What next??

[Canton44]

Hello. Brand new here! Diagnosed with Stage 4, Gleason 9 PCa during TURP surgery on 10/30/19. Mets to pelvic bones and bladder neck invasion. PSA has always been 2-3. ADT (Lupron and Erleada)has me at PSA of <.03. Confused about what’s next. MO says ride out ADT, urologist wants to remove prostate and bladder, RO wants to radiate all cancer areas. Any thoughts??

[tango65]

How many bone metastases? any metastases outside the pelvis?

If you have less than 4 metastases (pelvic bones metastases and distal metastases) , radiation therapy with a brachytherapy boost, along with radiation to the bone metastases and ADT is a treatment to consider.

redjournal.org/action/showP...

sci-hub.tw/10.1001/jama.201...

[Canton44 in reply to tango65]

Thanks Tango

[Canton44 in reply to tango65]

3 bone Mets in pelvic bones, bladder invasion

[tango65 in reply to Canton44]

The cancer is oligometastatic. Data support treating the primary tumor. There are data indicating a longer progression free survival when metastases are treated with radiation in oligo metastatic patients. Whole pelvis radiation (radiating the prostate and the Lymp Nodes up to aorta bifurcation) and long term ADT should be also considered .

If you go with radiation, the RO should have experience in doing brachytherapy in PC patients.

If I were in your situation I would get a second opinion in a center of excellence (Dana Farber in Boston, MSKCC in NY, UCSF, UCLA, etc.)

Best of luck on your journey.

[Canton44 in reply to tango65]

My RO says Brachytherapy is not used once PCa leaves the prostate? Agree?

[tango65 in reply to Canton44]

You need to have a second opinion with other RO.

[Canton44 in reply to tango65]

Gotcha!!

[Tall_Allen]

Whether or not it's worthwhile radiating the prostate depends on the number of distant metastases. If < 4 bone metastases, it may help to zap the prostate. This article describes your options:

prostatecancer.news/2017/06...

You have a low PSA subtype, so brachy boost therapy is something you should consider with external beam radiation to the whole pelvis.

[Canton44 in reply to Tall_Allen]

Thanks Tall

[TEBozo]

Thats a tough decision that many of us have had to make. Seems if I could save my bladder, I'd opt for the radiation. Have they given you any survival projections for each protocol?

[Canton44 in reply to TEBozo]

Thanks, good question. I just emailed them to ask

[Hidden]

They differ opinions.? Common my friend. A Uro makes the big money by surgery . I was complicated beyond surgery . So I’ve only done 8 weeks of imrt and I’m still on adt . I went undetectable and have stayed here five years now. That’s about the best we can hope for. APC always comes back . Live for today .. Our knowledgeable members will guide you . What to expect? Some take adt hard . I did . Others breeze through it .. don’t fear adt? Fear the dammed disease gone wild . We don’t want end stage APC any time soon. If we can kick this can far enough then maybe we can be here for a cure. Welcome aboard ! 😎

[Canton44 in reply to Hidden]

Thanks so much Whimpy! Big help

[j-o-h-n]

Greeting Canton44..... What's your age and location? Info is voluntary but it helps us help you and helps us too. Just post info to your home page. You look very healthy,,,, Keep posting here for important info....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/21/2020 7:14 PM DST

[Canton44 in reply to j-o-h-n]

60 and in Canton, OH

[j-o-h-n in reply to Canton44]

Thanks for the response, you're a young whippersnapper.....

Canton/Akron Football hall of fame..... Been there, done that.... I know New Philly and Dover (down the road a piece) a bit.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/22/2020 2:03 PM DST

[Canton44 in reply to j-o-h-n]

Thx John, you nailed it. Football HOF. I was born in Dover.

[j-o-h-n in reply to Canton44]

I was not born in Dover..... but I know of Union Hospital on the boulevard......

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/22/2020 2:55 PM DST

[GoBucks]

If you are in Canton Ohio take a drive up to Cleveland Clinic or to The James in Cbus. If you are in Canton China get me some of their great chow mein.

[Canton44 in reply to GoBucks]

Lol. Thx Go Bucks. I’m at the Cleveland Clinic

[GoBucks in reply to Canton44]

I went there for a review/2nd opinion. A 2nd set of eyes never hurts. The James at OSU would be good for that. I went to CC because they got me in first.

[Justfor_]

Your first priority should be the bladder invasion. Someone I knew had a kind of immunotherapy for this. They would catheterise some unrelated virus into the bladder in hope that the immune system would be alerted and fight cancer as a bystander. Regretfully it didn't work for him.

[Canton44 in reply to Justfor_]

Thx for your interest. I’m hoping radiation can get it. I thinking Dattoli Cancer Center in Sarasota, FL. Anyone ever heard of it? If so, thoughts??

[Justfor_]

Normally, the irradiation towards the badder is kept to as little as possible for long term urinary side effects. Also my urologist told me that bladder is the most forgiving organ of our body Resecting the bladder neck and performing the anastomosis there is not an easy task and comes along with a high risk for incontenance. I really don't know which of the two, i.e irradiation vs surgery to be more successful and at the same time have the least, long term, side effects. Wish you find the optimal answer.

[Canton44 in reply to Justfor_]

Thanks