Recommendations for metastasized prostate cancer clinical trial options?

[tdelpozz]

I had my first psa test at age 56 in 2006 and it was 30 or so. From then until last October psa levels remained high and had 2 biopsies which were clear, and high psa attributed to BPH. In October 2019 had HOLEP surgery to reduce prostate size and biopsy of removed prostate material revealed cancer with 9 Gleason. After several scans diagnosed with metastasis in some bones and lymph nodes. Being treated now with bicultamide and eligard. I am now looking at possibility of taking part in clinical trial through Ohio States James Cancer Center. If I qualify after physical I would be randomly placed in either a control group with only approved options available to deal with the cancer, or in the other group where I would have 2 options, taking the prostate out or having radiation therapy of prostate. So I am looking for any insight as to pros and cons of these 2 options if they are made available. Thanks in advance for any insight!

[Tall_Allen]

I think there is great risk of permanent incontinence from an RP after a TURP. There is also a risk with RT after a TURP, but it is less.

How many metastases do you have in total? If there are less than 4, prostate RT may be beneficial, otherwise not. There are now 4 drugs approved for your situation (docetaxel, Zytiga, Xtandi and Erleada). All of this is available without a clinical trial:

prostatecancer.news/2017/06...

[tdelpozz in reply to Tall_Allen]

Thank you Allen. I had a number of bone shadows, some thought to be arthritis or degeneration and some cancer. I know some drugs were just recently approved so will include in my next appointment discussion.

[GP24]

I think the control group with only approved options will get the drugs Allan mentioned. If you get into the other group you will get surgery or radiation in addition to that. I believe it will be beneficial to treat the prostate as well but that is what the doctors want to determine in this study. Both options will work just as well against the cancer. Surgery has different side effects than radiation but both can have side effects.

[tdelpozz in reply to GP24]

Thanks GP. That's my dilemma, is it worth having additional side effects, since I'm experiencing some now from the HOLEP and current meds? Or should I pass from the trial altogether, or take chances with RP or RT in a trial.

[GP24 in reply to tdelpozz]

Treating a Gleason 9 without side effects is difficult. In your response to Allan it seems that the number of bone mets is unclear, but you can count the definite ones with five fingers I guess. In this case this study reports that you live longer with radiation of the prostate:

esmo.org/newsroom/press-off...

They did not test for surgery but one of the investigators said, he sees no reason why surgery would not work just as well as radiation in this case.

[tdelpozz in reply to GP24]

Thanks again GP.

[j-o-h-n]

1 Surgery First followed evenutally by radiation.

2 Radiation First surgery is useless after.

Options 1 and 2.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/06/2020 11:17 AM DST

[tdelpozz]

Thanks John!