Hi, please see below details on my dad’s PC journey till now. Doc are suggesting prostatectomy and may be stopping firmagon post surgery. Please advise if this would be recommended path to recovery or better alternatives/ outcomes.
He had CABG surgery in 2022 and Nov 2024 he was diagnosed with high PSA. After MRI and Biopsy it was confirmed that he has prostrate cancer, Gleason score 4+3.
Biopsy date: 7/12
PETCT scan date : 12/12
PET CT scan indicates the below:
3.6*3.2*3.9 cm ill defined PSMA avid enhancing mass in the left transitional and peripheral zones extending from base to apex with contra lateral extension and infiltration of the seminal vesicles - carcinoma prostrate
PSMA avid left mesorectal lymph node - metastasis
15dec 2024: As per doctor the metastasis is not a concern and may be due to PET CT scan done with a week of biopsy.
They started Firmagon injections for now.
5-March 2025: Post 3 month firmagon, dad’s MRI review shows left semi vesicle involvement,PSA drop from 38 to 1.4. No lymph node involvement. Doc suggests prostatectomy.
Written by
OB23
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I had prostatectomy and left seminal vesicle involvement (SVI), so you can draw some comparisons.
First, my case was milder than that of your father's, as my PSA at mpMRI was 7.3 and SVI wasn't identified until post RP pathology. My chances with GS 4+5=9 for a 5 year BCR-free were only 20% and by no surprise I fell into the wrong 80% 2.5 years post RP. If I was to decide again now, I would have followed the exact same steps as the alternative, Radiation Treatment (RT) is to be used only as a last resort according to my personal cost-benefit assessment. The majority of users here are mostly pro-RT as they think that irradiation is something similar to a walk in the park. If only they knew better... But this is a very long story, so do your dew diligence and decide accordingly. Only certain thing is that there is NO single treatment that leads to any type of "cure".
OB23: we've spoken in another thread about possible mesorectal node.
Your Dad's pathology is very similar to mine (me: Stg 3b, PSA 33, GL(3+4), +SV, +LN)-- the very high risk here is +SV as that area is very vascular, and can lead to PCa cells circulating in the bloodstream that might later form mets. I would feel more confident treating that area with focal radiation followed by pelvic radiation, the later which you might have to do anyway adjuvant to surgery. You should really consult with an RO about Brachtherapy/IMRTpelvic/18mosADT, which I did six years ago and have a durable remission.
Saw your post so how are things? I am doing well in new drugs, issues with liver and more side effects, but are doing the job of more time in the planet! Sadly, the oncologist I saw has not. BOthered to update me so very upset at this!!! He did get me started so the trip was worth it. Your pharm firm has been vg! So thanks stay well
Just trying to stay metabolically healthy. Learned a lot playing around with the CGM as to which foods affect glucose/insulin levels. One odd correlation I've noticed, as glucose goes up, my tinnitus is louder. So I have my own built-in CGM for free! Stay well...!
In terms of dad, given his high psa the cancer has for sure spread thus no cure is possible. Given his age etc I would not put him thru surgery to remove his prostate but perhaps seeds would suffice, with the drugs we now have he will be ok for at the least 4/6 years so why put him thru any more then us absolutely necessary
Brachytherapy was a one-day event, in at 7am, out at 3pm. Was able to walk back to hotel, then to dinner later. First night had some burning urination and some soreness in the perineum. First week had some retention where it felt bladder wasn’t fully empty after urinating. Other than those short term SE’s, never had anything serious like radiation proctitis or such, which would have shown up by now after six years.
I would definitely consult with a radiation oncologist. Chances are the cancer is in the lymph node and whole pelvis radiation may be the better option with 2 years of Firmagon. My husband was in a similar situation with the “questionable lymph node” that appeared to be a metastasis that the surgeon kept saying not sure if it really is a metastasis. The surgeon kept insisting my husband was a good candidate for surgery even though he knew he couldn’t get to the lymph node. The medical oncologist was the only impartial doctor in the room when I asked him if surgery was the right way to go. He simply stated no since in his opinion the cancer was as already in the lymph node. Why put your father through the surgery and then have to go through salvage radiation. He will surely have more side effects with the RP and salvage radiation than with the radiation and Firmagon injections.
it is generally believed that psa above 5.5 is clear signs of disease spread beyond prostate, so a blast is less intrusive than surgery which although taking out a large number of cancer cells does not provide a cure- no longer possible! Tal is best suited to provide more details
Thank you very much for your response. How was the experience with radiation? I really want him to have lesser side effects and don’t want him to undergo surgery as he says he is not ready for surgery.
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1 month Post-Doublet Therapy (Firmagon & Nubeqa) PSA down from 335 to 32 and Testosterone down to 13
History of my cancer becoming castrate resistant
Latest update
THIS IS NOT GOOD over 40 Liver Lesions 
