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.
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?
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.