Chemotherapy or Zytiga or both? Metastatic or Locally Advanced Prostate Cancer?

[StephH72]

Husband Diagnosed 7/22 at age 50. Gleason 10, PSA 146, all 14 cores positive at 90-100%. PSMA PET scan shows seminal vesicle invasion, 1 pelvic lymph node, perineal invasion, large tumor is affixed to rectum and pelvic floor (no bone mets found). Stage 4, T4bN1M0. Started on ADT/Orgovyx and Abiraterone/Zytiga plus prednisone, with plan to shrink tumor and do radiation. Got second opinion at Mayo that recommended adding chemotherapy due to aggressiveness and also family history that suggests a genetic component (still waiting on testing). Unsure what to do re: the chemo as local oncologists (at a center of excellence) won’t prescribe because they say husband is not technically metastatic and they feel ADT + Abiraterone plus radiation therapy is an aggressive plan. Thoughts?

[Tall_Allen]

A recent STAMPEDE trial proved that there is no survival benefit to adding chemo when there are no distant metastases:

academic.oup.com/jncics/art...

Lot's of evidence to wait for docetaxel:

prostatecancer.news/2019/02...

However, there is a benefit to adding abiraterone:

ncbi.nlm.nih.gov/pmc/articl...

[StephH72 in reply to Tall_Allen]

Thank you tall_allen. There’s so much to learn when newly diagnosed and having two very different opinions is making our stress incredibly high with an overwhelming amount of pressure to make the “right life altering decision”. It’s unbearable at times truly. I sent you a messags with a follow up question. Thanks