Chemo and hormone therapy both got my PSA down to 5 range and then began slow rise up. My MO said that could be my base given I still have my prostrate. I was diagnosed after it had spread so removal or radiation weren't an option. Two questions if you could help me with:
1) Why not remove?
2) Does that sound like a feasible explanation for a base of 5?
Thanks.
I was diagnosed 6 years ago and soft tissue mets have been the issue. Bone mets have remained somewhat stable. At time of diagnosis the SOC was just ADT. Today I believe the thinking has changed and you are more likely to find someone to remove the prostate and radiate the area to reduce tumor burden. If I could have found that person in the beginning I could have perhaps limited invasion of the bladder and now extensive lymp node involvement. The real issue as you can read on this forum is everyone is different and responds to treatment differently. I would be over the moon if s treatment resulted in undetectable PSA. Good luck and remember nobody will work harder to keep you alive but yourself.
After the cancer has spread beyond the prostate there is no reason to remove it. It puts your urinary function at risk and accomplishes nothing. As to 5 being your baseline, it may be hard to get your PSA below that level.
Some have proposed that removal of a primary tumor, in some instances, may possibly serve to promote further metastatic spread rather than prevent it. There seems to be both pro and con evidence regarding this, so nothing conclusive (that I am aware of).
But even if there is a possible benefit of removing the prostate after metastases are discovered, there are also the possible costs and complications that come with RP. So it seems safe to assume if there was a definite and proven benefit to removal, that usually outweighed any possible costs, removal would be the norm.
Interesting. So can removal of the prostate on the front end sometimes cause a spread that leads to metastases?
That's the question, and I don't think it has been conclusively answered. But here is just one of the many articles that suggests the mechanisms:ncbi.nlm.nih.gov/pmc/articl...
Thanks for quick comments. So much to think about.
Primary tumor removal may not have an advantage .If ADT works for you you can continue on it for 18 months.Check,T,DHT,HEA and Estradiol. Keep them low.
Newyork6264: Thanks for asking this simple but important question. I'm alert for answers. Based on what I've read, I suspect this is a classic example of a simple question without a simple answer. Lots of tradeoffs, many of which are subjective, and some of which are speculative.
It depends on how many metastases you have and where they are (your profile doesn't say). If very few metastases, debulking the prostate may have some oncological benefit. If you have a lot of metastases, it will only add to current side effects.
prostatecancer.news/2018/09...
Cancer in the prostate certainly elevates PSA.
Thank you. I have a fair amount in hips, lower back and leg.
If the cancer in your prostate is interfering with peeing, that may be a reason to have a TURP or radiation or ablation of the prostate.
You could ask for an early palliative surgery. If the cancer in the prostate grows it can close the urethra and you will have to get surgery then. Some doctors are willing to do this operation in advance before this happens.
Keep as a show piece........(souvenir?)
Good Luck, Good Health and Good Humor.
j-o-h-n Saturday 01/23/2021 6:14 PM EST
Love the humor John. Good break, weird sometimes but always welcome.
Thank you..... especially the weird part........
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 01/24/2021 2:31 PM EST
I have never been clear about the answer to your question even though I have a similar circumstance. I did a focal cryo- treatment almost 10 years ago and ablated about 40% of my prostate. My psa stayed at about 4 without any treatments for almost 6 years. Fast forward 6 years and my psa rose to about 6. All the latest imaging at the time showed no cancer in the remaining prostate but showed it had metastasized to two spots in my pelvis and one on my ribs. I used SBRT on the three spots. And I did chemo Lupron and zytega for two years. I was able to get my PSA down .01 (undetectable despite my 60% of a supposed healthy prostate) for over a year at which time I went on a “vacation” for the last year. No meds. Now my PSA has slowly gone up to almost 5. Since there’s no way to know if that psa is from healthy prostate tissue or spread of cancer, I’ve done two PSMA scans that we’re both negative and I have another one scheduled for February 20. I tell you this because at least in my case I was able to get my PSA to undetectable with those meds despite 60% of a rather large remaining prostate. Only when I got went off my meds did my PSA go up.
Schwah
So what are you going to do now? How do you frame the pros and cons?
Well in my case, there does not appear to be a reasonable argument to remove my remaining prostate given that multiple PSA tests and MRIs and Doppler imaging have all shown no indication of residual cancer in the prostate itself. It appears my prostate cancer horse left the barn prior to my focal cryo-procedure. I will however continue to monitor my PSA and have PSMA and perhaps other imaging tests to Determine if and win I need to go back on systemic treatment and perhaps additional SBRT to any metastasis.
Schwah
I had participated in a trial called SIMCAP that was looking to determine if having RP for us metastatic patients could be effective. I was also told the surgery would be nerve sparing. Unfortunately, neither was true for me.
As TA noted, it depends! And for most of the treatments, timing is essential in consideration as to it's benefit. There is some benefit to debulking the mother load. And at the same time there is risk, especially if advanced disease has already progressed.
As for CTC causing metastatic lesions...? Hmmmmm, that one is debated, and you'll never get a clearcut answer on that for sure. Best I've read is there is a low, like 1 percentile possibility for that to occur, but are they really tracking, or checking? And if they are, how so (?) would they prove those distant Mets came from the main tumor?
Anyways, once the PCa has spread, there is a general standard to the care of PCa patients, to switch to a systemic treatment modality, to try and control disease progression. Discuss the up and down sides of this with your doctor, and get a second opinion as well if it is something you feel will benefit you.
Best Regards
I was dx with widespread mets mainly to bone but also in several lymph nodes. I opted to have my prostate radiated using IMRT. I made this decision after reading a lot of info on debulking and especially after reading Snuffy Myers book where he explained that the high concentration of prostate cancer cells in the prostate may continue to cause additional mets as well as mutations (it’s a numbers game). I had a very skilled RO who felt I’d get a longer run from ADT if I debulked the prostate and said ADT and radiation have a symbiotic relationship.After consulting with several doctors about half were for it and half against it. Those against it felt there was a risk of damage to other nearby organs. Those for it felt that reducing the tumor burden made sense and that it could prevent the cancer from spreading into nearby organs like the bladder etc.
I went ahead and had my prostate and several affected lymph nodes radiated over a 45 day period. Of all my treatments it was probably the easiest. I’d do it again in a heartbeat. So far so good I’m coming up on 7 years since dx. I recall Snuffy telling me during a visit after I became a patient of his, that it was probably the best thing I did treatment wise. I’ve taken an aggressive approach to treatment, you could read my profile to see what I’ve done. I’m not crediting the debulking of the prostate as the sole reason for my run but it is one of the treatments that I think has played a big part.
Ed
Looking backward, and patients who were not quite like you, but those with lymph node spread detected at surgery and surgery continued to remove prostate and nodes, had fewer urinary blockage issues later compared to those who had surgery abandoned. In other words, with best surgeon, short term risk and side effects were greater and longer term effects were less.
I had my prostate removed just over a year ago via a RALP. Have been incontinent since. I have been on therapy for that almost since the surgery, with very little progress. Being incontinent is no fun at all. I now wonder whether I should have explored other options to having it removed, even though it did take care of the cancer. If I were you, and didn't absolutely have to have it removed, I would leave it and not run the risk of incontinence, which is not negligible. I was Gleason 8 and am 74.
My personal experience: I have widespread mets including neuroendocrine in my liver. I still have my prostate and it hasn't been radiated. My PSA was as low as <0.01 for about a year (my T was also undetectable the one time it was checked). I have no urinary issues, and when it's time for a scan we talk about my liver, lungs, bones, and bladder. The prostate doesn't get talked about because it's normal size and at last DRE no longer had a nodule. I have an odd cancer that seems to have abandoned my prostate. I'm hoping it will someday decide to abandon my body and go away and leave me and my doctors puzzled but happy.
YES that explains it. Do not remove your prostate...
A considerable number of men develop urinary incontinence or other complications after a prostate surgery, regardless of what a surgeon may suggest. If your cancer may already have metastatic spread to some significant degree, requiring "systemic" treatment, how would you feel about potentially dealing with an added hassle of pads, incontinence, and related each-and-every-day workarounds, perhaps for the rest of your life? In support groups I have known men who deal with incontinence issues fairly well, taking it in stride. I've known others who have real psychological difficulties.
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