Attorney) for sure. I encourage that of anyone 18 or older, sick or not. Encourage him to speak to his doctor about a DNR, if that’s what he wants, but after that’s done, your job is to be his friend…take him out to dinner when he feels up for it, sit with him at home watching the game when he’s not up for going out, and listen to him as he feels like talking. Babysit his kids at your place or take them out so he and his wife have some time alone to have the discussions they need to. Help with repairs around the house if you’re handy or mowing the grass or shoveling snow if you’re not.

Prognosis (“how long have I got, Doc?”) is really difficult with metastatic cancer. They told my grandfather (prostate to start, and then all over) 6 months, and he lived 5 and a half more good years and then 3 pretty sucky months. They told my grandmother 1 year (breast/lung) and she was gone in 3 months.

Chemo is not fun, but there are many kinds of chemo, and not all of them make you pukey and weak and awful. You know how childbirth in movies is always screaming and dramatics and rushing around, but childbirth in reality is only sometimes like that? Same with chemo. You don’t always puke, you don’t always lose your hair, you don’t always lose a ton of weight. Sometimes, some chemos do that, but not all of them. His doctor is his best source for that kind of information.

3

Chances are extremely high that he’ll die of cancer. However, I know several Stage IV cancer patients who lived 3-5 years after being diagnosed. One of my friends with Stage IV breast cancer (it was already in her liver when they found it in 2011) actually went into remission thanks to an experimental drug, before it recently returned. But she’s still fighting it, and we’re hoping she’ll live to see her son graduate from high school.

Cancer sucks. I’m sorry.

4

My father in law was diagnosed with Stage IV prostate cancer in 2004 and was given 6mos to a year. He ended up living six years through aggressive treatments and by taking part in as many clinical trial treatments he could.

It’s going to get him eventually, but he might have a few good years in him left.

5

My father was diagnosed with Stage IV prostate cancer in 1991, shortly before the PSA test was out, and managed to live for four good, solid years. With any cancer at Stage IV, it’s usually just a matter of “when.”

6

It is probably true that sooner or later this guy will die of the cancer, but most doctors intentionally do not try to predict how long any individual will live. Depending on how aggressive an individual’s cancer is and how well it responds to chemotherapy/hormonal treatments/radiation/etc. the person can potentially live a long time with an incurable cancer.

It’s also really good that he is looking at clinical trial options. I know of a few people who ended up doing really on an experimental cancer drug for at least a while even if in the end they died of the cancer. I always recommend that people who have stage IV cancer look at clinical trials, since the experimental drugs/vaccines/etc. may be their best hope.

The point of giving chemo in these situations is that you can hopefully slow the cancer down even if you can’t eliminate it. Some people who are very fortunate may even go into remission for a while even though it’s understood that the cancer is not really gone and will come back at some point.
Different kinds of chemo have different side effects, and some are much easier on the body than others are. In some cases, people can have a pretty decent quality of life despite being on chemo.
In my mother’s case, by the time we found out about her advanced cancer she was pretty sick from it - but chemo beat the cancer back enough that she felt a lot better on chemo for several months until the cancer started growing again. Those months were good quality time for us and well worth the downsides of chemo. Don’t be afraid of chemo - even though nobody wants to be on it, a lot of progress has been made to try to make it more effective and tolerable.

7

Thanks, all. He spoke (by phone) with his oncologist team at MD Anderson yesterday, and it does sound like they have some chemo regimens available there that he doesn’t have access to where he lives. They also cautioned that, in their opinion (vs local oncologist), it is not a clear case that he should start chemo now. He has on-site appointments at MD Anderson next week, where besides the consultations they will also do a full-body scan.

None of the OP was intended to imply that anyone is telling him what to do. Because of his young family and a spouse still in graduate school, we’re all just trying to think of how we can best help them if he goes sooner rather than later. Everything from best-wishes to having them move in with us is on the table, so it’s a pretty broad range of possibilities. Knowing what to expect is part of that.

8

Whatever happened to that treatment where they would use a geneticaly engineered antibody to carry a radio active isotobe directly to the cancer?

9

It probably cured a handful of mice with cancer. We’ve gotten pretty good at curing mice with cancer…not nearly as good with humans.