My options in dealing with a metastasis

[mcp1941]

I had an Axumin scan a few months ago that revealed one metastasis starting in the prostate bed, prostate gland and extending thru the wall of the bladder. MO said I had two options: Cryosurgery or Proton radiation. Met with RO and he said that it is too dangerous to radiate since I had prior radiation for initial treatment (1996). Cryosurgeon said that he would not do cryotherapy because he would not be able to get the entire met and there is no use in doing surgery if you are not getting 100% of the met. I agree with him on that.

My Uro did a biopsy of the met that extended into the bladder and that came back as adenocarcinoma with no sign of neuroendocrine cancer. Specimen was sent to Foundation One and waiting for results. Uro said that he could remove the entire met (prostate bed, prostate gland and bladder)and put in a permanent bag to collect urine. MO said that I could try chemo first and either delay surgery or not need it at all if I have a good response to chemo. I am 79 years old with co-morbitities - Type 2 diabetes, Afib, 6 Stents, Multiple Myeloma

QUESTION: Do I get chemo or surgery? Can I get Provenge while getting chemo?

MikeP

[Tall_Allen]

Strictly speaking, that doesn't sound like a metastasis. It sounds like cancer from the prostate that has penetrated into your bladder. It is staged T4, rather than M1. It is still troublesome.

I suggest you talk to an RO who does HDR brachytherapy. It can treat the cancer that has penetrated the bladder. And because it is highly precise, your previous radiation will not matter. Maybe get a telephone consult from Mitch Kamrava at Cedars-Sinai in L.A. If you talk to him, let me know what he says.

Provenge is only approved so far for prostate cancer in patients who are both metastatic and castration-resistant - you are neither.

[mcp1941 in reply to Tall_Allen]

Thank you TA for the info. I am in a funk due to all the ailments I have. I had been putting off an eye exam and finally got an appointment for yesterday. When I made the appointment I explained that I am immune suppressed and cannot be sitting in a waiting area with 10 other people That is exactly what happened. I was so pissed off. I waited 20 minutes and no one was called in for an exam so I knew that I had at least an hour wait. I told the receptionist to cancel my appointment and left. I have my appointment with my myeloma team today and will see how I am doing. I know that my immune system is still in the tank.

[Tall_Allen in reply to mcp1941]

I don't blame you. I hate that all this shit happens as we age.

[LearnAll]

TA has made a great point. This may be just an extension of the primary tumor inside prostate and now, growing into bladder wall.

A simple way to find out will be transrectal ultrasound...but if you want accurate and definite answer...need to go for multi-parametric MRI of entire prostate and adnexa.

[timotur]

If you consider HDR-BT, you may also talk to Dr Chang at UCLA.