Starting Stage 4 treatment

@dan67
Your biopsy should’ve given you a Gleason score. That’s very important to know because a high Gleason score can tell you if your cancer is Aggressive and could come back sooner.

Some people with high Gleason scores live for decades after treatment, others don’t.

When you have other tests, they normally don’t refer to your Gleason score. If you were to have a prostatectomy, they would.

I am very sorry you are going through this issue. I agree with the others that you need to find a good oncologist that treats prostate cancer. If in fact this is prostate cancer, then starting treatment is absolutely required. I was diagnosed de novo with stage 4 prostate cancer over 3 years ago. I'm doing fine and have remained in deep remission and undetectable. I am on ADT, Nubeqa, and Xgeva (for the bones). I had 10 rounds of radiation to the spin and 4 additional rounds to my ribs. I then had 10 cycles of Chemotherapy. The standard of care is 6 cycles of chemotherapy, but if you have the strength you can request more. There are studies that show that >= 8 cycles of chemotherapy increases overall survival. So, I went in that direction. But this is a personnel decision between you and your oncologist. Discuss your treatment options with your oncologist.

@northoftheborder thanks for your clarification, both descriptions are what my doctor told me when I asked about “Gleason “ today. It’s not in my bones yet but it is in my abdomen and chest area lymph glands. It’s looking like the cancer is abnormal and may be why it was not recognized earlier. Innerductal aggressive cancer. Hormone therapy begins next week, I am happy that the medical team is becoming urgent and appointments are flowing. They are also very open to clinical trials being considered.

@jeffmarc
This aggressive and at stage 4 which means they do not use the Gleason measurement. They also are not recommending any therapy only for the prostate since it is metastatic to lymph glands already. Thanks for your in put.

@wooldridgec
I’ll be beginning hormone treatment next week. This is an aggressive cancer and that has reduced types of treatments. Your experience encourages me. Thanks

@dan67 Good luck. Hormone treatment is a solid foundation, and hopefully your care team will be able to layer other treatments on top of it if/when needed.

@dan67 My cancer went *only* to my bones — there's never been any evidence of local spread, lymph nodes, etc. Prostate cancer can be weird.

In any case, there's no reason to assume that yours will continue to progress, at least not for a long time (if ever), given modern treatment. The most common treatments in your situation would be

- ADT (which you're going to be getting)
- an ARSI, like one of the -lutamides (which blocks the testosterone signal at the cancer end)
- radiation to your prostate
- radiation to the individual metastases (if there are few of them); or
- chemo or Pluvicto (if there are many metastases)

The important thing now is to tell your care team very directly and clearly that you want to fight hard and are willing to tolerate some rough side-effects (if that's how you feel) — it makes them more comfortable knowing your preferences, so they're less likely to hesitate over decisions.

In my case, it's one of the main reasons they "threw the kitchen sink" at my oligometastatic cancer in 2021 (their words), which has kept me in remission ever since.

@dan67 Your next big milestone will be finding out whether your cancer is "castrate-sensitive" or "castrate-resistant".

2–3 months after you start hormone therapy, your PSA should start falling, until (ideally) it becomes undetectable. If that happens, great! You're in practical remission.

If it doesn't happen, don't despair: in 2025, there are many good treatment options, even when the cancer is castrate-resistant.

Best of luck!

I had a second biopsy of the abdominal lymph gland that clarified the diagnosis of my cancer. It is spreading but it is not aggressive. PET Scan found cancer in prostate, abdominal and chest lymph glands. I started hormone therapy this week. The possibility of radiation is dependent on its approved use on the chest lymph glands. Is this a possible treatment?

@dan67
Radiating lymph nodes is very common. The question is, is that lymph node near something else that could be damaged by radiation? Usually, it’s not a problem, but sometimes it is and you have to find out what the doctor says about the risk.