While reading the bio of forum member, I noted the following advantage to radical prostatectomy (paraphrased):"No more PCa factory"
As I have written in multiple posts I am enjoying very effective triplet therapy against my high volume metastatic prostate cancer. And because my cancer was diagnosed so late (multiple metastases to the spine and a PSA of 1700+) I never had any surgery or radiation. I generally think that in this crummy world of prostate cancer that this was a major blessing!
Tall_Allen once alluded to the idea that once metastasis has occurred then the idea that the prostate was the original source of cancer is not that relevant any more. The cancer is now a systemic problem.
This was the thinking of my doctors who saved me from surgery and radiation - apparently there would be no upside with prostate removal in terms of suppressing cancer - and there would be a lot of downsides. And so we have just been fighting cancer for two years with drugs (and have program of chemo). So far very good results.
But the poster's bio comment about "a factory" got me thinking. Is there any sense that a prostate-still-in-place is a kind of "prostate cancer cell factory pumping out cells to colonize distant locations for metastasis?" And that this prostate factory could in fact be more important and even dominant in my body system than other prostate cancer metastases? If this is the case then perhaps there is still an argument for a prostatectomy? Which would be horrible I think.
Currently my sense is that the prostate is not special anymore in terms of cancer cell germination and dispersal.
Any thoughts on this will be welcome!
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JohnInTheMiddle
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I am not an oncologist but I think any spot with PC cells is potentially a PCa factory, not just the prostate. The factories are shut off while on ADT or with radiation. Perhaps after mutation the prostate can become the most productive factory, I am not sure about that. But until then there is probably no need to remove it.
The prostate remains a source of metastases, but metastasis-to-metastasis spread outweighs any prostate-to-metastasis spread after there are 3 metastases:
If you have more than 5 mets there is not advantage in survival. The mets will take care of propagating the cancer.
independently if the cancer in the prostate could be or is a factory of mets, you could consider treatment of the primary to control local problems down the road when the cancer becomes more difficult to control and may affect the urinary system.
To me it is a peace of mind to know that my pelvis is free of prostate and mets since all the nodes have been irradiated and I had a radical prostatectomy.
I think that radiation of the prostate with the new linear accelerator machines using conic CT or MRI has become pretty safe. Look for the Kishan papers about using the MRI linear accelerator to treat prostate cancer.
When I was seeing Snuffy Myers he saw that I had my prostate radiated (debulked) early on in my treatment even though I was dx Stage 4 with extensive mets, he said it was one of the best things that I could have done - eliminate the “mothership”. Almost 10 years later I’m still following Snuffy’s treatment protocol, and none of my doctors have told me to change anything, including Dr. Sartor who replaced Snuffy as my PCa specialist oncologist after Snuffy retired.
You're stating a reasonable opinion. When offered the chance with state 4 prostate cancer, I had mine removed for the same reason. But it's still just an opinion.
😃 North America used to be the manufacturing center of the world. In World War II the arsenal of democracy. And then all the idiots offshored all the factories. And we lost all the skills and capabilities. And decent jobs too. It's like having a radical prostatectomy. Offshoring of a factory or your prostate is a one-way street. Once it's gone, it's gone. (I was inspired by your comment John!)
I’m a little confused but maybe it’s because I have not been on this journey as long as some of you.
Here’s my experience. PCa diagnosed in 2018. Surgery to remove prostate. 2 years 0 PSA, then the appearance of PSA under .1 . I then recieved salvage radiation for a total of 39 treatments. About a year and a half later PSA was at 2. I had PSMA scan and it showed a mass in my pelvis and another in my left lung. ( an unusual spot for mestatisis. Am currently on my 2nd 6 month injection of Eliguard last scan showed slight shrinkage of tumors in both the pelvis and the lung.
My thinking at this point is because of all the side effects of the surgery ( incontinent and complete loss of sexual function) and radiation ( incontinents even worse) and now the side effects from the Eliguard ( no energy , no libido, and a completely low mood ) I’m thinking even having the initial surgery was a bad choice. Recently I’ve been considering discontinuing the Eliguard and just letting this whole thing run its natural corse. I’ll be 67 this year don’t have a partener .or any children . No body gets to get out of this world alive and I’m just not feeling the benefit of continuing this seemingly unwinnable fight . I’m really thinking about quality over quantity here. Any words of wisdom that might make me think this fight is even worth engaging in?.
You could switch to 150 mg Bicalutamide per day and stop lupron. If your PSA start rising again switch to Apalutamide monoterapy. If your PSA start rising again you could add Abiraterone plus ADT again.
My PSA started to rise from 0.2 about 2 years ago and I did all the scans possible at around PSA 1.25 to 1.4 a year and a half ago and I didn't have any Mets that time only the cancer in my prostate therefore I decided to irradiate my prostate a year and a half ago after the scans.
Around six months after irradiation of my prostate my PSA dropped to 0.25. I was very happy with the results.
Unfortunately my PSA started to rise again an about six months ago I did again at PSA 1.1 the psma pet ct scan and the bone scan and the prostate MRI which showed a PIRADS score 5 in my prostate correlating with the psma pet ct scan SUV Max 6.5 in my left side of my prostate.
I am currently on 100mg Bicalutamide per day and my PSA stabilised at around 3. I will consult the surgeon soon what is the best to do. I don't want an operation but I also don't want local spread to my rectum or bladder etc. It is very difficult to get rid of the cancer from the prostate as a prostate has a high DHT environment. The cancer from the prostate could also metastasize if left untreated.
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