1. < Prostate Cancer

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

Posted by cheriekhan @cheriekhan, May 14 2:07pm

My partner was diagnosed with stage 4 A prostate cancer with spread to pelvic lymph nodes. Oncologist has recommended surgery followed by radiation and hormone therapy for a good prognosis. He is 65 healthy and no symptoms. PSA was 11. Has a history of prostrate cancer. Was wondering if we should get another opinion regarding getting surgery first. The dr wants to treat it aggressively. Any advice on what to expect, next steps appreciated.

More Information: Hi father died of prostrate cancer as did his uncle. His Gleason score was 9. And all 12 pieces of the biopsies had cancer: Prostatic adenocarcinoma, Grade Group 5 (Gleason score 4+5=9), involving 100%, 100%, 90%, 90%, 90%, and 80% (15 mm, 14 mm, 14 mm, 14 mm, 14 mm, 5 mm) of 6/6 cores. PSMA pet scan results: Intense PSMA uptake in the prostrate gland from apex to base.No psma avid osseous metastases. Non puma avid low attenuation bilateral adrenal nodule are indeterminant. Recommend dedicated contrast imaging for further evaluation. They did genetic testing waiting for results. This is being done at Cornell Weil in Manhattan with experts in the field.

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

robertmizek | @robertmizek | May 19 11:23pm
In reply to @russ777 "Whew, lots of things to consider! Given the extent of the lesions in his prostate, risk..." + (show)
@russ777

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.

Jump to this post

Well put. I agree especially with regards to the timing for nadir post RT and the advantage of using PET-PSMA post RP.

REPLY
stantallusa | @stantallusa | May 20 4:54am
In reply to @russ777 "Whew, lots of things to consider! Given the extent of the lesions in his prostate, risk..." + (show)
@russ777

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.

Jump to this post

Don’t forget to check our ivermectin. Has shown great success actually eliminating prostate cancer

REPLY
2 replies
Moderator
Colleen Young, Connect Director | @colleenyoung | May 20 7:11am
In reply to @stantallusa "Don’t forget to check our ivermectin. Has shown great success actually eliminating prostate cancer" + (show)
@stantallusa

Don’t forget to check our ivermectin. Has shown great success actually eliminating prostate cancer

Jump to this post

@stantallusa, I believe it is premature to state that ivermectin "Has shown great success actually eliminating prostate cancer". Can you share links to information that bear out that claim?

It is true that researchers are studying Ivermectin to see if it may be used as an anti-cancer drug and early studies show promise. However, this research is in the early stages (mice studies) and has not yet been tested in human trials. Ivermectin is not a proven standard treatment for prostate cancer.

Ivermectin combined with other chemotherapy drugs or targeted drugs is being studied in early clinical trials and shows promise in patients for whom conventional chemotherapy has not worked in some cancer types. It may be effective against drug-resistant cancer cells.

– Ivermectin, a potential anticancer drug derived from an antiparasitic drug https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505114/

Important
It is NOT safe to take ivermectin used in veterinary medicine. Please talk to your doctor before taking any over-the-counter medications or supplements that claim to fight or cure cancer.

REPLY
northoftheborder | @northoftheborder | May 20 9:28pm

Perhaps in 10 years there will be ivermectin treatments available to help treat cancer in humans, depending on how the current early research progresses (it likely won't be a magic cure-all, but just an additional treatment option that helps in specific situations).

For now, though, anything you read about people self-dosing with ivermectin for COVID-19 or cancer is dangerous quackery, and following their advice could kill you. I strongly discourage anyone from experimenting on themselves like that.

REPLY
bens1 | @bens1 | May 21 6:49am

stantallusa: I certainly understand the unexpected results from your prostate removal. My brother is in your immobile position, having survived colon and prostate cancer with radiation and ADT. He now has pancreatic cancer and has recently had most of his pancreas removed as well as his spleen.
I would be pissed if I were you but you might want to get opinions from other experts as to how to solve your issue. Maybe there is a solution an expert at another center of excellence might be aware of. Don't give up hope.

REPLY
dmccarthy104 | @dmccarthy104 | May 21 7:56am

Of course get a second opinion. Dana Farber has a 2nd opinion program as does Mayo I believe.
I used Dana Farber and was thrilled on the process and access to great staff.

Good luck.

REPLY
OTTADV | @ottadv | May 21 8:58am

I had prostate surgery in 2017 and 5 years later it metastasized to my abdominal lymph nodes making it by definition, Stage 4 prostate cancer. My mother's 6 brothers all had prostate cancer and died, but lived long lives thanks to treatment. I had 39 radiation treatments and have been taking hormone suppressants for 1.5 years, Lupron Depot, Abaraterol, and prednisone.

I don't like taking the drugs, because of various side effects, but I am pleased that now I have the odds on my side for life. I determined it would be short-term selfish and long-term foolish of me not to pursue the very best medical advice. Your husband's numbers are not marginal, and although unusual, sometimes prostate cancer can take off.

I hope this helps. But most of all, I would pray about it and seek second or third opinions.
One last thing about the consideration of Ivermectin... I suggest searching cures for cancer and see if you don't find hundreds of anecdotal testimonies that anything from fruits and vegetables to pine tar is promoted as a cure.

REPLY
1 reply
jsh327 | @jsh327 | May 21 12:02pm

I recommend getting another opinion on surgery first, as opposed to having radiation as the first primary treatment. If only to fully understand the advantages and disadvantages of doing the surgery when it is known that the cancer has spread outside of the prostate and surgery will be followed by radiation.

REPLY
lag | @lag | May 21 9:17pm
In reply to @stantallusa "Don’t forget to check our ivermectin. Has shown great success actually eliminating prostate cancer" + (show)
@stantallusa

Don’t forget to check our ivermectin. Has shown great success actually eliminating prostate cancer

Jump to this post

This is not correct. It would be a waste of time pursuing this "treatment" without reliable studies and trials to support its efficacy. It doesn't cure prostate cancer any more than it cures covid-19. Focus on treatments with good data over a span of years.

REPLY
melcanada | @melcanada | May 22 6:04am
In reply to @ottadv "I had prostate surgery in 2017 and 5 years later it metastasized to my abdominal lymph..." + (show)
@ottadv

I had prostate surgery in 2017 and 5 years later it metastasized to my abdominal lymph nodes making it by definition, Stage 4 prostate cancer. My mother's 6 brothers all had prostate cancer and died, but lived long lives thanks to treatment. I had 39 radiation treatments and have been taking hormone suppressants for 1.5 years, Lupron Depot, Abaraterol, and prednisone.

I don't like taking the drugs, because of various side effects, but I am pleased that now I have the odds on my side for life. I determined it would be short-term selfish and long-term foolish of me not to pursue the very best medical advice. Your husband's numbers are not marginal, and although unusual, sometimes prostate cancer can take off.

I hope this helps. But most of all, I would pray about it and seek second or third opinions.
One last thing about the consideration of Ivermectin... I suggest searching cures for cancer and see if you don't find hundreds of anecdotal testimonies that anything from fruits and vegetables to pine tar is promoted as a cure.

Jump to this post

Same 2017 then mets to L2 lumbar Radiated and put on Xtandi It failed after a year so now 5th injection of Xofigio or Radium 223
What's next?Lu177 if it gets approved as standard or chemo
80 feel great but pains to back
on Zolodex and Xgeva ever 12 weeks Pray daily

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