my friends i have very important question about surgery after metastases

[saeed_alexy]

My father dignisted G score 3+5

And PSA 60 with about 10 bone met lungs and ... Other part of body

Our doctor started taxoter and zometa for 3, years ago and also we start ADT each 3 month

After chemo finished we just stay on ADT zolodex

During this time my father start fasting therapy do to our riligen..

To day we test new psma pet CT scan all the metastatic gone just prostate and 5 millimetres met on iliac and 5 mm on lymphoma

My doctor says with this new scan im so happy

we start zytiga for tow month and maybe IMRT for reall cure if metastatic gone

I have very important questions is there hope to cure this tow 5 mm metastatic with zytiga abiraterone and radiation IMRT and after that we do the prostatectomy and take of the prostat ???????

The PSA start raising 2 month ago and know is 1.6

If there is any advice and any way to get real cure i will be thank full for that

😔

Sorry for my English speaking 🌹

[Hidden]

No need for RP after the IMRT. Looks like you've had really good results from the systemic treatments.

Good luck.

[saeed_alexy in reply to Hidden]

Thanks my friendBut i read thats real cure before metastases is surgery

So i think we can do imrt and also remove the hole prostate

[Hidden in reply to saeed_alexy]

That is a very wrong approach to your father's treatment plan. Metastatic cancer is out of the capsule. The genie cannot be put back in the bottle....surgery would be a huge mistake for your father. Good luck.

[saeed_alexy in reply to Hidden]

Thanks my friend i got it

[GP24]

With a Gleason 3+5 and bone mets there is no cure but you can live for a long time. There are probably a number of mets now too small to be detected with a PSMA PET/CT. I would radiate the prostate to remove the cancer cells there. In this study they did that for patients diagnosed with a few mets only.

esmo.org/newsroom/press-off...

You could argue that with the excellent response to the systemic therapy your father may also benefit from radiation now. Radiating the visible mets in addition to that can be done with SBRT radiation.

[Tall_Allen]

Those are excellent results and there is every reason to believe that his cancer can be managed for a very long time.

But I'm afraid you are misinterpreting the results. Just because you can no longer see the cancer on the PSMA PET scan does not mean the cancer is gone. It will come back, it already is coming back. That is why the PSA is rising.

With 10 bone and lung metastases originally, there is no value in treating the prostate. Why put your father through the side effects of radiation or surgery if it will not add to his survival? If any of his bone metastases are causing pain, he can get radiation to ease the pain.

With his quickly rising PSA, his best strategy now is to try docetaxel.

[saeed_alexy in reply to Tall_Allen]

We had docetaxel 2 year ago and our doctors says we can use zytiga

And you think it's better to have chemo again...?

Which is the best ?

And i understand the risk and im doing what ever i can for more life expectancy

And in Pet scan shows also prostate cancer is clear

[Tall_Allen in reply to saeed_alexy]

Can he get cabazitaxel? Zytiga is failing.

It has already been proven that taking the prostate out of the picture does NOT improve life expectancy.

PET scans only show that there are no metastases larger than 5 mm, not that prostate cancer is "clear." There are probably hundreds of metastases smaller than 5 mm.

[saeed_alexy in reply to Tall_Allen]

I know that we have cabazitaxel in Iran but i speak to much with doctor

He believed we have to start zytiga and maybe IMRT if needed

[Tall_Allen in reply to saeed_alexy]

Perhaps I misunderstood. I understood you to say that he has been taking Zytiga for 2 months, and in the past 2 months, his PSA has already risen to 1.6. If I misunderstood, Zytiga is a good next step. IMRT is a waste of time, unless the metastases are causing pain.

[saeed_alexy in reply to Tall_Allen]

Thats it

So we don't need radiation and bone metastases is under 5 mm and its tiny

May be it can gone with zytiga

[Tall_Allen in reply to saeed_alexy]

Zytiga will shrink them, but we currently have nothing to make them vanish entirely. Think of it as a disease to manage (like HIV or diabetes) not a disease to cure.