New to the club of Advanced Stage 4

[OldGuysRule]

It was just recently discovered that my PCa has metastasized and spread to my spine. Originally diagnosed (at age 54) in 2015 with Gleason 3+4 and contained to the prostate we opted for focal laser ablation. All went well with that but, a 3T MRI in 2017 showed small recurrence so, another FLA was done that resulted in a fistula. It was pretty awful but it did heal. In 2020 another 3T MRI showed recurrence was in the same area. At this time Cryo was done. As you can tell by now, quality of life was a definite priority in my decisions, for better or for worse. Present day, PSMA PET scan reveals metastasis in the prostate bed and to the spine to the T2 vertebrae. Since the latest diagnosis I have met with one Urological Oncologist and two Medical Oncologist. I have an appointment to meet with a Radiology Oncologist this week. So far the concern is radiation is off the table because of the complication with the fistula. The concern is, radiation may cause further damage to rectum wall. The general consensus is that I will be on hormone therapy for the rest of my life. Does anyone out there have any ideas or experience with something like this?

[Tall_Allen]

At this point, with metastases on your spine, I doubt that there is any point to irradiating your prostate and prostate bed. I'm sorry about your fistula - that is the worst outcome one can have with ablation therapy. I agree that hormone therapy will be permanent, but it may be possible to have vacations from it.

[Fitzbruce1]

I was diagnosed 4 years ago with over 25 metastasis on my bones, with several on my spine. I have been on androgen therapy since. My PSA is under 1. I am a little tired, I get hot flashes and don’t sleep as well as I should, but 4 years in at age 71, I am riding off road motorcycles, rode my jet ski to the Bahamas, just got back from a fishing trip in Alaska, etc. I am generally in a good mood w myself and others. Lupron, Zytiga and Prednizone have put me into remission! My PSMA scan 2 months ago showed that every metastasis but one was dead or at least in remission. I just had 10 radiation sessions to get that last one. So don’t fear the androgen therapy. It has added many years to my life. It might do the same for you! Don’t fear the side effects, celebrate life! Good luck to you!

[OldGuysRule in reply to Fitzbruce1]

Thanks! That’s very encouraging.

[jfoesq]

I have been on ADT for 10+ years. It has had side effects, such as: loss of sex drive, weight gain, breast enlargement, among others. BUT- I am able to be around for my wife and to see my kids grow-up (the youngest is now 15) and play a lot of tennis in the Spring and Summer with them, shoot baskets ,(but can't play a game because of a mediocre result following knee replacement surgery), watch my kids play soccer..... Life is still good, even with the side effects of ADT.