I was diagnosed in 2019 with advanced Prostate Cancer with bone, lung, and lymph mets....why wasn't prostate removal even discussed? Seems to me that getting rid of the original habitat might be a good thing.
I went straight to ADT + Zytiga and Prednisone
"Seems to me that getting rid of the original habitat might be a good thing."
There is a strong data driven case that it is wasted sword motion once the horse gets out of the barn.
It's called "debulking." Sadly, it doesn't work the way you imagine. When there are multiple distant metastases, most of the spread is from met-to-met. They tried it and it failed to provide any benefit in two large randomized clinical trials:
prostatecancer.news/2018/09...
Those trials used radiation, and there is an ongoing trial for debulking with prostatectomy, but I expect it to have similar results.
Apparently you got no chemo yet. I know a patient who got rid of many lung mets with a Docetaxel therapy. Therefore I suggest to get a chemo now.
Tommy, I was Dx in Oct of 2020. Same as you, told no surgery or Radiation of Prostate. The SOC has changed since then. The old theory was do less for Stage 4 Metastisis patients, and do more for for those with no metastisis. Then at ASCO in Spring of 2021, it was proven that Triplet Therapy Docetaxel upfront, along w ADT + Zytiga-pred extended biochemical recurrence, and overall survival. Then in 2022, it was proven thru RCT’s that for Stage 4 Men with Oligometastatic (light metastisis), there was extended benefit from Radiation Thereapy (SBRT//SABR) along with ADT + Zytiga-pred.
I had been told by 7 surgeons…NO! Some citing NCCN Guidelines. 2 Radiologists also said No. Then at month 13 after Dx, Mem Sloan Kettering showed out my latest scans compared to original scans showed progress and we agreed to proceed with 5 days SABR to Prostate, and 3 days to T5 spine. Wait 3 mos to avoid PSA bump then test.
Now 10 mos later PSA continues downward to .022, and PSMA PET (Pylarify) last month showed no PCa in Prostate, or any bones or any organs. Yes, still same 3 lymph nodes from prev scans, but much smaller in diameter. So far, so good.
For me….next steps getting SABR to 3 lymph nodes, then 2-3 treatments of Leutitium J-591 (liquid radiation) , going for total annhilation of micro metastisis in blood etc., along with some mBAT. Will it work? Early days. No one knows. Going for cure seems a better strategy (for me) than going until ADT fails, as it always does. Dr Eugene Kwon at Mayo says these PSA low Nadirs are opportunity for cure, and we only get 3 or 4 of these opportunities. Best to you and yours, Mike
Mike your an inspiration for being your own advocate! Knowledge is power and power is life! Keep on rockin!
as several have already noted, what _seems_ is often not what is scientifically true. Doesn't the world seem flat? For a century surgeons held fast to the notion of "reducing the tumor burden" and millions of women had radical mastectomies despite ample evidence that such surgery did not improve survival.
Great answers.....thanks everyone
Doc told my husband, surgery not an option at this point...Im sorry, I thought the same as you did...just get rid of it!
Hey Tommy! I was 53 and non-op myself . My prostate exploded with pc tumors T-4 ….no way !
yah! A real blast! 😂👏👏
We are wondering the same thing, we understand why “they” may not want to remove the prostate, but it seems men have longer over all survival with prostate removal in the groups we follow…maybe I’m wrong, but, other studies show it could be worse…very confusing issue.
I also found this, below
Tall_Allen what do you think about this ?
At this time there is not enough evidence to say that prostate removal has a positive effect on life expectancy and quality of life. (Apparently)
The urologist who diagnosed me said that the risk the patient takes with the surgery is not outweighed by the known benefit of prostate removal.
I agree with you. I enrolled in a clinical trial at MD Anderson in Houston to test this very thing. Happy to say that so far my quality of life is fine; don't know about my logevity yet
Prostate
Prostate removal 
Prostate 
Concerns 3 years after prostate removal. 
prostate infection
