Has anyone had metastatic prostate cancer and had surgery?

[goodgoal]

My father is 53 years old. He has metastatic prostate cancer. Therefore, he received 6 rounds of chemotherapy and is using Zoladex. The initial PSA value of 24 is currently undetectable. We are now at a decision stage. His urologist wants him to have surgery. The goal of the urologist is to remove the burden on the prostate. Do you think radiotherapy makes more sense or surgery? What is your story or suggestion in this difficult choice?

[Magnus1964]

Once the cancer has spread beyond the prostate, even if it just in the lymph node around the prostate, surgery in not advisable. The risk is too great for no advancement.

Stick with Lupron or other similar drugs. If needed radiation should be used.

[AlvinSD]

I am 52 and was just diagnosed. It has spread to my lymph nodes and a small spot on my right hip. I was told surgery was off the table. Unfortunately there was little explanation and no discussion to help me understand why. Fortunately the people on the Reddit PC sub and the people here were helpful with their explanations

But, even if I could have had surgery, because of my Gleason score I would have to have ADT and radiation anyway. So, some have said to me, why even bother with surgery since that’s the case.

So, I’m proceeding with ADT, starting chemo in about a week then having radiation in the fall.

[RyderLake2]

Hello, I was told by my oncologist that there is no point burning the barn down (radiation) or tearing it down (surgery) once the horses have escaped. He said it is all about risk and reward and the potential risks of surgery and/or radiation outweigh the reward. A much better approach would be a systemic treatment. Consequently, I have been on Zoladex (goserelin) for nine years and Xtandi (enzalutamide) for nearly five. I still have my prostate.

[wolverine11 in reply to RyderLake2]

Hi Ryderlake2... I just read your Bio. glad to see you do so well is very encouraging. I was dx Dec. 2020 PSA 970 ALP 930 with innumerable bone metastatics GL 4plus 4= 8.Currently PSA 0.10 ALP 138. So we have similiar diagnosis, albeit your PSA was 1700 WOW, and going on 8 years, that's friggin great. Hope to follow in your footsteps, wishing you the best

[RyderLake2 in reply to wolverine11]

Hello, I hit nine years at the end of May. I seem to be the "poster boy" for men diagnosed with metastatic prostate cancer and extensive bony mets (from my knees to my neck). I have talked to many men (and wives) in our community and I tell them attitude is everything, so is education (learning about your options). A supportive wife, family and friends will take you a long way. I am fortunate to have all three. Good luck!

[wolverine11 in reply to RyderLake2]

Thanks for your reply. 9 years....that is great..

[Hidden in reply to RyderLake2]

Age, other medical issues at diagnosis and luck all play into results. You are doing great!

[RyderLake2 in reply to Hidden]

Thank you so much! I am very grateful!

[j-o-h-n in reply to RyderLake2]

To RyderLake2 (Utah),

I am fortunate to have all three.

You're firing all cylinders.....GREAT!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 06/30/2022 8:20 PM

[Concerned-wife in reply to RyderLake2]

You did well. I do think they have changed recommendations these days to radiate the prostate in cases of oligometastatic spread based on studies they did since when you were advised. ( and systemic therapy)

[Tonwantonga in reply to RyderLake2]

RyderLake2, my oncologist told me the same thing, almost word for word. horses, risk and reward. I've only been on this journey just short of two years. i still have my prostate too, but i have been told it is very shrunken. so i guess after the horses escaped we downsized the barn. chemo, and then radiation as part of a clinical trial, and just Eligard since then. so far, so 'good'. good is a relative term, of course, being a member of the 'No T Club' is no picnic. and the membership dues are really high........

[Tall_Allen]

They have only tested debulking with radiation so far. Why would he undergo all the extra side effects of surgery when radiation does the job with fewer side effects?

[Bigdo58]

I was also 53 at diagnosis. I also though, found out that I was BRCA 2 positive same time (Peter Mac - Melbourne Australia) with a registered familial hotspot there as well. I had RALP..robotic assisted laparoscopic prostatic removal. In 2012, at Dx, given my gene fault, that was the only real option all advisers recommended. There was only 2 Da Vinci 3D's in Oz at that time and the Sydney NSW (State) option much closer to me, was booked out for 12 months. I flew 1000k to Melbourne Victoria to have my RALP. I am alive because I chose that option I believe, as BRCA 2 produces highly aggressive prostate cancer.

Without a BRCA 2 involvement (and I recommend goodgoal be checked), I would highly recommend radiation and ADT instead of surgery, as that has a much higher chance of preservation of normal penis function than any surgery, and I really believe it is the way of the future until immunotherapy gets better. At 53, to lose a highly significant part of functionality there is a big risk for little further reward in my experience. Try and find an MRI guided Linac facility somewhere and go there.

[Seasid]

Can you consult also a MO and a RO?

[Flash64]

I had surgery post Docetaxel and a year of Lupron, including the removal of 26 lymph nodes. This was done as a PSMA PET scan showed some very slight uptake in the prostate and lymph nodes even after prior treatment. Although radiation was discussed my “team” thought surgery would be best and that radiation could still be an option in the future. Good luck with your decision.

[EdBar]

I was dx at 55, metastatic, stage 4, G9. I had my prostate and several affected nodes radiated. I chose radiation because it was less risky than surgery. That was 8 years ago. I became a patient of Snuffy Myers about a year after my dx and he said getting my prostate radiated was one of the best things I did early on, “kill the mother ship” as he put it. For me hitting it hard early on has worked well, I threw the kitchen sink at it.

Ed

[SteveTheJ]

This is a test; my last reply got lost in the ether.

[SteveTheJ]

On the surgery... I was diagnosed with stage 4 cancer in April 2020. In October 2020 I had my prostate removed. My recovery was difficult; DM me if you want more info on that.

The current standard of care is not to remove the prostate if you're stage 4 because there's no known medical benefit.

My oncologist at MD Anderson enrolled me in a clinical trial to see if there is any improvement in life expectancy and quality of life with ADT (Erleada + Lurpon) and prostate removal. Since the ADT therapy started, my PSA is unmeasurable and my quality of life is very good.

Don't be scared of prostate removal if it comes to that; just be prepared.

[NotAlwaysSunshine]

The SWOG S1802 trial had a couple arms where the patient could choose surgery or SBRT. Husband chose SBRT.

[Tonwantonga]

Ask your oncologist about clinical trial S1802, it is studying standard systemic therapy (SST) v. SST+Surgery or Radiation for Met Prostate Cancer. If your father has to have surgery or radiation, participating in the trial might benefit others , as well as your father. As for your question, my two cents is - radiotherapy.

[jfoesq]

I had the surgery 10 years ago even though it was against the standard of care, as I believe it still is today. My doctor explained the lack of evidence supporting surgery but because I was other wise young (54) and healthy he thought so could handle it well and thought it MIGHT Possibly be beneficial. Based on the latest science, I don’t believe it has helped but I didn’t have any serious side- effects either and am glad I gave it a try. I was only his 13th patient he treated this way. My guess is, he wouldn’t do the surgery today, nor do I think I would have it today, based upon current information.