I'm looking for some wisdom from my learned brothers.
The Urologist who diagnosed me (April 19th) told me that my PC was advanced and I had 'positive margins' which I understand to mean that there is evidence the cancer in my prostate was evident at the very end of at least some of my biopsy cores (10 of 12 cores had cancer present). He said that I could not have surgery because the cancer has almost certainly grown outside of the prostate and therefore surgery was not an option. He sent me for a bone scan which confirmed I have metastasis in many places in my skeleton, with 2 or 3 'significant spots' in my femur and spine.
I consulted a second Urologist for a second opinion and he asked for a PSMA/Pet scan and an MRI and after viewing the results, he said that me cancer was extensive, but he considered that I was a candidate for surgery. He said he had done 1,500 radical prostatectomies and although my case was 'tricky' he was prepared to 'have a go'. He said there are risks of complications, but he believed that he could operate. He also said that most other surgeons would not attempt the procedure (he was a bit cocky, but I don't think that's a bad thing - you want a surgeon who is sure of his abilities).
When I asked him if there was a survival benefit he said 'For sure'. He said that the prostate is the 'cancer factory' and 'de-bulking' the tumor is definitely a good thing.
I have tried to do some research on the subject and I have not found much to support or discredit what he has told me. Much of what I have found is contradictory. One study I found confirmed there is a survival benefit, but the authors admitted the study probably suffered from 'selection bias' as the candidates chosen, probably had a better survival profile than the ones who were not selected for surgery.
I am just wondering if anyone has had to make a decision like the one I have to make and/or whether anyone has any insights into the benefit (or otherwise) of surgery, where one has metastatic prostate cancer, with advanced local PC also.
If I don't go for surgery I have one of the forms of radiation as an option. I can't say why exactly, but I am leaning towards not having the surgery, with all of the resultant complications, but I am open minded.
Thanks in advance.