Hi
Wondering if someone can explain why Debulking the prostate is not advised for more than 5 bone mets? I'm just trying to understand why reducing where the seeds originally came from does not reduce the progression of metastases to other areas of the body? I have done a lot of reading and it still makes no sense to me. If it is because of the damage done with the debulking of the prostrate than that damage is also done if there are only 1-5 bone mets too? Thanks for your valuable knowledge
It is explained here. 3, not 5.
prostatecancer.news/2018/09...
Met-to-met spread is more important when there are more than 3 metastases observable on a bone scan/CT. The observable metastases are just the tip of the iceberg.
Thank you , this was exactly an explanation I needed to make it make some sense
Picking up on your last sentence, would that be true even if only 1-3 metastases, even if marginally less? What can't be observed is still an issue? Is 3 simply what clinical trials have used, with nothing higher studied in that detail? Seems somewhat arbitrary. Thanks.
Read the article I linked. Your questions are answered.
Done. Thanks. I'll have to check my original CT scan, which I believe only showed three. Of course, that was in 2018, so not the same, I guess. Currently, PET scan only shows three, but back in 2018, possibly more.
3 on a bone scan/CT. Ever.
Thank you.
I did find it interesting that the bone scan my husband had showed a met in the same spot he had broken a rib years ago and also a met in shoulder area on a broken bone from same accident years ago. There must be a way they see this as being cancer mets and not just old brakes from years ago?
Any radiologist worth his salt would discount those.
Well that's what I don't know ? Are those mets or old breaks? Can they really tell for sure somehow?
It's very common for old breaks to show up on a bone scan.
Profesor Emmett Said to me that bone scan picks up fauls positives. That is why I had also a psma pet ct scan.
Somewhere you have to draw the line between an oligometastatic or polymetastatic diagnosis. Some doctors use 3, some 4 and some 5 mets. Question is, is this number based on CT/bone scan or PSMA PET/CT? There is no consensus on that.
Dr. Palma in London/Ontario will treat more than five mets when the patient asks for it.
My husbands is based on one bone scan, living in Canada I'm realizing that a PET scan when his PSA was higher would have been optimum care but that was not a possbibility. Just getting a bone scan has been a challenge . Also wondering if a previous accident years ago was showing up on the bone scan? Not sure if that's possible . Thanks for your reply
Yes, fractures can show up on a bone scan. However, when there are several mets, it is unlikely that they all are caused by an accident. With a Gleason 9 there are bone mets often.
I'm in British Columbia. I never had difficulty getting bone and CT scans. At first I was having a set done every 4 months. I've been stable for a few years so my oncologist just does them once per year to monitor for progression. PET scans are available but there is no need for me to have one at this time.
Guess you are lucky with who your oncologist is , we have not been lucky . Not even able to meet with an oncologist , just 2 phone calls. I'm glad you have had great care but this should be standard across the board in my opinion. Currently we do not have anyone but a phone call in June from a urologist at which point we will be insisting on an oncologist
Yes I had similar discussion with dr. Thank you for sharing more lights on it.
Radiation is not without risk. It is worth the risk if there is a significant chance of improvement. Otherwise the potential negatives outweigh the possible positives.
My husband had more than 3 mets in bones as his diagnosis was delayed and so was not offered surgery. But he had SBRT for the prostate in Toronto. He knew that it would not stop the spread of mets as the other mets could become a mothership. It did help in other ways. He did not have the very frequent washroom visits from before.
I debulked with many more than 5, just seemed to make sense to me, Snuffy Myers agreed, that was about 10 years ago, seems to have worked out.
Ed
I'm gonna ask my docs (again) about this on next visit. My MO is very conservative, seemingly even oblivious to profit that could be made by his institution. What a guy! But I appreciate his caution, and I guess there's no perfect answer.
I ran into the same thing, my urologist was against and I think one of my oncologists was against. The radiology oncologist who recommended it said it may help to make ADT more effective, Snuffy Myers said during one of my first appointments with him it was the best thing I could have done (and he talks about the prostate continuing to be the main source of new mets in his book), another oncologist told me it’s a good idea because it eliminates the risk of cancer spreading to my bladder and urinary tract which is very difficult to treat. I went directly to radiology oncologist to discuss I didn’t wait to get the ok from uro or onco, Snuffy’s book and some guidance from a higher authority moved me in this direction.
Ed
Thanks. One more question. If one debulks then later (miraculously?!) gets off Lupron, does the debunking radiation render the prostate unusable. I know the odds are against that after 5 years on Lupron, but thought I'd better ask beforehand. Thanks.
I can see your mind works the same as mine by the questions you ask
Thanks. Knowing what's been shown in clinical trials is very important, but since not every situation has been studied that way, I can't help but wonder if one needs to reach a bit further.
I had my prostate radiated after I completed the chemo treatments at the beginning. I had an enlarged prostate and this helped with urinating. They did 20 targeted beams over 20 days and it was fine. No problems other than the urgency to make a bowel movement during treatments.
My husband has always had issues for years with urinating but since starting treatment it is back to normal peeing
Hello everyone. Although I have been gaining a wealth of knowledge from this site for almost 3 years, this is the first time posting. I want to sincerely thank everyone for taking the time to share their personal journey and subsequent treatments with all as it relates to this disease, and especially TA for breaking down and explaining in layman terms the science and providing the appropriate links to all. I have been following with great interest the continuing research from the Vancouver Prostate Center and came across the article below (Jan 4, 2024) that might possibly shed a little light on what might be a significant change in treatment options for those of us having more than 5 met's. I'm not sure if this has been "peer reviewed", but it does provide another view point for treatment options through the wonderful and ongoing research that is done at the VPC. Thanks again everyone.
vchri.ca/stories/2024/01/04...
Interesting , I read the article and it sounds like debulking is best , apparently
I don’t really know, but I plan to investigate further and consult with both my MO and RO for their thoughts. Would love to hear from TA’s on this as well
We have been left to our family doctor now that chemo is done, but did get a call from Vancouver prostate centre that Urologist will be calling in June for phone consult. This is on our list to talk about . Hope they give us the time to ask and answer questions.
Let us know what you find out , thanks
Best for de novo maybe, but not for recurrent. I have recurrent, for which debulking is not recommended.
Any idea what the difference is and why that is? Thanks
I've long wondered the same. Apparently a minority of doctors will consider it.
I imagine that after recurrence in a radiated prostate, debulking the gland carries the same risks as removing it. And apparently little is gained for the risks of either debulking or salvage treatment, if the cancer has already metastased.
But I would like to be rid of the cancer remaining in my prostate, as I imagine it continues to seed the bloodstream, and could invade the bladder or rectum. I am told that I must rely on my systemic treatment (Orgo + Abi) to hold it back.
Very few surgeons are competent and willing to remove a radiated prostate -- surgical salvage. The radiated prostate tries to repair its damage with scar tissue, growing into surrounding tissue from which it is difficult to separate. The prostate no longer comes out intact, as it is stuck to everything around it. The scar tissue of the radiated prostate must often be scraped off the rectum. Going a little too deep will cause a fistula or opening in the rectal wall, a bad complication. Rejoining the urethera when a prostate is removed after radiation can also have sphincter complications resulting in incontinence. It is a long, difficult and dangerous operation, usually a last resort because of the risk it poses to quality of life.
In my case, a scan showed the tumor still growing in the prostate. I then started the ADT + ARPI pills. If they don't stop it, it might shut off the urethera, and then I would have to do some kind of ablation, or removal.
I am currently considering to remove my radiated prostate. I have an appointment with the surgeon about it is definitely possible but I will let the surgeon to evaluate and to decide what to do.
That is IRE, irreversible electroporation ablation. Its advantage is not exposing the prostate to radiation or heat or cold as other focal ablations do, so less chance of collateral damage. I think it is proprietary, only at certain centers that go for the training, and I had not seen it offered for salvage.
But now I see mention of a FIRE Trial for salvage, though can't find the actual trial.
"The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours." pubmed.ncbi.nlm.nih.gov/364...
I wonder if I would be excluded because the PCa in my prostate is no longer localised. And aside from that, my tumor is now on both sides of the prostate with the urethera in there somewhere. I would not want it electrolyzed.
Your thinking is correct. I am consulting professor Stricker soon and will ask him for his opinion.
What about exposing the prostrate to a TURP? Does this also cause scaring/damage that ends up damaging? A man needs to pee too?
I was told at the beginning of my cancer journey that I will need a TURP later. My bladder wall is thickened now therefore I may need to do something about it in the future. My urine flow is weeker then before. I really need the attention of a urologist. My MO didn't even notice that from the prostate MRI report that my bladder wall is thickened.
I had not heard that a TURP damages the prostate. I think the transurethral resection just reams out the urethera when an enlarged prostate begins constricting it (BPH).
You would be suggesting a TURP if a tumor within the prostate does that? I wonder if a tumor within the prostate affects the urethera in the same way was an enlarged prostate. BPH might simply squeeze the urethera, while maybe a tumor grows into the urethera.
Information about the nano knife in Australia:
The link just gives a paragraph or two on the treatment, but does not show an article. No mention about using the treatment for salvage
You can repeat it. That is interesting. Of course that is only a very basic information. It cost 16000 A$. You can also Google it.
"It can also be used as salvage therapy in patients who have already had radiotherapy to their prostate cancer which has failed to clear the cancer. The NanoKnife therapy may then fully clear the cancer without making incontinence or impotence worse. "
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