define "metastatic"

[runtrails]

Is this when it is no longer localized or anything outside the prostate. For example I had SV invasion, and bladder neck invasion as well as surgical margins. Does that fall inside definition of metastatic. Specifically , I am looking at the article by Ian Davis "Combination therapy in metastatic hormone-sensitive prostate..." (pubmed.ncbi.nlm.nih.gov/353... Wherein this statement is found " survival of metastatic HSPC can be improved with the addition to ADT of any one of docetaxel, abiraterone, acetate, prednisone combination, apalutamide, or darolutamide in combination with docetaxel". Obviously a lot more to the article. Have my first consult with an MO and then RO coming in 2 weeks. Trying to get armed with as much data as I can. First uPSA test post surgery tomorrow. Fingers crossed. Love this group ! Maybe should post another question separately but what is not in my bio that would be helpful to people when responding.

[Tall_Allen]

Metastases represent an entirely different phenotype from outgrowth of prostate cancer tumors from the prostate (stage T3 or T4). There are two types of PCa metastases:

(1) pelvic lymph node metastases (stage N1)

(2) distant metastases (stage M1). M1 metastases can be lymph node (M1a), bone (M1b), or visceral (M1c). The distinction between M1a and N1 is arbitrary, and I expect that some of the lower M1a metastases should be reclassified.

[runtrails in reply to Tall_Allen]

Very helpful.

[Ahk1 in reply to Tall_Allen]

I have pelvic and abdomen LN Mets identified by a psma scan 2 years ago and not by ct or bone scan. Which one mine can be described? M1a or N1? Thanks

[Tall_Allen in reply to Ahk1]

PSMA hasn't yet officially been included in that staging. Officially, only the bone scan/CT counts. But your MO has a lot of latitude.

[tango65]

Cancers inside the pelvis and with N1 metastases , following the internal iliac artery can have a high rate of control with whole pelvis radiotherapy and ADT plus zytiga for 2 years.

urotoday.com/conference-hig...

They are extending the area of radiation treatment to lymph nodes metastases around the common iliac artery up to the bifurcation of the aorta and getting the similar results.

pubmed.ncbi.nlm.nih.gov/358...

[MateoBeach]

Metastatic implies a more advanced stage of the cancer that has more factors involved that are required for cancer to transplant and grow at remote sites such as outside the pelvis. What you have described from your surgical pathology are considered locally and then regionally advanced from progressive invasive spread. Growing and invading adjacent tissues. Bad, but not as advanced as distant metastasis.As long as it remains only in the pelvis and not beyond the pelvic lymph nodes, there is still a good chance for cure with radiation (SRT) combined with short term hormonal (ADT plus an AAR drug) for two years.

Triplet therapy (adding docetaxel to this) I don’t believe has fully been established yet. Paul

[runtrails in reply to MateoBeach]

Thank you

[runtrails in reply to MateoBeach]

So ADT meaning LHRH like Lupron, Eligard, Zoladex and AAR like Flutamide, Enzalutamide, Darolutamide?

[MateoBeach in reply to runtrails]

Mostly correct. Except flutamide, like bicalutamide were first generation AR blockers. The current Advanced AAR drugs are Abiraterone +p, enzalutamide, apalutamide and darolutamide.

[rococo]

I recall a Pittsburg hospital mo prescribing nulutamide as an excellent aa manipulation, Any one remember this popular hospital, which had record treating adv, pc