There has been a lot of questioning and theorizing about "de-bulking" tumors, i.e., removing a prostate even when the disease is already known to be metastatic. During my recent experience on a prostate cancer research review panel (see: "Proton beam vs. x-ray therapy") I asked panelists, one a professor of urological surgery and one a professor of radiation oncology, what they thought about that.
They both opposed it. The surgeon said she thought it would put the patient through a lot of stress and damage and provide no benefit. Neither one thought it would extend life.
Are they right? I have no way of knowing. I think their views are the same as the majority of specialists in prostate cancer but, when it comes to getting at the truth, reality is reality and it is not determined by majority vote or by personal intuition either. So I'm posting this without being able to argue one way or the other but just offering it for everyone to consider.
Alan
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AlanMeyer
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Your doctors are not alone in thinking that what they did was the right thing.
Personally, I just don't know. It's one of those things that, hopefully, all the experts will eventually come to a consensus on. There seem to be a lot of those kinds of issues in cancer treatment.
I'm primarily active on the ovacare form; and joined this due to the possibility of the brca mutation being associated with prostate cancer. That being said, my belief is mostly generated from research and is more generalized to solid dense cancer, rather than prostate cancer in a hole.
I believe Debulking surgery, can be beneficial, if there is a good probability of it being an optimial debulking (ov ca defines as <2 cm of visible disease). This can allow chemo (possibly other drugs, though I'm not fluent in hormonal suppressants) to "mop" up all the rest. I don't think I could be anti-debulking in any way, as it allowed my mum to achieve ned; but then again, I'm not a doctor!
I spoke with my Oncologist about this last week. She admitted that a recent meeting at MSK that there was heated debate on the subject and no clear winner. As someone who is stage 4 and still has an intact prostate, I wish that there was clearer guidance here.
Can somebody, (meaning the medical community) please come to a consensus? I feel like a lab rat being forced to exercise on a spinning wheel in order to soothe the medical communities ego. "What should we start first, Docetaxel or Zytiga"? On and on. How about expending energy towards a new life extending drug as opposed to shuffling the deck until the ace of spade appears? The FDA fast tracking a drug is the biggest oxymoron of all time. It takes years for the panel to setup shell companies in order to buy stock in a drug maker before they approve the drug. Meanwhile we die. Make up your minds white coats, rip my prostate out or leave it be.
This recently published review from Mayo is a summation of their theoretical guidelines for years that recommended removal in anticipated risk of node positive disease; another definition of debulking. Few of these men would have received the modern second and third lines of treatment with newer drugs and radiation techniques due to the very long followup of these patients treated from 20 to 50 years ago
Note: "node positive" seems to mean that there is cancer in the lymph nodes, but no evidence of "distant metastases".
Alan
My prostate is still intact. I wasn't a candidate for RP after TURP 10 years prior. I opted for HIFU. Is that considered 'de-bulking' -- roasting the meanies?
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