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Hybrid Approach to metastatic prostate cancer

Posted by elohelp @elohelp, Jun 8 7:07pm

Have one lymph node with cancer. Is there a good reason to not choose having the prostate surgically removed, recover, and then start oral treatments for both testosterone deprivation and killing testosterone making cancer cells. Once that has gone on for 1-2 months, have radiation on the lymph node to kill it. This way, I reduce the risk of long term radiation issues near other organs while still retaining systemic treatment for cancer cells not yet large enough to show on the PSMA PET scan. What is wrong with this approach?

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topf | @topf | Jun 8 8:56pm

I assume that the lymph node lit up on a PSMA. During RP several lymph nodes are also surgically removed to test for spread. So, they will likely remove that one. If additional ones test positive, you will probably be given adjuvant treatment.

Radiation shortly after surgery multiplies toxicity. Depending on your age and overall health, you might want to consider RT instead of RP as a first line treatment. Definitely get second opions from at least two different urologists, radiologists, and specialized oncologists before deciding on treatment. Tryto get these at a center of excellence.

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jc76 | @jc76 | Jun 9 5:42am

@elohelp
@topf has passed on to you great feedback for you.

You mentioned radiation damage to other organs. Are you familiar with proton radiation?

You have some really good questions. Have you discussed them with your urologist or R/O?

If you are not receiving treatment at a center of excellence, really consider that as @topf mentioned. Even getting a second opinion at one is what a lot of MCC will suggest. My experience with this is I did get second opinion regarding getting photo or proton radiation and confirmation on diagnosis and treatments.

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heavyphil | @heavyphil | Jun 9 11:55am

While your idea is a good one it probably wouldn’t do you much good. If one node ‘showed’ cancer, others may have traces as well, and you don’t even know if other cells are lurking elsewhere.
If you want to undergo surgery to remove the main focus of the disease, that’s a strategy…but you will probably have to have full pelvic radiation (IMRT) to the prostate bed and pelvic lymph nodes while on ADT.
Or just do RT, as others have suggested; perhaps IMRT and SBRT to the affected node. You really need to talk this out with a full cancer team if you want the best treatment plan offering the best chance for a ‘cure’
Phil

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