Prostectomy possible after radiation

[dress2544]

I was diagnosed for stage 4 prostate cancer with iliac lymph node involvement (Gleason 5+4) in 2015 at the age of 60. My urologist told me radical prostectomy is not possible because the cancer has already spread out of the capsule to nearby areas. Instead of radical prostectomy he did TURP. Started with elegard injections and IGRT radiation done for prostate gland (70 gy) and 60 gy for nodal area and 50 gy for entire pelvis. Now the disease is castration resistant and I am on zytiga + Prednisone. Last psa one month ago was 1.0. Latest psma pet scan showed the prostate gland and nearby organs are free of cancer. Even though there is cancer still in the iliac node, the size is not increased for the last two years. Scan also showed cancer involvement in paraaortic lymph nodes. Again IGRT radiation was given in this area to get rid of cancer from that area. Now I like to ask you all whether radical prostectomy and lymphectomy (only one iliac node ) is possible for me. One urologist told me that the surgeons will not be ready fo do this surgery as there will be scared tissues in these areas because of the radiation done two years ago. I am thinking of this surgery only to avoid a possible recurrence in these areas. Kindly give me proper guidance and advice in this.

[Tall_Allen]

No. Prostatectomy after radiation is usually a terrible idea, but in your case, where there is no cancer in the prostate it would serve absolutely no purpose. You can't keep irradiating places that have already had their maximum doses of radiation - the tissue in the area disintegrates and may cause necrosis and fistulas.

You don't understand the disease. It is not just in those few places you can see, by the time it is castration resistant, it is EVERYWHERE. It is systemic and micrometastatic. You have to treat what you can't see. Fortunately, the Zytiga is still working. When it stops working, you can try Xtandi or docetaxel.

[dress2544 in reply to Tall_Allen]

Thank you Tall Allen for your wise reply. I am sorry for my ignorance. In fact my RO was very much reluctant to do the second radiation (for paraaortic lymph nodes) . Now I remember that he had told me the disease has to be first controlled by systemic treatment.With zytiga the the disease progression came into control ( psa from 7 to 2.2). Then only he was ready to give me RT. He further told me that as the disease has turned to castration resistant, there can be microscopic disease which no scan detect (even psma pet). Now I can corelate his opinion with that of you. You have told me about adding docetaxel in the next treatment. But I had attempted this chemo two years ago. But due to very serious side effects I couldn't tolerate the chemo. I had heavy diarrhea, vomiting and mouth sores with the initial dose ( 130 mg of docetaxel). My MO told me to discontinue the treatment as I developed mucositis grade 3. Still I think this was because of the way of adminstration of chemo. Without giving any premedication ( steroids) he gave the highest dose. Only after the infusion I was given steroid. Now also I talked to him about a second attempt with a lower dose. He told me we can think about it when zytiga becomes inactive. Please give me your valuable opinion about this also. Thank you Tall Allen.

[Tall_Allen in reply to dress2544]

The standard dose of docetaxel is 75 mg/m2 every 3 weeks along with prednisone. However, if you are already taking prednisone with Zytiga, you may not need more. Higher doses have more side effects. Some men experience fewer side effects with cabazitaxel (Jevtana) given at a dose of 25 mg/m2 with prednisone.

Some patients tell me that sucking on ice chips during the infusions may be helpful in preventing mouth sores.

[dress2544 in reply to Tall_Allen]

Thank you Tall Allen for your tips to reduce side effects of docetaxel. I think cabazitaxel also gives the same benefit of docetaxel. My MO told me that there bi weekly infusion of docetaxel with a lower dose. But I am doubtful about the benefits. I will suggest cabazitaxel also as an alternative. Let me know the opinion of MO. Thank you Tall Allen for valuable reply

[Shooter1]

Docetaxel at 156mg(75mg/Mg/M2) was trying to kill me. Added many buffers over course of treatment./ ended up with : prednisone tablets--5mg twice a day Emend (fosoprepitant dimeglumine) 150mg IV Palonosedtron hcl inj. 0.25 IV Push Dexamethasone sod phosphate, inj 10mg IV Hydorcortisone sod succinate,Inj. 100mg IV Boiled out of my arms as chem burn on #1, Mouth sores. Added PICC line. Pimples, sores on arms and back with # 2 Added new buffers for #3----better. PSA jump at #5 and added xtandi. Back down for #6, continued through #9 where all my skin was sloughing, nose bleeding, eyes leaking, belly full of knives, eyes out of focus, hands and feet dead (numb beyond much use) I'd hit the wall and was done. Good luck. /We are all different and hit the wall at different points. When benefits are out weighed by side effects you are done.

[dress2544 in reply to Shooter1]

Sorry to know that you also suffered severe side effects from docetaxel. Maybe the dose of 156 mg was given to you because of your big body structure. How was your condition after 9 infusions? I hope you are benefited from docetaxel despite the severe side effects. How are you doing now? Which treatment you are taking now?

[Shooter1]

7 weeks after last cycle and still getting new side effects. As feeling returns to hands/wrists/feet/ankles, I have pins and needles in fingers/toes. Shooting pain up through wrists and ankles. Pain in knees and elbows. Still sloughing some skin but not nearly as much as first month after #9. Still have toe nails dying, numbness across face and back. Nose has stopped bleeding. Eye sight is returning to close to normal (was blurry and double to quadruple). Taste coming back.

On healing cycle from chemo. full scans and blood workup first week of June. Two surgeries first week of May if scheduling works out right. One for sure. One is unrelated to cancer, just repair of old injury.

Life goes on. Just agreed to another years lease on retirement home in Idaho. Hope to someday be able to use it.

Doug

[dress2544 in reply to Shooter1]

Sorry Shooter to know the severe side effects of docetaxel even after 7 weeks. If your benefits from the treatment outweighs the suffering from it, we can console ourselves. Two years back I could do only one infusion. I suffered the worst side effects like non stopping diarrhea. My total digestive tract from mouth to anus was something like burnt. I was bedridden in the hospital for a week. Mouth sores were sever. My feets, legs and thighs swollen like anything. I could walk properly only after one month. I could eat somewhat normally only after three months. Even after two years, now also I find it difficult to drink juices or water at a stretch. When I think of those days, it is a nightmare for me. I couldn't complete the treatment. With only one infusion I was forced to discontinue because of the toxicity of docetaxel. But I know most of the patients tolerate docetaxel without much side effects. Each person react differently.

I wish you all the best when the scan reports and results of blood test comes in next month. Thank you Shooter for replying me.