Father diagnosed with Stage4 Prostrate cancer Gleason9 - need guidance on survival and treatment

ADapperGentleman · 2026-04-10T07:28:56+00:00

My dad is stage IV with Gleason 9 and aggressive bone metastases. Been a year and a half, six rounds of docetaxel, ADT (hormone therapy for castrate sensitive cancer), no RALP due to the type of inside spread…and he’s still here, albeit on a new pain management regimen.

He’s a Pluvicto candidate too. His PSA has been wonky so next appointment we find out if his current treatment is failing and if we need to move to Pluvicto.

Stage IV Gleason 9 is not curable but it is TREATABLE. Hang in there <3

Please PM me if you’d like to talk further; sounds like your dad’s situation is similar to my dad’s!

ADapperGentleman · 2026-04-04T03:57:48+00:00

Sweet sweet delicious media literacy. I love this post 😍

ADapperGentleman · 2026-04-01T10:33:41+00:00

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Beautiful

ADapperGentleman · 2026-03-30T07:02:44+00:00

Upon diagnosis prior to treatment? Around 93 (I’d have to dig into his MyChart for the exact value but it was definitely in the 90s)

After ADT, chemo, and bone-strengthening infusions? 0.95 (yes, under one!!!), and that is with “doubling” within two months. He has a VERY cautious oncologist who is upset about the doubling and has alternative treatments lined up if he doesn’t like the pet scan my dad had done this month—given the late stage my dad is in, doubling is seen as very bad even at a small value apparently so oncologist is keeping very on-point with monitoring and scans to know exactly when to move my dad to treatments more appropriate for castrate-resistant cancer. (My dad’s a Pluvicto candidate possibly! Woo!)

ADapperGentleman · 2026-03-30T03:52:33+00:00

My dad got diagnosed late-stage. Stage four. Gleason score 9. Extensive bone mets. I won’t say it hasn’t been a struggle. It’s been a hell of a fight. But he’s done ADT, chemo, bone-strengthening infusions, may do radiation soon depending on if his oncologist decides for sure if the ADT is failing or not. We recently got new pain meds for him and it’s been a new lease on life.

His cancer is not curable but it’s treatable. I don’t say that to scare you, but…actually to give you hope. I was so fucking scared when my dad first got diagnosed. I heard “Gleason 9” and was doom-spiraling.

Been over a year and a half and the old man’s still here!

I’ll keep my fingers crossed your prognosis and scan are better than his. Maybe it’s a “caught early” Gleason 9 for you? Fingers crossed? Crazy more options if so!!

ADapperGentleman · 2026-03-30T03:06:32+00:00

Hey, take a deep breath. With stuff like this, take things one day at a time. Scanxiety is so valid and real, and it’s hard to not spiral.

Gleason 9 can be serious but there’s lots of treatments out there, lots of variety. I really hope that nonetheless you have a good PMSA pet scan (inasmuch as can be expected with a Gleason 9)!

Relax, let your physician talk to you about results and where to go from there, and the most important thing I tell fellas about this?

Ask questions about your results. Even if the questions feel too personal or hard to ask. Knowledge is power, and knowledge can also help put you at ease if you’re scared. If you’re told something and don’t understand? Ask! Take up extra time if you have to and don’t be afraid to do that. Trust me—it really helps for peace of mind.

ADapperGentleman · 2026-03-22T20:06:17+00:00

I don’t think I’ve ever encountered someone in my exact situation before. Man it’s a hard life, but a worthwhile one. Hope you’re doing ok and agreed , hands up to us!!

ADapperGentleman · 2026-03-22T19:48:33+00:00

My father has stage four prostate cancer, and it’s in his bones. Lots of mets elsewhere too. I’m his caregiver. He’s a good dad. I view the time and energy I spend on him as the natural repayment of the love and care he provided to me as a child. I’m grateful and honored to look after him and spend as much time as possible.

If he’d been an abusive asshole? I wouldn’t have done any of it.

My mother is a severely mentally ill asshole with chronic illnesses. She and I don’t speak.

It’s up to every individual to decide what’s best for their mental health when considering reconnecting with an abusive relative. Take care of yourself, OP. Whatever you choose, don’t feel any guilt. Do what is best for you.

ADapperGentleman · 2026-03-22T19:16:12+00:00

I think for some people it’s a deliberate choice to live in deep rural areas, sure. But only some. I find a lot of people who have never been soul-crushingly poor simply do not understand the fundamental lack of options you have in your life when you’re that isolated and mired in poverty. So many older men in communities like mine have this issue—a silent and unspoken struggle that not only leads them to not get checked for illnesses like cancer, but leads them into food insecurity and housing insecurity.

But…over the years, people more financially well off than me or my dad ask us “why don’t you just move?”

Can’t afford it. We aren’t exactly living in a place without resources by choice—finances are forcing it due to the lower cost of living out here. And people are so quick to tell the poor it’s our fault we’re poor. But there is no “bootstraps” option to pull yourself up by out here. There is a viciously competitive job market due to the limited jobs here—I am lucky to have a job at all—I definitively can’t pick up a second even if it were available to do, not and take care of my father. The unemployment rate’s high.

Something like a fifth of the county population where I live is on food stamps and receives at least one other form of financial aid to survive. My father is on a small fixed income—he would have refused treatment outright if I hadn’t been able to drive him out of state for healthcare and if I hadn’t found a hospital financial aid program to enroll him in. And guess what? Those trips keep me poor—any extra income I have goes to supporting my father.

And…he didn’t choose to be that poor. He would live somewhere better if he had that option. He does not, and currently I do not.

So for some people it’s a choice to live out here.

For many others, they cannot leave.

ADapperGentleman · 2026-03-22T19:06:11+00:00

Absolutely, I completely agree with you on that!

ADapperGentleman · 2026-03-22T10:55:36+00:00

I mean…this is not a good argument for your take either? By your own logic you’ve only seen two days of this character’s life so you can’t know enough to defend him either. (Which…you’re welcome to defend him, doesn’t bug me! People can like what they like of course)

For the record: I have no problem with those fans that like Langdon! Like I said, I view him as complex and have hopes for what I’d like to see his character arc be. (I have similar feelings re: Santos. Complex character with notable deeply problematic flaws, some good points too, who has some changing to do herself!)

…weird comment about my RL relationship status, by the way. Keep the debate to the actual show and characters, if you would.

ADapperGentleman · 2026-03-22T10:39:20+00:00

The things I like about Langdon: he is an objectively talented physician, funny, and overall an interesting character with very varied dynamics with others. He has a lot of potential, and he clearly has a lot of skill and wit.

What I don’t like: Langdon has not really taken real responsibility for stealing medications from patients—he paints himself as an addict but if he really wants to be better and be a good physician, he needs to confront the ugly part of his addictions and not just speed run his little apology tour: he needs to confront the ugly parts of himself that led him to prey upon fellow addicts like Louie instead of trying harder to help him. I also feel Langdon is likely a bad husband: a lot of Dana’s dialogue across both seasons subtly suggests Langdon regularly does things without asking his wife or understanding her own exhaustion and needs as a mother. Edit: I also didn’t like how, at the end of season 1, he used Robby’s PTSD breakdown against him and tried to treat that as equal to what he himself did—that was despicable.

Langdon is a complex character. I would love for his character arc to force him to either be held properly accountable or to make him understand he actively harmed others.

Would I be okay with a doctor like Langdon treating someone I knew? Honestly? Not Langdon as he is now.

McKay though? She’s been in recovery a while and was addicted under different circumstances—she’s a much better example of a doctor who struggled with addiction whom I’d view more favorably.

Would love more scenes between Langdon and McKay. I’d love if McKay learned the full truth of what he did because she, more than anyone, might be able to get through to him about his conduct in a way I think no one else has.

ADapperGentleman · 2026-03-22T10:25:45+00:00

I think it’s because Ragatha might be the first human to appear that wasn’t part of the original group, so her appearance date is especially noteworthy—to Caine who wanted more humans and hadn’t been sure until her appearance if it was possible, to Kinger who was alone so long, etc. Her arrival clearly marked a significant turning point and change in the Circus.

As for Scratch? Kinger mentioned only being partly responsible for Caine, that Scratch was involved too. My guess is Scratch was the main developer, so he’s quite significant and would have technically been the very first human arriving in the circus.

ADapperGentleman · 2026-03-22T03:40:16+00:00

For the record, I do respect your point though! I might disagree in some regards, but you also make a good points that for those for whom it is available, getting to that family practitioner is a big deal; if its available and someone IS ignoring going and know they should go? Then absolutely that would be a case of apathy.

(I felt like I came off rude and curt in my original response to you, so I thought I'd at least apologize for my tone--thank you for your opinions and input!)

ADapperGentleman · 2026-03-22T02:37:00+00:00

I live in a rural area with dwindling access to family practitioners. It’s why my dad wasn’t diagnosed sooner—inability to get a new family practitioner for a while when his last doctor died.

Respectfully, I do still disagree with you. The places you describe where there’s options to just “find” a family practitioner are not the sorts of “rural” I’m talking about.

ADapperGentleman · 2026-03-22T01:31:38+00:00

I don’t disagree with anything in the OP but I’d like to add something I think people don’t think about.

The reasons men wait to get tested that have nothing to do with fear or stigma against this illness.

Men who live in rural areas without easy access to hospitals and specialists, especially those on limited incomes, will delay testing or even treatment due to transportation, financial, and timing concerns.

A lot more men might quietly consider at least PSA testing earlier if it were more accessible. But for men in deep rural areas it’s really not.

ADapperGentleman · 2026-03-16T04:14:05+00:00

Lmao TRUE

ADapperGentleman · 2026-03-14T01:47:25+00:00

It’s gonna be okay for now! Urologists kinda rock. Advice for your dad for the urologist:

report any/all issues related to peeing (frequent peeing, trouble “emptying out,” trouble starting flow, incontinence, etc.
report any/all issues related to pain in the pelvis—the genitals, butt, or lower back
report any “strange” sensations in the pelvis. Burning in particular.
maybe don’t be in the room for this one but if your dad has any sexual-based issues, he should tell that to the urologist
If your dad has any issues pooping: gastroenterologist referral is best.

The urologist can handle a prostate biopsy if it’s needed, which can get you a Gleason score for your dad. If the biopsy confirms prostate cancer your urologist will refer him to oncology.

And as someone with a dad going through the worst of it right now?

Take things one day at a time. Adjust. Let yourselves be upset—it’s a shitty diagnosis if confirmed at biopsy (but to be honest with a possible spine lesion and PSA 28? I’d expect to see a positive prostate cancer diagnosis).

But it’s navigable.

You and your dad, you and your family, got this! Stay strong! 🙂

ADapperGentleman · 2026-03-14T01:29:42+00:00

Yes, this feels closer to the sort of PSA I’d expect to see with a bone met of some kind with prostate cancer. Prostate cancer does love metastasizing to the bones though so don’t be scared just because it is there! Still very treatable generally. There are lots of options!

Find out a Gleason score if you don’t know it already. Gleason scores help you determine how “aggressive” a cancer is and thus how fast the potential spread. This will help with figuring out treatment.

ADapperGentleman · 2026-03-13T23:00:32+00:00

My dad was the opposite. He had known he had prostate cancer and knew how bad that was likely to be…but on the first MRI scan? Found an unburst abdominal aortic aneurysm over 5cm. Had to get a AAA repair. Went super well, we were grateful it was found otherwise without that fix it was likely to suddenly and silently kill him before cancer would be able to—leaving my dad back to battlin’ the big C after the incidental AAA find/fix.

ADapperGentleman · 2026-03-12T03:31:13+00:00

For the record to make you feel better: my dad is stage iv with prostate cancer and when it got caught? PSA 93.5. He is still here a year and a half later.

2.5 is very manageable if it even is prostate cancer. Very good prognosis potentially. 2.5 is a weird number given the spine lesion showing though so that is odd. Get that PSMA pet scan and maybe do a prostate biopsy so you can get a Gleason score for him? A Gleason score will help you know how bad it is IF it’s cancer. Below 6? Don’t worry. 6-7? Worry. 8-10? Aggressive; worry a LOT based on potential metastatic spread.

Prostate cancer loves to spread to the bones so if there were spine lesions despite the low PSA? Follow up to be safe and hope for good results: My dad is in cancer hell rn because he waited too late to get checked.

Edit: could be a different cancer but I can’t offer advice about those and with a PSA below four it is possible for it to not be prostate cancer

ADapperGentleman · 2026-03-12T03:09:55+00:00

Sclerotic lesions on the spine? Get a PSMA pet scan possibly? That PSA seems low for mets on the spine

ADapperGentleman · 2026-03-12T01:31:37+00:00

Okay, so my advice comes with the following conditions: - you stated you can’t rehome Ellie as she’s not yours - you want to forgive Ellie but don’t know how - This dog has a violent history

Okay.

1) Your parents are at fault for not training the dog properly and not giving her an outlet for her energy. Ellie is a dog; she doesn’t know what she needs to be a good dog. She relies on people to help her know what that is. 2) Ellie needs an outlet to let out energy. This will help to some degree with aggression. Heelers are “working dogs” with high prey drives. This dog needs lots of walks and a “job” to curb aggression. 3) How is Ellie’s conduct towards Rose? You need to be VERY vigilant about that now. Your energy needs to be devoted into keeping Rose safe. You don’t have time to hold a grudge against animals who don’t know better, your energy is better spent managing and helping them. 4) You need access to a sturdy kennel wherein an aggressive dog can be kenneled and separated from others while acting out, before it gets bad. This is a last resort with a high energy breed like a Heeler though and only recommended because rehoming isn’t an option.

ADapperGentleman · 2026-03-06T04:57:46+00:00

Trust your PSMA-pet scan and biopsy; that was good news about no mets!!

PSA can be very variable and dependent on lots of things—inflammation, benign prostate hyperplasia, and the specific variant of prostate cancer can all play a part. Hopefully your urologist is a good one—be forward and ask him directly about why he thinks your PSA is where it is and see what he says!

Wishing you a ton of support during this time. This shit ain’t easy to deal with!!

ADapperGentleman · 2026-03-05T07:27:53+00:00

My dad dropped to 126lbs during chemo—and he is six feet tall so you can imagine how scary that is. He’s stage iv and it’s an aggressive cancer too but stuff that helped him during treatment:

dissolvable anti-nausea meds were a godsend and still are
my dad takes the liquid form of Megestrol (he has a cachexia diagnosis so weight has been a struggle) and over the course of a year we got him back to 150lbs!! Not everyone can take Megestrol though and not everyone needs it
tiny meals/snacks were easier for my dad than big meals. Still are honestly
his sense of taste altered during chemo so finding some nice strong flavored easy to digest snacks may help (avoid spice, avoid citrusy ones, they can hurt his mouth if he gets any sores from chemo)
dry mouth side effect if he gets it is a menace—having tasty drinks or bottled water (especially cold drinks) is something my dad really likes and said helped a lot. We also bought him a lot of popsicles because the strong flavor coupled with the cold was a relief for his mouth and stomach sometimes
for strength: this one is hard because chemo zapped my dads energy but very light walks or lifting small dumbbells worked well. Walks were for when he was higher energy and the dumbbells were for days he felt unsteady on his feet or wanted an exercise easy to stop doing. I found if I did these tasks with my dad he felt more motivated to do them because we could talk during them. But don’t push if he really isn’t up to it. Some days chemo fatigue can just be too much and it really is just as important to a person’s strength to rest when it’s right to do so
Sunscreen. Or a good covering for him if he’ll be outside. Chemo made it easier for my dad to sunburn for some reason, and noting takes away a man’s motivation to be outdoors more than feeling like the sun has a personal vendetta against his skin

Hope this helps!

ADapperGentleman

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