What are the better treatments for metastasis of the bone and pelvic lymph nodes?

[PARKER3237]

Just found out the past few weeks from a biopsy and a PET/CT scan that the cancer was not contained in the prostate but metastasized to the pelvic lymph nodes and the bones. Was a surprise to me and to the urologist as well. He is recommending no surgery but a multimodal therapy with androgen deprivation therapy, medication for the bony metastases (Xgeva) and oncolytic treatment.

Did not recommend radiation at this time but not sure if that is the direction he is going. He had suggested it before discovering the metastasis.

Any recommendations for now before starting treatment? Also has put me on Vitamin D and Calcium tablets daily.

[GP24]

I would suggest that you see a different doctor at a major center. Current SOC is ADT plus Abiraterone, Enzalutamide or Apalutmide. The ADT reduces bone mass and Xgeva helps against that but does not fight the bone mets. You should see your dentist before starting with Xgeva to avoid necrosis of the jaw from Xgeva.

If there are not that many bone mets a radiation of the prostate does extend overall survival: esmo.org/newsroom/press-and... You can include the pelvis when the prostate is radiated to fight the lymph node mets.

[fireandice123 in reply to GP24]

Yes, see a medical oncologist.

[PARKER3237 in reply to GP24]

Thank you. As he lives here in Dallas, Baylor is usually used for the center for cancer treatments.

[Tall_Allen]

The current SOC is "Triplet Therapy." You can read about it here:

prostatecancer.news/2021/05...

Whether it is worthwhile to irradiate the prostate depends on how many bone metastases were found on a bone scan:

prostatecancer.news/2018/09...

You should also NOT be taking Vitamin D and calcium unless you are deficient on a blood test:

Li et al., Xiao et al., and Boland et al. reported that supplementing calcium, but not dietary calcium intake, was associated with a higher risk of myocardial infarction, and increased rates of plaque deposition. Kassis et al. found the association was true whether or not Vitamin D was supplemented with it. It is possible that increasing calcium absorption using Vitamin D may increase the risk of myocardial infarction. It also increases the risk of kidney stones.

prostatecancer.news/2018/07...

There is no need for Xgeva unless your bone mineral density was less than -2.5 on a DXA scan.

[Mascouche in reply to Tall_Allen]

It's too bad that some oncologists, mine was amongst those, when they prescribe Abiraterone they also automatically prescribe Calcium + Vitamin D by themselves, without anything to push it from the blood to the bones.

I agree with you that this is more dangerous for the heart and arteries than it it beneficial to the bones. Alimentary calcium and heavy lifting do a safer/better job at protecting the bones.

[PARKER3237]

Right I take ONe a day 65+ vitamins but the doctor gave some numbers that the level should be at for protecting the bones. Have not started any treatments as yet since they will do blood work next week and the following week meet with the partner.

They are urologists at Baylor. Should I be seeing an oncologist instead? They seemed to have their act together with the treatment plan; but it was not set in stone as yet until the blood work was done.

Thoughts?

[Tall_Allen in reply to PARKER3237]

In Texas, you have some first rate urological oncologists: Eleni Efstathiou at Houston Methodist or Paul Corn at MD Anderson. Don't waste your time with a urologist.

[MJCA]

See a medical oncologist. IMHO this is really outside the scope of a urologist.

[Maxone73]

hi! Look into a trial called ARASENS, or forward it to your doc

[Mbnm]

shocking that urologists are too busy or just crappy

I saw the same urologist fot 20 years never missed an appointment and when my psa climbed and an mri showed a larger lymph node I pleaded with him to send me to an oncologist…he took his time and when I finally got there I was shocked to have the oncologist tell me I had advanced cancer hadto go directly to abiraterone and pred…..I am still angry !