Anyone have thoughts or experience with Dr. Walsh’s mothership theory?

Maybe because of age? Or if the docs think it’s way too advanced to make a difference? I think it is the case that sometimes the prostate isn’t treated.

My mindset? ...kill what you can kill and treat the rest. Cancer sucks 😡

The prostate is a solid, identifiable target. Kill it or remove it. Mothership theory notwithstanding.

❝Why would one not treat the prostate? I’d assume it would be a continuous source of further metastases.❞

I know, it seems obvious. But in the old days (and I mean only 5–10 years ago), as soon as your cancer had metastasised they often assumed you were dying and switched into full palliative-care mode, where they tried to avoid any "pointless" interventions.

Fortunately for us, the medical community is starting to look at metastatic prostate cancer as a chronic disease that can (often) be managed long-term, instead of a terminal disease. Unfortunately, the memo hasn't reached all the practitioners yet, and it seems every few weeks we get a new forum member with a message like "My doctors found a metastasis and told me I have only a few years to live." Sometimes that still will turn out to be true, but not nearly so often as it used to. It's OK to hope now, and it's definitely OK to fight back against stage-4 prostate cancer.

Can you explain what you mean by Dr. Walsh's mothership theory?

Dr. Patrick Walsh, a renowned urologist and researcher at Johns Hopkins, has introduced a concept in prostate cancer treatment known as the “mothership theory.”
1. The Prostate as the “Mothership”
The theory suggests that the prostate gland isn’t just the site of the primary tumor—it can act like a “central hub” sending signals (chemical or hormonal) that encourage cancer cells elsewhere in the body to survive or grow.
Even tiny cancer cells that have spread to other areas (micrometastases) may rely on signals from the prostate to thrive.
2. Traditionally, treatment focuses on the prostate (surgery, radiation, etc.).
The mothership theory raises the idea that as long as the prostate is present and active, it could “feed” distant cancer cells.
This has led some doctors and researchers to consider treating the prostate aggressively, even when cancer has spread, to potentially cut off those signals.
3. Research Status
This is a conceptual theory, not a universally proven fact.
It’s still being studied and debated, and it hasn’t yet changed standard care guidelines.
In simple terms: Think of the prostate as a “command center” that can potentially help cancer cells elsewhere survive. Treating the prostate might, in theory, weaken those distant cells.

I'm not sure he introduced the theory; I think he just invented "mothership" as a metaphor to try to explain the science to laypeople reading his book. I believe the research findings supporting applying radiotherapy to the prostate as well as the metastases for oligometastatic prostate cancer come from STAMPEDE.

Thanks. I know Dr. Walsh because he treated my father in the late 1980s. This was highly successful and my father lived on until 2013, when he died at home at the age of nearly 93.

If this is true, why is it that men who have early-stage prostate cancer and have the prostate removed still have reoccurrences?

The STAMPEDE study found specifically that for stage four oligometastatic prostate cancer (just a few metastases), treating the primary cancer in addition to systemic therapy (ADT + ARSI) and treating the individual metastases extended overall survival by a significant amount of time. They found no benefit for polymetastatic prostate cancer (many metastases), and didn't look into early-stage, non-metastatic prostate cancer in this context.

Dr Walsh's "mothership" is just a simple metaphor to try to explain some complex research findings from Switzerland and the UK to a non-scientific audience, but the simple summary is that if you have oligometastatic prostate cancer (as I do) — or "low burden," as they call it in the Lancet article — you'll likely benefit from radiating your prostate.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32486-3/fulltext.

I would say that may happen if there are micrometastices that had already escaped the prostate and were undetectable at the time the prostate removal took place. So, they were already out there and show up later sometimes many years down the road. Enter salvage radiation and hormone treatments.