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Stage 3a, Group 9, just discovered. Dr. gave options but have question
So, I went from happily living a "normal" life, being on finasteride and tamsulosin to having Stage 3a, Group 5, Gleason 6, 8, and 9 in a year. Yikes. Already in fatty tissue outside of the prostate, so he scheduled me for a PET scan on the 19th. He was kind of down when talking to my wife and me and said "you have years, not months" etc.
He laid out two plans for me: 1. if not metastasized have RP and radiation, maybe chemo. If metastisized get hormone therapy, radiation, and chemo.
So, my question is: even if it has metastasized, why would they not remove the prostate to get rid of the "source?"
Thanks!
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I'm just a layperson, but from what my onco team told me (and I've read elsewhere since), radiating the prostate is as effective as removing it, and is the standard treatment for advanced stages.
Since your cancer has already spread, perhaps they think that radiation might kill some of the cancer near the prostate as well, which simply removing the prostate wouldn't.
I'm surprised they're offering chemo already at this point — your cancer is still only local — but I understand some oncologists are getting more proactive about that.
I'm at stage 4b oligometastatic. I had debulking surgery on the lesion on my spine (it was paralysing me), then radiation to both my spine and prostate. Over almost three years since, ADT and ARSI (Erleada) have held my PSA at undetectable levels (< 0.01), there's no sign of cancer progression, and my onco team has shifted to talking about double-digit years now. I haven't had chemo yet because my cancer is still castrate-sensitive (it responds to ADT). I feel great.
If you're not at a Center of Excellence (U.S.) or a Cancer Centre (Canada) and feel that your doctor is talking down to you, see if you can get to a research centre where the doctors are up on the latest developments. Prostate cancer treatments have changed dramatically in the past 5–10 years.
Best of luck.
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12 Reactionssomeone once explained it as "the horse has already left the barn". I wish you the best on your journey.
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5 Reactions«someone once explained it as "the horse has already left the barn". »
Exactly. It's too late to close the barn door, but we can still keep it from trampling down the garden (aka vital organs). Luckily, oncologists have many more ways to do that than they used to.
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6 ReactionsHi and welcome to the brotherhood that no one wants to be a member of. This is a wonderful forum that Mayor Clinic hosts. I am a fellow stage 3 Gleason 9 prostate cancer patient so I’m only sharing my personal experience and not giving medical advice.
As fellow Forum member northoftheborder stated you need to make certain that you are being treated at a center of excellence with a great track record of helping men with prostate cancer. Local community hospitals do their best but seldom have the resources as places like Mayo, MD Anderson, Northwestern Medicine and others. Here is a link to nationally recognized centers of excellence: https://www.cancer.gov/research/infrastructure/cancer-centers/find
A PET scan is a great idea as long as it is the more advanced PET-PSMA scan. That scan is most helpful for recognizing metastasis which is spread beyond the prostate itself.
Good luck on your journey. Please don’t hesitate to keep keep us informed as to your status. We’re interested in you and here you.
I strongly recommend you purchase the book surviving prostate cancer by Dr, Patrick Walsh and Dr. Edward Schaffer. It reflects state of the Art cancer care here in 2024. I own a copy and it’s given me great confidence in the care that I have received and will receive. https://www.amazon.com/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1455504181 Personally, I think it’s the best $10 you’ll ever spend on understanding your disease.
According to Dr. Edward Schaffer, who is the head of urology at Northwestern medicine in Chicago, state of the treatment in 2024 for stage three prostate cancer patients is radical prostatectomy to debulk the cancer, radiation where appropriate such as the prostate basin and prostate lymph nodes and then up to two years of first and second generation ADT. Removing the prostate reduces the size of the battle that has to be fought with radiation and androgen deprivation therapy. This is well discussed in the book along with summaries of the research that has been done to determine the effectiveness of this protocol. I am a patient at Northwestern Medicine and this is the protocol that is being used for my case. Removing my prostate, which had extensive cancer along with extra capular extension and paraneural involvement on one side along with removing each of the locally available lymph nodes reduced the battle to the area around a single difficult to reach lymph node.
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4 ReactionsThat's all great advice. I did decide to grab the book, and I found it helpful (to this forum's credit, it mainly helped me pull together the excellent information that I've already learned from fellow members here).
As far as treating the primary tumour (the "mothership", as Dr Walsh called it), radiation and surgery are about equally effective, especially if (as @robertmizek mentions) you still have radiation after the surgery to catch anything that might already have spread just outside the prostate. They both come with side effects, but (in my case, at least), nothing I'm not happy living with in exchange for being able to live.
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5 ReactionsI, too purchased the book from Amazon. It provides a lot of information in a detailed form so one can fully understand the context of the various options for treating prostate cancer. Each person has a different and varied situation-no two are alike.
As to treatment: I chose proton at Loma Linda in 2010 (PSE: 6.47; Gleason 3+3; T1. Each morning around 0730 a group of about 5 to 8 men were huddled in the waiting room ready to be called to one of the three "huge" proton radiation machines. So, there were moments of spirited discussion. I would affirm about 70% were physicians or those directly in the medical treatment business. This fact affirms my individual decision on proton radiation therapy.
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2 ReactionsHave you had any radiation or ADT treatment at this point?
I had salvage RP January 18th, 2024
Started Orgovyx on 4/22/24.
Started Generic Zytiga (Abiraterone acetate) on 4/29/24.
Handling ADT well overall. Hot flashes are annoying at worst. PSA undetectable.
Received 31 sessions of VMAT IMRT to the lymph node basin including 6 sessions of VMAT IMRT boost to the left obturnator lymph node. Completed treatment 7/18/24.
Good luck on your journey! Bob
No, I am having the PET/PSMA scan on the 19th. I just learned I had this cancer last week.
I am already on Finasteride, which I have been on for about 3 years now, which drastically reduces your testosterone (and supposedly regrows hair, but THAT ain't happening) :). That's it. It's all up to the special PET scan on the 19th.
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3 ReactionsUnfortunately; Dr. Walsh's book does not address Stage T3 (seminal vesicle) involvement in his book. Very disappointing. Better researching it on the web.