1. < Prostate Cancer

My husband has stage 4 metastatic prostate cancer

Posted by lynnie4ever @lynnie4ever, Apr 16 10:35pm

My husband was diagnosed 2wks ago with prostate cancer following a biopsy.
He has gone through a petscan and an MRI. Today we met with a radiation oncologist and he according to the results of the scans has metastasized cancer that has gone into lymph nodes on both sides of his pelvis and into his lower abdomen. The radiation oncologist stated that now prostate surgery is off the table and recommend s he go into aggressive radiation and oral medication? Am wondering if surgery first would be the way to go then follow with radiation? Any imput would be greatly appreciated!

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

kujhawk1978 | @kujhawk1978 | Apr 17 12:27pm
In reply to @kujhawk1978 "Well, yes an no. I don't like statements from my medical team that are "all or..." + (show)
@kujhawk1978

Well, yes an no. I don't like statements from my medical team that are "all or none" choices. It indicates to me that they are not current in their practice or worse, biased based on their clinical speciality.

There are some who advocate for removing the prostate in this situation - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449684/ while combining systemic therapy such as ADT or chemotherapy and potentially whole pelvic lymph node radiation with boosts and wider margins around the identified sites. The idea behind removing the prostate is to eliminate the mother ship though with he PLNs identified, maybe not. Yes, the surgery has side effects, well known. Those will vary based on in part the skill of the surgeon, whether or not it is nerve sparing....I had mine in March 2014, no incontinence, nerve sparing, I was able to and still have the ability to gain and maintain erections though with assistance, daily Cialis and greater stimulation required. Yes, the ejaculation is gone, some miss it others don't. Sex is different after surgery, no doubt, but for those who are fortunate to have nerve sparing surgery, there is a vast array of possibilities in penile rehab therapy. A couple can also choose to "redefine" sex other than just penetrative intercourse.

There is also the option to not remove the prostate and do doublet or triplet therapy combining radiation and systemic therapy to eradicate the PCa cells in all identified locations as well as the micro-metastatic disease too small to be seen by even the most sensitive imaging today - https://www.mdanderson.org/newsroom/metastasis-directed-radiation-therapy-plus-hormone-therapy-improves-progression-free-survival-for-men-with-advanced-prostate-cancer.h00-159543690.html#:~:text=Metastasis%2Ddirected%20therapy%20(MDT),which%20is%20continuous%20hormone%20therapy.

So, he has options, try and do some literature searches on the options, have discussions with your medical team (urologist, radiologist, oncologist) and with their input, decide what is best for you two.

Kevin

Jump to this post

Consider watching this, may be useful when discussing your treatment decision with your medical team - https://www.urotoday.com/video-lectures/eau-2024/video/mediaitem/3976-treating-metastatic-hormone-sensitive-prostate-cancer-beyond-counting-metastases-karim-fizazi.html?utm_source=newsletter_12810&utm_medium=email&utm_campaign=prostate-cancer-daily

REPLY
lynnie4ever | @lynnie4ever | Apr 17 12:46pm
In reply to @kujhawk1978 "Well, yes an no. I don't like statements from my medical team that are "all or..." + (show)
@kujhawk1978

Well, yes an no. I don't like statements from my medical team that are "all or none" choices. It indicates to me that they are not current in their practice or worse, biased based on their clinical speciality.

There are some who advocate for removing the prostate in this situation - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449684/ while combining systemic therapy such as ADT or chemotherapy and potentially whole pelvic lymph node radiation with boosts and wider margins around the identified sites. The idea behind removing the prostate is to eliminate the mother ship though with he PLNs identified, maybe not. Yes, the surgery has side effects, well known. Those will vary based on in part the skill of the surgeon, whether or not it is nerve sparing....I had mine in March 2014, no incontinence, nerve sparing, I was able to and still have the ability to gain and maintain erections though with assistance, daily Cialis and greater stimulation required. Yes, the ejaculation is gone, some miss it others don't. Sex is different after surgery, no doubt, but for those who are fortunate to have nerve sparing surgery, there is a vast array of possibilities in penile rehab therapy. A couple can also choose to "redefine" sex other than just penetrative intercourse.

There is also the option to not remove the prostate and do doublet or triplet therapy combining radiation and systemic therapy to eradicate the PCa cells in all identified locations as well as the micro-metastatic disease too small to be seen by even the most sensitive imaging today - https://www.mdanderson.org/newsroom/metastasis-directed-radiation-therapy-plus-hormone-therapy-improves-progression-free-survival-for-men-with-advanced-prostate-cancer.h00-159543690.html#:~:text=Metastasis%2Ddirected%20therapy%20(MDT),which%20is%20continuous%20hormone%20therapy.

So, he has options, try and do some literature searches on the options, have discussions with your medical team (urologist, radiologist, oncologist) and with their input, decide what is best for you two.

Kevin

Jump to this post

Thankyou for your imput Kevin! All of this imput from men on this site has been very helpful! May God Bless you on your Journey!

REPLY
1 reply
kujhawk1978 | @kujhawk1978 | Apr 17 1:16pm
In reply to @lynnie4ever "Thankyou for your imput Kevin! All of this imput from men on this site has been..." + (show)
@lynnie4ever

Thankyou for your imput Kevin! All of this imput from men on this site has been very helpful! May God Bless you on your Journey!

Jump to this post

Thanx, he has, ten plus years!

Your response reinforces the value of this forum, sharing patient experience, understanding and our layman's knowledge.

REPLY
agustinferrari | @agustinferrari | Apr 18 6:20am

Ask and oncologist, on the side of the radiation oncologist, im in the same page, de novo (newly diagnosed) Stage 4, did the triplet therapy, Nubeqa + Lupron + Chemo (Docetaxel x 6 rounds): chemo is not as bad as they show it in the movies, do not be afraid! (but be careful, follow instructions to the milimiter) and it will be OK!!!!

My PSA went from 255 to 0.10

good luck and we (all of us) we are with you

REPLY
flax | @flax | Apr 18 10:22am

I also was diagnosed with advanced prostate cancer with a Gleason score of 9.4. My age was 83. Removing the prostate was not even a consideration. Initially went on Lupron and Proton beam radiation. Further test showed it had spread to pelvic lymph nodes which required required external beam radiation. Nine weeks 5 days a week was divided equally between the two types of radiation.

I received my last Lupron 3 month shot 3 months ago. So far my PSA is at 0.10. Hopefully it will stay low. The last scan, a year ago, showed the cancer greatly diminished but still present. Hopefully the next scan will show it not present.

The external beam radiation which radiated the lymph nodes has caused some slight lymphedema in in the pelvic area and lower leg which I can live with. It has also cause some rectal irriataion which causes bleeding from the area damaged by the radiation. I pass bright blood several times a week when having a bowl momement. I am now considering cauterization of those damaged areas in rectum.

The Lupron has had the usual side effects experienced by all. I was active before and I remain determined to stay active by living my life just as I did before before. I work out at the gym three days a week to keep muscles and strength healthy. Staying active in the yard and gym and the derermination to not get lazy I credit with allowing me to live my life as close to normal as possible.

Good luck to both of you.

REPLY
ozzie51 | @ozzie51 | Apr 18 1:05pm

Age 72. Diagnosed february PCa extraprostatic. Not operable!
It has metastasized to L hip, R femur, both lungs.
Had bilateral orchiectomy yesterday with reconstruction (implants). Minimal pain and walking about today.
It was the right and best decision for me. Really a no-brainer for me.
Achieved a 95% reduction of my testosterone production permanently and immediately.
One less thing to worry about or manage.

Tomorrow we address other possible/necessary treatments.

REPLY
2 replies
lynnie4ever | @lynnie4ever | Apr 18 7:38pm
In reply to @ozzie51 "Age 72. Diagnosed february PCa extraprostatic. Not operable! It has metastasized to L hip, R femur,..." + (show)
@ozzie51

Age 72. Diagnosed february PCa extraprostatic. Not operable!
It has metastasized to L hip, R femur, both lungs.
Had bilateral orchiectomy yesterday with reconstruction (implants). Minimal pain and walking about today.
It was the right and best decision for me. Really a no-brainer for me.
Achieved a 95% reduction of my testosterone production permanently and immediately.
One less thing to worry about or manage.

Tomorrow we address other possible/necessary treatments.

Jump to this post

May God Bless you on your Journey!

REPLY
melcanada | @melcanada | Apr 19 9:26am

Fourth injection Radium 223 this week feel great at 80

Enjoying Sandals Great Exuma Bahamas as we speak

REPLY
russ777 | @russ777 | Apr 19 11:00am

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.

REPLY
1 reply
melcanada | @melcanada | Apr 20 6:07am

Mine is in spine and right hip Radium 223 or Xofigo 4th injury Feel great Xtandi or enzalutamide stopped working after a year

REPLY
View MoreView Less
Please sign in or register to post a reply.