Advanced Prostate Cancer

[mustang-66]

Hi all, I'm new here. I am the spouse of a man with the following diagnosis:

A. Prostate, hypoechoic lesion, core biopsy: Prostatic adenocarcinoma.

Gleason score 4+5=9, Grade group 5

Gleason pattern 4: 90%

Gleason pattern 5: 10%

Quantity: Carcinoma involves 3 of 3 cores, representing approximately 95% of the tissue.

Perineural invasion: Present

Additional findings: Intraductal component identified.

CT pelvis showed fullness in the right posterior lateral mod prostate, measuring 2.4 x 2.1 cm and a 7 mm right perirectal lymph node, indeterminate. Nuclear medicine bone scan showed no findings.

SBRT to prostate and second round to perirectal lymph node. PSE now less than 0.1

Quarterly Lupron shots, Zytiga 500 mg (2) and prednisone 5 mg.

Tolerating medications with symptoms of tiredness, loss of strength and medication brain fog.

You all seem to have a wealth of knowledge. How concerned should I be?

[Tall_Allen]

Sounds good so far. Did perirectal LN shrink with ADT? No side effects from treating it with SBRT?

[mustang-66 in reply to Tall_Allen]

We won't know for awhile if the tumor shrunk. The plan is to have the 4th Lupron shot in June (one year mark started in September 2020) and to stop Zytiga/prednisone at the end of 2021...then to test and watch to determine if the numbers start to rise again. No significant side effects with SBRT. Overall, he is tolerating the drugs and medications well.

[Tall_Allen in reply to mustang-66]

I take it back that it sounds good so far - but I'm probably misunderstanding. What I understood is that he had strong radiation to a lymph node on his rectal wall that may or may not have been a metastasis? Why wouldn't he see if it shrank with ADT first (indicating a metastasis)? Either way, whole pelvic radiation is necessary to clear up the mets that are probably there. It's not too late for salvage. You have to treat what you can't see. If it was a met, 2-3 years of adjuvant ADT are needed. If he is metastatic, he should stay on it for the full term, irrespective of the PSA. PSA isn't cancer- you can't treat PSA and think he is cured.

[mustang-66 in reply to Tall_Allen]

There were 3 nodes detected outside the prostate...one large enough to most certainly be cancer. The others too small to know. The first 5 days of cyberknife was for the prostate. The second for the regional metastasis. What is salvage? We were told surgery was now not an option, as it would not be a cure.

[Tall_Allen in reply to mustang-66]

Salvage does't mean surgery. It means getting thee rest. When there is even one LN metastases that you can see, there are many more you can't see. That is why it's important to irradiate all the pelvic LN metastases and not just the ones you can see. A recent study at Mayo demonstrated this:

prostatecancer.news/2020/12...

[mustang-66]

It definitely was an open ended question! And, I should have said how much trouble are WE in after 55 years of marriage. (the PC, not the marriage) Glad you think the protocol sounds good. So far, so good. We are lucky to live in an area where there is excellent care and we have great confidence in our team of doctors.

[Chugach]

Hi Mustang- what is your husband’s age and have you had genetic testing of the cancer done? Stage 4 prostate cancer is handled by everyone differently as affected by so many different variables. It’s a long road- it can be tough. It’s a marathon not a sprint. So breathe deep and enjoy every day. Stay strong science is amazing and changing rapidly!!!

[mustang-66 in reply to Chugach]

Husband's age is 81 this year. Genetic testing done with results negative for family connection.

[Chugach in reply to mustang-66]

Genetic testing can also evaluate opportunities for other treatment options, something to ask your doctor about

[CSHobie]

Hi Mustang 66, I would say you have reason to be concerned yes, but the fact that the bone scan is clear, is something to celebrate. No need to panic

[Hidden]

I welcome you here. Those in the know shall help you .. 🙏

[mustang-66 in reply to Hidden]

Thanks. Since we're rather new to this prostate cancer stuff, it has been overwhelming. It's a shock since my husband has always been great about his checkups. I stumbled upon this site and look forward to learning as we fight this battle together.

[Hidden in reply to mustang-66]

You’ve found a good place.. Apc is a shock and it takes time to fathom. It’s a convoluted disease . Walking with others on the same path can help. 🙏

[Guppyman1773]

Surgery too late for me 2012. Pretty much same treatment ops but so far no metastatic findings. Another Pet scan probably soon. Now on Zytiga and Lupron first time since 2012. Cassodex prior to that. Age now 79. Overall feel great...may be getting muscle cramps at night due to Zytiga.. Stay positive ..think quality not quantity...I feel bad for guys under 65 ..