Post 3 month firmagon, dad’s MRI review shows left semi vesicle involvement,PSA drop from 38 to 1.4. Doc suggests prostatectomy. Pls advise

[OB23]

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.

[Murk]

IMO I would get a second opinion from a Radiation Oncologist before I made any decision. Also if that second opinion agrees that there is left semi vesicle involvement and metastasis, a Radical Prostatectomy will be a waste of time and not be a cure or long term solution!

[OB23 in reply to Murk]

As per latest MRI these is no metastasis. Only left semi vesicle invasion.

[Murk in reply to OB23]

OK sorry on misunderstanding your metastasis comment.

I had a Radical Prostatectomy in 2020 with a highly acclaimed surgeon at a top three hospital here in the USA. I had Left seminal vesicle involvement and three years later PSA started rising and I had to for salvage radiation.

My surgery went fine and I was lucky to have very little side effects versus the norm and you can read my bio and post.

If knew that I would have to go for radiation and ADT afterwards, I might have changed my original decision. In any case I would have definitely went for a second opinion from a Radiation Oncologist.

[Tall_Allen]

Talk to a radiation oncologist too. If you are close to Mumbai, I'd recommend Vedang Murthy at Tata Memorial. You have plenty of time because the Firmagon stops all progression.

[OB23 in reply to Tall_Allen]

Sure will do. I live in Bengaluru. Do you know recommend any radiation oncologists in Bengaluru?

[Tall_Allen in reply to OB23]

Sorry, I don't.

[OB23 in reply to Tall_Allen]

All good. Thanks a lot

[Don717]

Definitely see an RO/MO. With any chance of cancer outside the gland I'd not consider surgery. It just doesn't make sense at that point. Didn't see his age, but that makes a difference in surgery as well. Good luck to ya and thanks for helping your Dad!