Peritoneal Mets, how to treat?

[BWeaver1224]

Hi does anyone have experience with peritoneal metastasis in stage 4 prostate cancer, if so how was it treated? Any success stories or any info would be much appreciated. 3 out of 9 lymph nodes positive also, but no other mets that we know of.

[Tall_Allen]

Have you talked to a radiation oncologist? What did he suggest?

[BWeaver1224 in reply to Tall_Allen]

Not yet, that appointment is set for early September. This is for my brother who just had his prostate surgery about 3 weeks ago. The pathology report from surgery showed the peritoneal metastasis. Thanks for responding.

[Cooolone]

It is as my MO said, an extremely rare presentation of your PCa. There are basically a few cases of it (U.S.) like "ever" and as such, there are no previous patients to follow or predict the outcome.

Stage IV SOC is that ADT will be now for life, and other drugs or therapies applied. The choices I looked at was ADT/Zytiga/Prednisone or Docetaxel. I opted for Chemo. Just finished and won't know how well it did until tests...

There's not a lot of data for PCa in the Peritoneum, but there are other cancers that go there. Some interesting treatment modalities as well, like HIPEC, but they're not used or approved for PCa patients. I asked my doctor about using Docetaxel in the HIPEC method, hahahaha, but it was a stretch. The reaction on his face was priceless 😂

My story is here somewhere... But I had mets to my Peritoneal and Appendix! Even the Appendix is RARE! Appendix cancer affecting only 1000 people per year in the U.S., I was lucky, being an MSKCC patient, one of my team surgeons handles about 1/4 of those. So, I'm going to think I'm in good hands! Moral is, get yourself to the very best you can access! A Cancer Center of Excellence, and don't skimp here. Experience wins!

Anyways, Best Regards

[MateoBeach in reply to Cooolone]

HPEC with docetaxel sounds like a natural thing to consider. “You put a catheter in. You put the doxetel in and you shake it all about. That’s what it’s all about”! 🤗😆

[BWeaver1224 in reply to MateoBeach]

Is HIPEC for prostate cancer mets to the peritoneum an option??

[MateoBeach in reply to BWeaver1224]

Not at this time. Just an interesting idea. Toxicity, clearance and effects on implanted tumors in animals would need to be done first. Probably will never happen given the rarity.

[Cooolone in reply to MateoBeach]

That is correct... Fighting the SOC all the way through! What's good for the "group" is what ya get! Until we get to true and honest individual diagnosis and staging with an accompanying individualized treatment plan for those patients who don't fit the mold...

[Cooolone in reply to MateoBeach]

Hahaha, lmao!

Wish it were that easy!

[BWeaver1224]

Yes, I'm seeing this is very rare. My head is in a whirlwind. This is for my brother who just had his prostate surgery about 3 weeks ago. He has not started any treatment yet and is scheduled to get a PSA in 3 weeks and then to see the oncologist in July and an appointment in September with a radiation oncologist.

I'm trying to research but all these abbreviations are new and confusing. What I know is that my brother had 3 out of 9 lymph nodes positive and the peritoneal biopsy was positive for prostate cancer. During surgery the doctor sent the peritoneal sample for a frozen section which was negative, but after it was sent to the lab it showed the cancer.

Are you in the US? Since the peritoneal mets are so rare I have no idea where the best place in the US would be for treatment? Any idea?

PS- I read your older posts and saw you had genetic testing. Is this recommended for better treatment recommendations? It seems you are doing pretty well which is encouraging.

Any info you can throw my way would be greatly appreciated.

[Cooolone in reply to BWeaver1224]

The metastatic lesions stage the cancer at IV... And typically systemic therapy is the norm. I had already went through lower staged therapy because that's what had been diagnosed at the time. Yes, I'm in the U.S. and with my initial diagnosis went to MSKCC as it was the closest Cancer Center of Excellence! Looked at other options as well. The lymphatic system being involved for you also elevated your staging. I was fortunate and did not have any (known) lymph node involvement, all taken and tested were negative.

Best suggestions is to have genetic and advanced pathology performed on the tissue removed. Immunohistochemistry staining, genetics, etc., will help try and identify any adverse features or mutations that there is some therapy for. Fact that the cancer has spread lends to aggressive disease already. But it's good to know. And yes, the genetic testing did identify mutations that would qualify me for some treatment lines, unfortunately they're currently reserved for mCRPC (castrate resistant) patients and I'm still mHSPC (hormone sensitive). So this is the crazy part where you might find or see effective therapy for some patients that might work for you, but you don't meet the script of approval (FDA). Ehhhhh, it's maddening at times.

Like the PEACE-1 trial has shown much benefit to adding Zytiga to Chemo (Docetaxel) with significant advantage. Something that I didn't have access to just a few months ago but would have definitely agreed to. Funny thing is I even had that very discussion with my MO (adding Zytiga) but was pretty much dismissed.

Problem with advanced treatments and or participating in trials is you don't know how your cancer will respond anyways, especially if you're fitting nicely into the stratification they're testing. So although I knock it, the SOC at least provides some guidance as to what to expect, what's known. Is why I went with Docetaxel.

You can have those biopsies 2nd opinioned as well, just to make sure it's all consistent what you're being told or what's seen. Might not change anything, but I think those type of things are worth it.

There are many Cancer Centers, and there are those that specialize in Prostate Cancer. Many here would be better versed with where depending upon your location. But again, I would look to get to the Best of the Best, that is close to you. Local facilities and doctors can't compare, sorry, I know they all need to start somewhere, but not on my body lol