Surgery if cancer has metastasized

What do you guys know about removing prostate if cancer has metastasized? Does it result in longer life?

Thanks
Tom

Goatts, I'm looking at your profile and don't see anything about mets. Post a little more info about what your uro told you about the mets from right side. Nice that left side was clear! Have you had any other scans or just the biopsy? The really smart fellows will respond to your inquiry with good info, but if there are mets surgery is not likely to be the best treatment. As my husband's medonc puts it, "the horse is out of the barn"

This would be considered experimental, but I know at least some are considering surgery even after metastases. At diagnosis, my husband had widespread bone mets and lymph node involvement (in addition to a prostate gland effectively wholly taken over by cancer -- 100% cancerous cells in 11 of 12 cores, 95% in the 12th). Surgery was clearly not an option, but about six months ago, after near-miraculous response to HT and other meds and multiple rounds of met-free bone scans, surgery was raised as a possibility. We were really excited about the idea that the cancer was diminished to such an extent it was possibly removable.

Our MO raised it, a surgeon at Mayo reviewed the records and thought it was likely worth doing, but right around that time his previously undetectable PSA peeked over the wall. I think we were at .24 at that time -- low, but enough to give us all pause on this "explore surgery" plan. He's over 9 now, and late last week a bone scan came back showing mets in a few locations.

So although his cancer's return makes it moot for us, thought I'd let you know there is at least some controversial consideration of this out there.

I had radiation therapy and HT, since my uro onc said he thought surgery unlikely to be curative. I understand the "debulking" concept, but I'd have to see a LOT of convincing data to take on the side effects of that surgery knowing in advance it will not be curative. Tough sell for me.

The radiation therapy can also be considered as debulking. Radiation is not necessarily trouble free either, but it's a different side-effect profile and may be more tolerable for some people. At about 18 months from treatment I've had nearly zero long-term side effects from RT. Some may still develop, but so far so good.

Jerry

Thanks everyone. Great info!

Tom

At the time I had my surgery, I asked my surgeon about doing path on my lymph nodes first, if they ever did that and then closed you up while leaving the prostate alone if there was cancer already in the lymph nodes. This chairman of the department at Vanderbilt told me – now keep in mind this is a surgeon speaking and all biases that may apply –anyway he told me that that was kind of old-fashioned thinking, that there were studies showing that people did better with the prostate removed even if it had escaped the capsule. But you know how that goes, there are studies showing this and there are studies showing just the opposite, pretty much on a variety of subjects. And again, consider the source. But there are definitely some big brains who think it's better to get a Cancerous prostate out of there. Though you may of course need additional treatments. but of course, adding on the side effects of surgery along with what ever side effects there may be due to radiation, you're probably going to want some dramatically improved odds to make up for all of that. Hard to say whether you would get odds that are improved enough to make up for all of that additional stuff to deal with.

Ed Messing led a famous study from before (or very early in) the psa era in which men with N+ PCa were randomized to surgery or ADT alone. The results were strongly in favor of surgery vs ADT. Horst Zincke at Mayo went to surgery with N+ patients for years and numerous papers over the years show that these men (most of them) live for many years albeit with a series of other treatments.
If the NIH personnel are waiting for a trial about this and will say the Messing study is insufficient, that means they will NEVER be satisfied because such evidence from a RCT will not be forthcoming at this point. If they recommend Radiation to primary and secondary sites as the alternative that can be supported.
The question about established bone metastasis at diagnosis and the value of surgery or radiation to the primary and secondary sites is still under discussion.

I see little harm in surgery when the horse is out of the barn ED is pretty much a given at some point if any hi grade pca has escaped. I hear you on incontinence and other S/E from surgery. Primary treatment will give you S/E, If that don't, secondary will. If there were no S/E's in medicine, "doctors and lawyers and such" would have lighter case loads. Keeping the hose on in a pool will do little to empty the pool. BTW, we did get a response to the BT question. So I will be the goat and again ask the question, that Celebratelife asked and TA alluded to by assuming the other answer to the question. Goatts have you been diagnosed with PCA mets. If so could you provide some info on that . If not I will ass/u/me the question about mets is informational/rhetorical. Nothing wrong with rhetorical questions, nothing wrong with guarded questions. As long as in the final throws of dialog, we all are looking and responding to the same patient with the same disease particulars. As you do not know that much about the disease, obviously you can only ask questions about that which you know. I am just trying to tidy up some errant cells of thought, lest they take root and skew the whole thread. So mets or not and where, if so????