Going for brachy said...
We sometime forget that how a 92 year old decides to treat or not to treat his prostate cancer is entirely his business. Some of us dealing with metastatic prostate cancer want to see our grandchildren go to college and graduate. For that we are willing to suffer hot flushes, bone losses, and fatigues.
This comment clearly illustrates what some are NOT getting with this unique case...this is NOT a one-size-fits-all scenario, as suggested. "Going for brachy" is in his 70s and recurrent PSADT is less than 2 months (low). If he doesn't treat, then he might die of
PC; I would treat in his case, too. In stark contrast to "Going for brachy," the OP's friend stands very little-to-no chance of dying from
PC. ADT effectiveness is measured in terms of 10-year survival rates. The best known study of ADT for nonagenarians highlighted that 10-year overall survival was only 3.1%. What did they die from? The vast majority (80%) died from OCM (other-cause mortality). Amongst the small percentage that died from PC, there was no stratification reported between those with low- and high-PSADT but think.....then apply that thought to OP's friend with the high-PSADT. The report concluded with doctors "questioning the rationale" of prescribing ADT for men in their 90's for these stated reasons, plus the more significant negative impact of side effects on QoL for the super-elderly for no apparent benefit.