Treatment for Prostate Cancer Metastasized to Bones

new here Oct 2nd was diagnosted with stage 4 metastasized prostate cancer spread to bones. m on eleguard and nubequa. did 6 months of chemo. question doing lots of on line research, trying to be my own advocate asking questions telling doctor to inform for next steps. im getting ready for genetic testing. also. i guess im trying to be informed what anyone else has gone through with stage4 metastasized prostate bone cancer so when i do go to my doctor i have a better understanding of what to ask. what were some of your steps i:e just drug therapy, targeted radiation, ect. any help appreciated. im 55 and want many more years, dont want to lose out by being uninformed,

You didn’t give us much information about your cancer case so it’s tough to give advice that is directed toward your specific type of cancer.

What was found in your biopsy? How many cores were taken, and how many had cancer?. What was the Gleason score of the cancer? Did you have any other issues in your biopsy like cribriform, Seminal vesicle invasion intraductal, etc?

How many metastasis did you have? Was chemo successful in removing them all? Have you had a PSMA pet scan to make sure that you don’t have any metastasis left?

You should’ve had hereditary, genetic testing already. Has it been offered to you by a doctor? You can get it done free with the below link, if you live in the United States. Do not check the box that you want your doctor involved or they won’t send you the kit until they get in contact with your doctor. It takes about three weeks to get the results and then a genetic counselor will call you to discuss the results.
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Prostatecancerpromise.org

The next steps depend on whether or not your PSA is rising after all of your treatment. If that is happening, then you do need that PSMA pet scan. If it finds any metastasis, you can have them zapped with SBRT radiation. If you get more than five metastasis to the bone and they usually want to try radium 223 (zofigo).

You should probably be on those drugs for at least two years. What has the doctor said to you?

What is the current status of your cancer? Has your PSA been undetectable?

I'm sorry for your news.

The big question is how many metastases they discovered. If there are just a few, then you're oligometastatic, and they may choose to treat the individual metastases with radiation; if they're widespread, they may choose chemo up front to knock it back a bit. It's also increasingly common to give a "curative" dose of radiation to the prostate, even at stage 4, because studies have shown a significant survival benefit (that's a big change in thinking from 10 years ago).

They'll likely also put you on hormone therapy, including an ADT like Orgovyx and an ARSI like one of the -lutamides or Abiraterone. If your PSA responds to that, then the cancer is still "castrate-sensitive"; if/when it stops responding, your cancer has become "castrate-resistant", and they may suggest other treatments like additional chemo or Pluvicto.

Don't be discouraged. I was 56 when I was diagnosed with de-novo stage 4 prostate cancer metastasised to my spine, and I was certain my life was drawing to a close. I'm 60 now, with no evidence of disease (that doesn't mean I'm "cured", but modern treatments can put many of us in deep functional remission almost indefinitely).

I am in the same club, diagnosed 9 months ago, stage 4, Gleason 9, localized spread, put on hormone therapy right after PSMA Pet scan. Cancer had spread outside prostate, right lymph node and 2 lesions in my pelvis. Had an MRI last month and the cancer has responded very well to the hormone therapy. Have not had any chemo, but will have radiation after the summer. I will most likely be on hormone therapy another year or more. The hormone fatigue can be mitigated with exercise, this has worked well for me. I use Chat Gbt/ AI to help me understand and keep track of my treatments and symptoms, it is a great tool for formulating questions for your oncologist or urologist. My docs are impressed with my questions and it certainly helps in advocating for the best treatments. I had a genetic blood test and the tumor, I have Brca2 mutation, which puts me at greater risk. Wishing you the best through these challenging times.

i forget my gleason score. was a bit of blur in beginning.
i have stage 4 that has metastasized into my bones both hip and legs shoulder and back near spine. my psa was 198 when i started nubequa and hormone therapy. its now 1.01 so that is working. six months of chemo. was told that it killed a "descent amount of the cancer" and there were no signs of growth and advancement. i have appointment moday so i will be asking alot more' and to see my new scans to old scans. i live in the white mountains and i am doing my best to make sure all is getting done. the more research i do the more unsure i am of what path to take. just trying to here from people with like issues to help to ask the rigt questions to formulate a good plan with my doctor.

Hi,
Did you have Chemo and if so how long ago did you have it? That's great you are doing okay after 14 years. That's really great.
My husband's PSA is up to 60 now. He's on Apalutamide and Eligard shot every 4 months, but the hormone therapy is not working as well anymore. He was diagnosed with Stage 4 metasasized to bones and lymph gland and his PSA was 418. They started him on hormone therapy and it dropped in 6 months to 2.6, but 1 1/2 years ago, it's been going up and up.
We just saw the oncologist last week, and they will do another bone scan and CT scan and them maybe Chemo in Sept., although we are both scared of Chemo and what will this do?
Did you have Chemo?

So at this point, your PSA is undetectable I would suppose? If so, you are like many of us here who are on drugs that keep our cancer away.

I’ve been on Nubeqa 22 months and ADT (Orgovyx now) for 8 years.. `After 15 years and four reoccurrences it’s kept my PSA undetectable for 19 months.

After the prostatectomy, they would’ve sent you a results of the final biopsy that had all of your specific cancer information, including your Gleason score. There are probably multiple Gleeson scores One for each core that has cancer. The highest number is the only one that counts, to the medical community.

At this point, they might recommend radiation, but it’s possible they won’t do that until your PSA starts to rise. The rule is after a prostatectomy if the PSA rises to .2 or higher, they should do salvage radiation. If it’s not done at .2 then the cancer becomes more risky. Some doctor say, however, that your chance of hitting the cancer is only 33% with salvage radiation. I know it worked for me and a lot of other people.

4 years, not 14 (though I'm hopeful 🙂). No chemo because there was just one huge metastasis on my spine, so they treated it with debulking surgery and radiation instead. Unfortunately, they didn't catch it in time to prevent temporary paraplegia, and it was a long road back to walking again.