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My husband has stage 4 metastatic prostate cancer
Prostate Cancer | Last Active: May 2 9:52pm | Replies (40)Comment receiving replies
It was unclear from your description whether he was classified as Stage 4a or 4b. If the former, meaning locally advanced without distant mets, some oncos will tell you he can be cured for all practical purposes, especially if he is older.
Even with 4b, if the number and location of distant mets is less than 5, that would be what is called oligometastatic (translated - a few mets) and some oncos like Mark Scholz say that may be curable if the distant mets can be radiated.
Even if you could find an institution that would agree to both modalities of treatment it is unlikely your insurance would reimburse for both treatments since, from their perspective, RT to the gland, prostate bed, pelvic region and booster dose to known pelvic node mets is equivalent to RP when it comes to treating the cancer in his gland. And RP alone can't possibly treat the disease that's escaped the gland.
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"Even with 4b, if the number and location of distant mets is less than 5, that would be what is called oligometastatic (translated - a few mets) and some oncos like Mark Scholz say that may be curable if the distant mets can be radiated."
That was almost precisely my treatment at a major research cancer centre here in Canada for stage 4b (oligometastatic):
1. Emergency debulking surgery on the metastasised tumour (which had compressed my spinal cord and left me temporarily paraplegic).
2. Immediately started on ADT (Firmagon/Degarelix) and an androgen-reception inhibitor (Erleada/Apalutamide).
3. 5 rounds of SBRT radiation to the surgery site a few weeks later, when it had had time to heal.
4. 20 rounds of SBRT radiation to the prostate 6 months later.
Now I'm at 2½ years since diagnosis with no progression and undetectable PSA — I'm registered in the IRONMAN/TruNTH study, so I get a lot of extra blood work every three months and it's all in the green. While I have some side-effects from the hormone therapy and (much more) from the spinal-cord damage, over all, I feel better and more energetic than I did in the years before my cancer diagnosis.