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[sbo4]

HI! My husband is 71 and was diagnosed with metastatic prostate cancer back in midsummer. His Gleason score is 9 with 4-5 mets in ribs and vertebral bone plus possible lymph node involvement. His PSA at the time went to 17. He has had two bone scans, initial being right away and just recently a second to confirm metastasis. His doctors would not remove the prostate and insisted best treatment at this time is Zytiga with 5 mg of Prednisone daily and a Lupron injection every 3 months. His PSA has dropped to less than .02 with the treatment. We wanted his doctors to remove the prostate but they all insisted it was not the best course of treatment at his age. He is 71 but has never smoked, does not drink alcohol and has always been very healthy. The only meds he took prior to this was a low dose of blood pressure medicine (Lisinopril) that has always kept his blood pressure under control. We would like to know if there is a doctor that would remove his prostate or if there really is no hope of ever getting rid of the primary tumor?

[spinosa]

Removing the prostate will not be "curative" at this point...BUT - with the tumor load reduced, one might expect longer remissions, etc. Next best thing is radiation - you should visit a quality center and get second and third opinions.

[tom67inMA]

Removing the prostate sounds like a good idea, but when they've done studies there hasn't been any survival benefit in patients with advanced cancer. It also might cause quality of life issues such as incontinence, not to mention the risks and recovery time inherent in any surgery.

The way I look at it, in advanced cases (like mine) removing the prostate will only get rid of a fraction of the tumor burden. If systemic treatments work, they will shrink all tumors, including those in the prostate itself. If you're lucky enough to reach a point where the metastases disappear and only the prostate has detectable cancer, then removing it becomes a decent option. This has happened to several members on this forum if I understand correctly.

[Tall_Allen]

There have been two major trials (STAMPEDE and HORRAD) showing that taking the prostate out of the picture (with radiation and probably with surgery too) has no effect when there are multiple metastases. It only adds to the side effects he will have to deal with. Zytiga is a much better option, so is docetaxel. Here's an article discussing the evidence from those and other clinical trials relevant to his situation:

pcnrv.blogspot.com/2017/06/...

[j-o-h-n]

Please tell us where you're located, where he is being treated and name(s) of doctors. This info helps us help you.

Good luck, Good Health and Good Humor.

j-o-h-n Thursday 01/31/2019 6:20 PM EST

[dmt1121]

I am in absolute agreement with "spinosa" that getting additionally opinions, if you have not already done so is very helpful in a couple of ways. First, it will provide confirmation or redirection. Both are good, if the MO is working in a research hospital or similar setting and you can trust the information you get is current and frontline. Also, you will have much more confidence in what decision you make about treatment going forward.

"Tall Allen" also makes a very good point that the side-effects of surgery and/or radiation at this point might outweigh the benefits. With advanced PCa and any long-term debilitating disease, quality of life is really important to maintaining a lifestyle as close to normal as possible, being independent and staying in good spirits.

Stay tuned to our network and I am sure you will get a lot of support and options to explore. There is a lot of knowledge here. Many times, it is more than you will find in any single doctor's office and give you questions to ask.

Good luck!

[Mormon1]

I am very close to boat. I am 68 and diagnosed in Jan 2018. Nonsmoker nondrinker never sick before. Mine spread to lung and thoracic spine. They did not remove my prostate. Seems after it spreads may be too late. ( note I am not a Doctor). I have been on zytiga and 5mg prednisone for one years. Monthly shots of lupron and xgeva for bones. Happy to report one year scan revealed a miracle sent right from Heavenly Father! The strawberry sized tumors have 100% resolved and disappeared. Cancer has not spread! Bone damage is repairing itself Daily pain in thoracic spine but I am 100% more mobile than when first diagnosed. My PSA has dramatically lowered from a deadly 11,000 to 0.1 ( less than 1). My morning toutine is raisin bran with big handful of blueberries and grapes in a translucent skim milk. I eat alot of dark green veggies like broccoli rabe with garlic and virgin olive oil. Fruits and salmon or chicken with honey. I supplement with calcium, D3 and K2. I went back to work as a lawyer, although part time. I spend alot of time boating and nature and loving my wife and Heavenly father. South Zjersey doctors.