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

Hi @ganway, I'm sorry to hear that your husband has stage 4 prostate cancer. Once cancer has spread, the surgical options are not commonly used. Here's more information from Mayo Clinic about treatment options for stage 4 prostate cancer. https://www.mayoclinic.org/diseases-conditions/stage-4-prostate-cancer/diagnosis-treatment/drc-20377972

You might be interested in these 2 discussions where members are talking about treatment for stage 4 cancer with Firmagon:
- Stage 4 prostate Cancer: Firmagon + Abiraterone?
https://connect.mayoclinic.org/discussion/stage-4-prostate-cancer-metastasis-to-bones/
- Has anyone else moved from Firmagon to Orgovyx?
https://connect.mayoclinic.org/discussion/has-anyone-else-moved-from-firmagon-to-orgovyx/

I’ve seen several of your posts on other topics and I was just following up to see If they did a prostatectomy to bebulk the tumor, and also if he is now going through radiation to the pelvic lymph node basin and receiving first and second generation ADT. Hope all is going well. Bob.

No surgery was not an option as the cancer had gone to a seminal vessel and a pelvic lymph node so oligomastic. Yes he is on Orgovyx and started zytega 4 days ago. Scheduled for Brachytherapy to prostate and seminal vessel on Wednesday. And 26 sessions of IGMRT or proton radiation in October. We are deciding between the two. So far his PSA and T has gone down as has his pelvic nodules on a current CT scan. So keeping fingers crossed.

I’m on Orgovyx and Zytiga as well; going on 5 months. As long as I exercise each day the side effects aren’t too bad.

I’ve had IMRT. Not sorry I chose it, but have wondered if I would’ve had less side effects with proton therapy. A consult with a radiologist specializing in each might be helpful in making a decision.

Since my situation is so similar to that of your partners, don’t hesitate to send me a direct private message if there’s anything I can help you with or you have any questions Did you think I might be able to answer from my experience.

Bob

Thank you so much I most definitely will.

My diagnosis is similar and my oncologist says no surgery

In July, 2022 my PSMA scan said no uptake in pelvic lymph nodes

In July, 2023 we ceased Lupron because another tumor I had responded overwhelmingly to immunotherapy (tumor DESTROYED after only 4 infusions of pembrolizumab (keytruda)

There was circumstantial evidence that the prostate cancer had also responded. It was difficult to ascertain because the immunotherapy was administered concurrently with Lupron

In retrospect my onco was rolling the dice and I lost, because the cancer came roaring back. The SUV uptake of 2 pelvic nodes was 7-8, so I’m almost certainly stage 4

Now I’m shopping for 2nd opinions I should’ve sought when my oncos discontinued the immunotherapy because my bowel tumor was cured. We should’ve kept going w it for the prostate

So now I’m about to start radiation. I’m on degarelex and hoping to give immunotherapy another try if insurance plays ball

Incidentally - my tumors are MSI-H, which is very rare and a driver of immunotherapy response. People with non-MSI-H tumors typically do not respond well to immunotherapy, melanoma excepted

So I’m interested in communicating with you because I want to try surgery AND radiation AND immunotherapy. Kitchen sink approach

I should’ve read all your posts to see where your husband is in his treatments.

I’m being treated at a top ten cancer hospital but I fear that stopping my treatment for a year was in retrospect reckless. I’m visiting another top ten cancer hospital later this month. I’m closing the barn door after the horse is gone. I need an prostate cancer doctor experienced w MSI-H prostate tumors to help me to understand if I should’ve had surgery when there was some chance of no spread to lymph nodes

Not sure if my post helps except to advise that oncos at the famous cancer hospitals are not infallible

Prostate

I had SBRT, which is somewhere in-between IMRT and Proton in terms of precision.

Despite some side effects, in retrospect I have no regrets about getting radiation therapy that affected a wider area — the less precise it is, the more likely it will catch something they missed.