Second opinion for husband's stage 4A prostate cancer? And update

Cheriekhan: my brother was treated at weill Cornell by Dr Himanshu Nagar. Someone on this site sent me a notice that he was moving to MD Anderson, In any case, His prostate cancer was outside of his prostate and they gave him Lupron and they used specifically the Mridian machine for radiation treatment, which is a narrow margin machine with built-in Mri.

My Prostate Cancer was contained within my Prostate and I had a PSA of 10.2 but had the same machine as my brother with no ADT. I had a consultation with Dr. Nager as well as four other radiation oncologists. I was treated in Florida. I would strongly recommend getting additional opinions outside of the institution but through a center of excellence which can be accomplished through sending images, reports and a Telehealth consultation.

I just met with the team and him and they are not suggesting surgery any more but radiation followed by ADT for two years.

Did you get surgery? And how long ago was your brother treated.

I met with the Cornell team and the oncologist was against surgery and now they are suggesting radiation for two weeks 5 times a day by MRI guided machine and ADT for two years. So no surgery.

Have a consult with Memorial Sloane Kettering next week then will make our decision. Feeling confused as want hubby to make the best decision that will give him full recovery from this disease.

Agree, an exact science is non existent due to too many variables. Who can make the best guess is what it amounts to for each patient.

No surgery.I finished my 5 hypo fractional treatments with the Mridian radiation machine in February of 2023 with no ADT. It was Dr. Nager who I had my first consultation with via telehealth.

My brother was treated with the same Mridian Linac machine a couple of months earlier than me but his situation was far more complicated. He previously had colon cancer years ago, then prostate cancer, pancreatic cancer and other complications since then that required pancreas and spleen operations.

The built in MRI and other features make a huge difference. As Dr Nager said to me, what you can see you can treat and in the case of the Mridian and Elekta machines, its real time.

Best of luck -- it's tough right now when all the decision demands are flying at you.

Surgical removal of the prostate would have seemed like an unusual choice for cancer that has already metastasised, but a) I'm not a physician (much less an oncologist), and b) best practices are evolving so fast these days it's almost impossible to keep up.

I'd think that radiation would be at least as effective (if not more so, because it can treat the areas around the prostate as well), so I don't see any cause for concern — they're just sparing him a bit of unnecessary extra surgical trauma and recovery (again, in my layperson's opinion).

As I mentioned in the other thread, I didn't get prostate surgery for my stage 4b prostate cancer (just radiation, ADT, and ARSI), and I've had no cancer progression at all 2 1/2 years later.

For the record again, I am a layperson and cancer patient so my advice is directed to things that I suggest you consider and not medical advise.

A combination of RT and ADT might be a totally appropriate treatment for your partner. That being said I again wholeheartedly with “bens1” regarding the value of getting a second opinion outside of Cornell with another center of excellence.

What concerns me is the extensive involvement of cancer that you describe; 100% in 12 cores from apex to base. If the cancer happens to be adjacent along a substantial length of the urethra requiring that the treatment margin extends into the urethra the urethra may get as much radiation as the lesion(s) and suffer damage as a result. That was the situation I was in which I why I raise this issue. As I was advised during the second opinion I received, if the urethra becomes damaged from radiation it could result in a stricture resulting in the need for a possible diversion (ostomy) or post RT surgery to clear the blockage. I originally planned to skip surgery and have RT until that risk was made clear in a second opinion. Hopefully the doctors at Cornel have taken this into consideration and told you and your partner that they would be able to avoid the urethra and adequately radiate the cancer.

My first opinion came from a well renowned center of excellence with an impressive record for successfully treating challenging cancers and I would not hesitate to recommend them. My second opinion came from another center of excellence where I had a robotically assisted prostatectomy. I had positive margins and will still need radiation and ADT however the risk of a stricture was eliminated. Additional the surgery “debulked” the cancer so one could argue that cancer that has been physically removed from my body can do no more harm to me.

Best wishes for a good outcome on your journey with your partner.

Did you mean 5 times per day or 5 times total over a two week period?

My husband has stage 4 prostate cancer that has gone to his limth nodes and spinal column and even the neck and shoulder bones. They do not recommend surgery for this once healthy 88 year old. The only treatment is the Fermagon shots every month and Xtandi pills 80 mg a day. He has seen a medical onchologist . They are only doing the hormone therapy to block the testoterone. I am wondering if he shouldnt go to Vanderbilt or omewhere else for advice. Can anyone suggest anything else? They have given him maybe 3 years.