What is Next? Dx 07/2022 PSA 942.40 current 0.24 Starting 5th cycle of Docetaxel Chemotherapy, Discuss Radical Prostatectomy or Radiation?

[Shorehousejam]

Currently on Firmagon, Zytiga with Prednisone, Vit D, Metformin

Will be starting Otelza for very severe made worse by ADT plaque psoriasis

From what I heard there are some clinical trials and cancer centers/hospitals conducting surgery, radical prostatectomy for men with advanced metastatic prostate cancer with less than 4 Mets …

Please share your insight

If Radical Prostatectomy is not possible, is radiation next?

I read somewhere it should of been done first or with chemotherapy for better results, anyone have any information on that?

[Tall_Allen]

It is standard-of-care to treat the prostate with radiation (called "debulking") if there are less than 4 metastases on a bone scan/CT:

prostatecancer.news/2018/09...

There are several ongoing clinical trials linked in that article to see if prostatectomy can give equal outcomes. It also discusses the small Dai trial that suggests surgery may work as well.

[Shorehousejam in reply to Tall_Allen]

Thank you

Also found this information

eu-openscience.europeanurol...

[Tall_Allen in reply to Shorehousejam]

Be careful about making decisions based on retrospective studies.

[EdBar]

I had my prostate radiated (debulked) 8 years ago and I had widespread mets. I followed that up with chemo per CHAARTED. I’m coming up on 9 years since dx and my PSA only recently became detectable again, going in for a PSMA scan next week.

Ed

[Shorehousejam in reply to EdBar]

That’s wonderful news, thank you

[slpdvmmd]

Sounds somewhat similar to my course. I followed up with radiation. My regret is that I did not have a PSMA scan when all the conventional therapy was completed. I think this should be done after completion of chemo and radiation.

[Shorehousejam in reply to slpdvmmd]

I totally agree