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

I consulted with both Dr Nagar and Dr Samadi. I ultimately chose surgery at the urging of family and friends even though it was my last pick!
But even though I had no spread, etc. my cancer seems to be coming back with slowly elevating PSA’s.
When I want to kick myself for going thru life altering surgery and not doing Meridian I just think back to Dr Nagar’s advice: “Whatever you decide will be the right decision”. In retrospect I guess what he was saying is that no one has a crystal ball and there are no guarantees. The most important thing is to be comfortable and confident in whatever path you choose.
After that it’s a waiting game and a fingers crossed lifestyle - or if you are religious, something else.
So my outcome probably would have been the same no matter what I did. Clean margins, negative lymphs, etc don’t account for a cell ir two that got away. Surgeons can’t see them, scans can’t see them and that is the unvarnished truth.
Best of luck with whatever you decide and your partner will definitely live a lot longer no matter what treatment he gets!

Sounds like my treatment for Gleason 9 prostate cancer that had spread to pelvic lymph nodes. Only I had radiation for 9 weeks (5 days per week) for 9 weeks. Also went on Lupron for 18 months ( one shot every 3 months ) Had my last shot almost 4 months ago. Doing well so far. PSA is at 0.10.

Most important thing is to stay active and exercise including weight training. Join the Y. It makes such a difference as to how well you feel and how well you deal with the side affects of the hormone Lupron. I'm in my 80's and never missed my Monday, Wednesday and Friday 2 hour workouts at the Y, not even on the days I had radiation. At home I did everything in my large yard as I always did..EVERYTHING, if not more.

I read of others like me that had the same results to the treatments by being active........ it's all up to you.

God bless you and your husband.

Get on Lu177 or if mainly in bones Xofigio or Radium 223

cheriekhan, one advantage of the MRI guided radiation is less damage to urinary and sexual function. Another advantage over surgery is that radiation is comfortable during and after (no catheter). Of course, the main issue is the best chance to beat the cancer. Nobody really knows. Bless your decision with luck.

We got 3 opinions, 2 surgeons and a radiologist. Gleason 8 stage 3b. All 3 recommended radiation over surgery. Removal would not get all the cancer, so why go through the risks and side effects if you know you will need radiation and ADT anyway.

flax:
I am also in my 80's. How low your Testosterone went down during the 18 months you were on Lupron. What kind of workouts at a 2hour stretch you were able to do with low testosterone? Like 1 hour cardio and 1 hour strength?
In my case, my Testosterone dropped to 8 ng/DL after 29 days on OROGOVYX from Quest diagnostics. Then after 45 days my Testosterone was 22 ng/DL from UCI lab.
I am just wondering if exercise raises testosterone levels while under ADT or is it a lab error.
Any information you give may be beneficial for me and others.
Thank you

ava11:
My testerone was never tested those i8 months. It was 780 before I was diagnosed with prostate cancer. At my last visit they did blood work for PSA and Testosterone. PSA came back at 0.10 which is what it was 3 months earlier. They tested it every 3 months. Testosterone results had not come back so will find out what it is at the next visit. I just want a base line to see how fast it rises after being off Lupron.

I don't believe working out raises Testosterone. I have a workout buddy also in his 80's who gets a Testosterone shot every 2 weeks since his level is low, around 200. The shots put it in the 700 range.

My usual workout starts on the treadmill for 1/2 to 1 mile at a 3.5 to 4 mile /hour pace. I then go to the machines and free weights for 2 hours. usually doing push exercises on Monday, pull on Wednesday and a combination on Friday. Usually do 3 sets on 8 to 12 machines and or free weights. At my age, 85 soon, they recommend more reps and less weight. I just do the opposite.........as much weight as I can do........ sometimes only 5 reps but most times at least 10. Never worked out until the Y about 10 years ago. I was amazed at how much muscle an old man can put back on even with busted up shoulders. I was very lucky that I was already working out when diagnosed. It would have been difficult had I not..may not have happened.

Hope this helps.

flax:
Thank you for the information. It is encouraging that we can add lean muscle mass in our 80's!

After 18 months on ADT, testosterone is pretty much zero......cancer cells have nothing to eat!

Whew, lots of things to consider!

Given the extent of the lesions in his prostate, risk group 5 and pelvic node +, my priority would be to halt any further spread NOW. So I'd get on ADT ASAP and probably go with Orgovyx or Degarelix over Lupron.

On whether or not to start with an RP, a lot of that would depend on the overall health of his urinary tract in his prostate. As extensive as the lesions are in his prostate they may need to treat with close margins around the urethra. So it may be challenging to avoid a significant radiation dose to his prostatic urethra if he has RT with his prostate intact. If he's had any BPH issues at all I'd be cautious about RT with the prostate intact.

The other advantage of undergoing an RP first prior to RT is your MO will be able to use PSA as a very precise biomarker for residual disease in the pelvis or anywhere else. With RT they would be measuring the PSA produced by the intact prostate cells and you have to wait a period of time for the PSA to hit a nadir, so you don't get that good of an idea of residual disease for some time.

The risks of doing an RP first are well known - sexual impacts, will take a few months in most cases to regain acceptable continence, and I've read some people thinks it increases the risk of physically spreading some cancer cells during removal.

I'm not sure of the timing relative to either primary treatment method, but the standard of care since the outcomes of the STAMPEDE platform of trials is ADT intensification by adding abiraterone/zytiga to the basic ADT for at least 24 months.

Prayers and best of luck to both of you.