What factors helped you decide on Stage 4 prostate cancer treatment?

Looking for alternatives to androgen blockers.

This sounds like a complex decision with several viable paths forward. Many community members have found it helpful to consider factors like their overall health, lifestyle preferences, potential side effects, and personal goals when weighing treatment options. The experiences shared here often highlight how different approaches work differently for each person, making conversations with others who've been through similar choices incredibly valuable for gaining perspective on what questions to ask and what to expect.

I completely agree that hearing from others who've walked this path is so valuable - you might also want to ask your care team about the timeline for each treatment option, since some people find that factor really influences their decision-making process.

I have been on androgen deprivation therapy for 1 1/2 years - Lupron once every three months and abiriterone daily with prednisone. My PSA is down to .01 so it seems to be working for now. It is a rough adjustment initially as you tire more easily. I was also rather depressed. I started an anti depressant (Wellbutrin) eight months ago and have much more energy. I am also going to the gym a few days a week which helps. The cancerous spot on my femur is gone and the lymph glands which were actively cancerous are much reduced in activity. Other treatments were not recommended by my oncologist. Assume other treatments may be needed in the future. Best wishes to you as you progress with your treatment options. Prayers are also important.

Todd, I was diagnosed at age 70 on 12/2018 with IVA (T3b, N1,Mo) prostate cancer. Surgery wasn’t presented as an option owing to regional metastasis. I was on Lupron for 3 years, Zytiga for 2, and ha 45 days of radiation for a total of 81 grays. Lupron was tolerable, though I had hot flashes, fatigue, 10% bone loss, ED and loss of libido. Naps, walking and light weight lifting helped. My PSA dropped to <.1 within 2 months, and remains there at the 7 year mark. I’m feeling well, though my age. Radiation cystitis and protists presented 2 years after radiation, were treated, and am now living without those effects. The Stampede Trial supports my treatment regimen. I would endure all the effects for the life extension that would have otherwise been my fate with a Gleason 9 PCa. Feel free to ask me questions.

Todd I was diagnosed with IVA in 2023 after a prostatectomy. They found 3 lymph nodes involved. PSMAPet showed it travelled to the retroperitoneal and iliac lymph nodes. I just finished 2 years of Lupron/Zytiga/Prednisone and in the middle of that I had 40 radiation treatments. My psa has been undetectable since my first test after starting ADT. My doctors told me the three pronged approach of the two ADT treatments and radiation is a curative approach, removing one is basically palliative. I would do it all. Hot flashes you get used to, the no libido is another issue. We are relatively young, I turn 61 next week, and very active in the bedroom so that’s been more bothersome to my wife than me since I have no sex drive at all. Good luck to you

Im w ya' Todd..! Fem hormones isnt my #1 choice, but since ive already been radiated ( gave me 17 yrs ) prostate cancer has returned...BUMMER...! !

Only my experience. Age 65, diagnosed, stage 4 Radiation on tumors not prostate. Gleason 9, psa 334 No surgery possible. Lupron and zytiga, 7 years. SEs the usual. Tolerable but big annoyance. Pluvicto when psa climbed . I'm 73, life is pretty good. I'm not a chemo candidate (lung issues). I'm glad I didn't panic and time was on my side. Go slow and be wary of anything off grid. Best of luck. Ps, I was in support groups, take them with a grain of salt. Get a good relationship with the oncologist, urologist is not as helpful.

Initially I had prostate removed because I was told cancer had not spread. After surgery, PSA became elevated. End up having 42 radiation treatments Then in the clear for about two years when PSA started rising. Had cat scan that showed cancer had spread to 11 areas in hip, back and spine. Currently taking XTANDI daily and then 4x’s/ year I have PSA test, oncologist visit with Lupron and Xgeva shots. Xgeva for bone density loss. For past year and half, current protocol working. Feeling good today but know at some point that will change. Have accepted this, and don’t worry until PSA test. No estimate of life expectancy so everything takes on more meaning and sense of urgency. Good luck and enjoy life!

I feel you, Lawrence. 7 years post Stage IV diagnosis, I have been <.1 PSA. Feeling well, but 78. Labs next week. Things will change … still, counting blessings.

I had stage IV with Mets to a lymph node and several to my pelvis and tail bone. Opted for two years of Eligard, Aberaterone, Prednisone, and SBRT to the bone Mets and EBRT to my prostate and lymph nodes. Finished ADT over a year ago. PSA has been undetectable since the first month of treatment. Now 3 years.

Dear Todd et al — I’m Dave Stauffer of Denver CO. Every reading of your experiences is yet more valuable education. How much I wish I’d educated myself BEFORE my PCa diagnosis! But then, why would I—having lived 74 1/2 years of a charmed health life—educate myself on any cancer? So here are a few of the key conclusions I can offer after 2 1/2 years of post-cancer education: 1. Gather fact and opinion as widely as possible, but remember that EVERYONE advises from the perspective of their own experiences and self-interest. 2. Bear in mind that clinical research has shown that as much as 50% of cancer treatment is OVER-treatment, and at times it can do more harm than good. When you’re a hammer, everything looks like a nail. When you’re a PCa doctor, every prostatic characteristic looks in need of a procedure or treatment. 3. Seriously examine your own personal position on quantity of life versus quality of life. My changing situation gradually gave rise to the necessity of weighing that life-defining consideration, which I wish I’d addressed under less dire circumstances. 4. Do all the research you can tolerate of every sort. Read peer-reviewed medical journals and do all the questioning of your doctors and advisers that they’ll tolerate. And especially focus on PCa patients, who collectively know more about your situation than all of the doctors and journals and friends and family. 5. That’s enough for now. For me, if not for you.

TD H - what specifically are you taking?

I’m not being treated now. Within a month of diagnosis I began 3 years of Lupron concurrent with 2 of Zytiga/prednisone. At two months post-diagnosis I underwent 45 days of IMRT for a total of 81 grays. By month 3-4 my PSA dropped to <.1 and has remained there for 7 years, having been checked every three months.

FYI, my oncologist followed the treatment protocol in the Stampede trial. I encourage you to read about it.

I have found a great deal of information on the PCRI website. PCRI.org Videos on all different stages and types of prostate cancer and information from some of the top prostate doctors in the nation.

I, too, have been a regular user of pcri, have watched their excellent videos and read their book. I bought several copies of the book and gave copies to my doctors.

Great information from everyone. I believe in being positive, being your best advocate and loving life!

I had my prostate and some lymph nodes removed in 2024. The cancer started to come back, so in 2025, I had radiation for a month and one half. I now take hormone medicine I will take for two years. I lost some weight, had a U.T.I. a couple of times. I now feel fine. The medicine dries your skin, but I use moisturizer to help. I see the doctor and have lab tests every couple of months. I now am undectable. Good luck 🤞!

Ild love to hear some of your responses since im pretty much in the same boat... "PEACE ON EARTH..."

I have a real hard time accepting the recommendations of any PCa “experts” for at least three reasons: 1. The greatest assemblage of cancer experts—the NCCN—ended its recommendation for PCa screening after age 70. My screening stopped. My cancer was diagnosed 3 yrs 6 mos later. 2. Prior to cancer I had three procedures, all of which failed and all of which later compromised my cancer treatment. (1. Prostatic embolization 2. Aquablation 3. Urolift.) 3. My blood panel showed PSA increase from 2.38 to 5 at age 71; the next showed increase to 9 at age 72 1/2. Neither my urologist in the first case nor my PCP in the second case let me know of the increase or suggested I do anything about it.

Dave S. Find another urologist! Arm yourself with information. Start with PCRI.org!

Dave S - Guidelines do say not to screen after age 70 because data show that because the mortality rate from prostate cancer is quite low, “most “ men will die from other causes, and thus PCa treatment causes more harm than benefit. Presumably that is why Joe Biden wasn’t diagnosed until his cancer had metastasized and created observable urological problems. Of course, each of us is not “most “ men, and at our age doctors cannot reliably tell us how long we have to live. To deny treatment because diagnosis is denied seems to me immoral and is contrary to the physicians’ obligation to do no harm. These guidelines, which I call spreadsheet medicine, seem driven by cost accounting rather than compassionate care. So you know, I was “guided “ away from screening in 2012, at age 68, by USPSTF guidelines that relied on the same harm v benefit reasoning. After 7 years with no offered screening, I was diagnosed with Stage IV cancer. Aside from the financial costs and emotional impact, I have endured physical effects from extensive treatment. There are many men like me. Medicine let us down. It is my hope that all will let our voices be heard.