potential treatments

Your PSA number seems relatively low considering the Gleason 9 result. I wonder if that would impact treatment options. Did the doctor explain anything? Hope for the best.

There are a lot of variables, so we can just share some ideas and experiences.

If there are just a couple of bone metastases in addition to the lymph nodes, then your cancer is oligometastatic. If there are lots of bone metastases, then it's polymetastatic.

If your cancer response to hormone treatment (PSA goes down after a few months), then it's castrate-sensitive. If not, then it's castrate-resistant. Castrate-sensitive cancer often evolves into castrate-resistant after a few months or years, but new drugs can sometimes delay that process for much longer.

For polymetastatic cancer, treatment will often involve chemotherapy and/or Pluvicto (radiation administered internally). For oligometastatic cancer, they will often radiate each of the metastases, and maybe your prostate as well.

For hormone therapy, in addition to the traditional androgen-deprivation therapy (ADT), you will likely be put on ARSI like one of the -lutamides.

Personally, I've have oligometastatic, castrate-sensitive prostate cancer since 2021, and treatment has prevented any progression since then.

Best of luck.

No not really, he just said he is scheduling me with the Oncologist for best option for treatment

Thank you, I'm sure will know more about it when I see the oncologist, thank you so much for the information

Zzotte

If you don’t have more than five metastasis, then you can have them zapped with SBRT and maybe at the same time zap your prostate. Question is what did the biopsy show? Was there any cribriform found? Other major issues in the biopsy?

If you have more than 5 metastases then they frequently do triple therapy ADT plus an ARSI (Zytiga or a lutamide) and chemotherapy.

They could do Pluvicto instead of chemo, not the standard but it is approved.

My Dr didn’t go over the results in a lot of detail, the biopsy showed 5+4 with metastatic to the prostate nerve, I asked what now? He said we do Pet scan and go from there, the pet scan show bone and two lymph nodes, so he scheduled a consultation with an oncologist so that will be next, I have to admit that I’m a little at loss, I didn’t not even know what I should had asked I know the sooner I accept the fact the better off I’m will be.

Thank you Jeff
Zzotte

It seems like you might be able to better advocate for yourself if you got the full results of the tests that have been done, like the biopsy, Decipher (if done), etc. While we cannot tell you what to do, we can look at that and tell you our own experiences based the same or similar results.

You have to understand that with good treatment, you could live many more years. You have a chance to be proactive, Find out a lot about what can be done, And then be prepared when you talk to the doctor.

When your doctor says you have bone Metastasis is it just one spot or are there more spots. That’s important to know because the more spots there are the more complex it gets.

Now they say that you are going to have an oncologist to work with. You want to make sure it’s the right type of oncologist. Genito Urinary Oncologists specialize in prostate cancer, Medical oncologist work with all different types of cancer. You want to speak with a GU oncologist about what is the best treatment to get? If you are going to do chemo, then you may go to a medical oncologist.

Tell your doctor you would like a copy of the biopsy report. You can check your medical records. It might be able to be downloaded from there.

You have a serious case of prostate cancer. You really need to get a second opinion so you can get the best advice and Have choices that make sense. Not sure where you are going now, Working with a center of excellence will give you a chance to have multiple doctors looking at all aspects of your Diagnosis and treatment.

There are a lot of people writing in this forum with similar cases to yours. Take a look at the titles and first message in this forum and find ones that are similar to your case and see what people said to do. You can get a real education here.

I forgot to welcome you to the club within a club (metastatic prostate cancer). 😕

As @jeffmarc mentioned, going to a decent multidisciplinary cancer research centre is critical at this point, because treatments for stage 4 PCa have changed enormously over the past few years, and the word hasn't gotten out to all the smaller practitioners yet.

If treated quickly with the latest best practices, it might become more like a chronic disease than a terminal one, at least for many years, and maybe indefinitely.

There are no guarantees, but we have genuine hope now.
https://www.scientificamerican.com/article/treating-prostate-cancer-at-any-stage/

Thank Jeff I will do the search,
Zzotte