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

What does it say? That you have ro remove the prostate to remove one potential source of future recurrences? I.e., that radiation has a persistent long-term risk?

Dr Walsh's book just reports on it. The radiotherapy arm of the broad phase III STAMPEDE trial found (among many other things) that for oligometastatic prostate cancer, radiating the prostate itself *in addition to other treatments* extends survival without serious impact on quality of life. This was already become standard practice at my cancer centre in 2021 when I was diagnosed.

(Unfortunately, they did not find any benefit for polymetastatic prostate cancer.)
https://ascopost.com/news/august-2022/long-term-benefit-of-radiotherapy-confirmed-in-advanced-prostate-cancer-stampede-trial-follow-up/

I think it says that surgery or radiation on the prostate is valuable even if there are metastatic spots because the escaped cells are out circulating and still communicating with the original tumor (the mothership). And this communication strengthens and invigorates the circulating cells.

I thought once they left the nest they were free to wreck havoc and grow, never read anything about a mothership communication. I have two lymph node invasions depicted on Psma/pet, but no light up or uptake from the prostate. Had proton 3-years prior for G6 1-core G7-1 core, G8 another core. So I guess the lines of communication are broken in my case.

Thanks for sharing your experience. I understand there is a study in progress that will hopefully one day determine if there is any validity to the theory. My husband has the lymph node situation as well. Best wishes to you!

STAMPEDE shared its preliminary findings on this topic a number of years ago, and the complete ones (I think) in 2022, so this is well beyond just speculation now. The one qualifier, which I'll repeat, is that they found a benefit to also radiating the prostate only for oligometastatic prostate cancer.

When I asked our RARP surgeon about the “mothership” he said he prefers the term “debulking”. And the “debulking” would assist greatly in lessening the load of cancer in the body. We knew there were two positive nodes before having the surgery and that radiation would most likely follow after healing from the surgery. My husband had a very large tumor in his prostate.

I think "debulking" is a little different. I had debulking surgery to my spinal lesion, which meant physically cutting away most of the tumour. What Dr Walsh colourfully calls the "mothership" (just a simplification for his book) means specifically treating the prostate even though the cancer has already metastasised elsewhere.

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

Thanks, very helpful.