Advanced Prostate Cancer

De-bulking tumors

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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I was told - without the tumor mass, everything would slow down... and, it did.

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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.

Alan

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I de-bulked my tumor. I believe it was the right decision for me.

Rich

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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!

Kris.

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Ture - nothing is for sure in this regard, I must admit.

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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.

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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.

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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

jurology.com/article/S0022-...

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Alan--I already gave my opinion on this, as I am one, who was metastatic, before surgery---but with no Nodes or bones lighting up. De-bulk---De-bulk! Common sense over-rules panels---sometimes!

One must consider the pathology----this is a foremost question. If you have Ductal, or Intraductal---you are dead man walking, especially if it is outside the capsule, and you have a big supply of home based armies of Pca cells, inside the capsule.

So you take out everything that is cancerous--get as far as you can to the margins, and then treat the escaped convicts. My OS was Listed as 18 Months--because of the pathology---now we know OS, is subjective. So my case is correct for me---as I have had more than 18 months just in terms of Undetectable PSA. We{Docs.and me beat the Sh-- out of what was left]. I do not know where I go from here----but it gets kind of cool, when the Docs. who talked about 18 month OS, are now suggesting I go IADT, or Go Off completely, or we will be discussing BAT this month. My surgeon, who has performed over 750 RP's at first did not want to do the Surgery, My OR Nurse wife who assisted on 500 of these surgeries, before she retired and I convinced him to do it.

Now the Uro Surgeon says as I see him each month---"wasn't it a great idea to do the Surgery".

I did not say anything! And yet my Medical Oncologist and Geneticist---once getting my Gene Mapping data and adding that info to the Ductal Cribriform Pathology---agreed---Surgery Yes! De-Bulk Yes! And at 72 years old at the time of the Surgery---I was operated at 8 AM on a Monday--left the Hospital 2 PM Tuesday---would have left earlier--but Doc wanted to see if I could walk---did a half mile dragging my IV bottle , and Cath. Bag. So much for hardship! That afternoon in my easy chair---watching Netflix, at home!

Nalakrats

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It looks like the two docs who told me not to de-bulk are starting to look more like a minority.

Here's another article promoting surgery or radiation for "node positive" disease:

gucasym.org/daily-news/how-...

Note: "node positive" seems to mean that there is cancer in the lymph nodes, but no evidence of "distant metastases".

Alan

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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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