M1 trial

As you may recall I was offered to participate in the M-1 trial by Dr. Chapin at MD Anderson. The purpose of Thur trial is to see if localized treatment in metastatic cancer helps improves life span. I accepted and was randomized today into the group that receives treatment. As you can see from my signature I have local mets of 1 spot on the spine. My options are have my prostate removed by Dr. Chapin or have radiation by the team RO to destroy the leasons in my prostate. This is a difficult decision to make, however I am leaning to removal after ready a report by Dr. Walsh who feels like it is bennifical to temove the primary leason. He thinks it will slow down the spread of mets. Any thoughts or comments on this.
Ron

Hi Ron,

I agree with Gear. (BTW Walsh is not a radiation oncologist, so take what he has to say about radiation with a grain of salt) With radiation, you would treat not only the prostate but a margin around it - destroying the cancer in the places it has most likely spread to. I don't know if your clinical trial limits the field of treatment (it probably does), but if you were doing this outside of a clinical trial, I think you would talk to the RO about including the pelvic lymph nodes in the treatment field as well, and the spot on your spine (if it's in a place that can be safely treated) - why not? Radiation also has a much better side effect profile than surgery.

The next question in my mind would be - what kind of radiation is best for this purpose? The obvious answer is: the same kind of treatment that does the best job on high risk patients - brachy boost therapy. I suspect the SBRT or SBRT boost therapy could do the same job with less fuss, but that remains to be proven. Increasing the dose this way is likely to kill off more of the prostatic cancer, but side effects are likely to increase with dose. And, because you aren't pursuing this as a curative therapy, and there's no assurance that cytoreductive therapy has a benefit (that's why they're doing the clinical trial), you may be content with a better SE profile.

Dr. Walsh is a surgeon, so you have to filter his opinions through his experience. In his long career, he has undoubtedly saved many men's lives. But, that does not make him an authority on radiation. I agree with the above posters in favor of radiation.

Is an endpoint for this trial mentioned above to determine whether radiation or surgery is superior, or is it a trial to determine if treating the primary tumor with any method is superior to ADT alone? Or is it powered to determine all those things?

Narnar(Ron) and also to George
Ron, that does look like a difficult decision for you. Take a little time to decide.

George,I'm very interested in that one reply you posted! You are a great resource also, thanks for the post and clickable links.

The cool thing about this forum is that knowledgeable people post responses and there is an openness about the flow of information. Some like the one of my most respected, Tall Allen, have a lot more info and studies shared with us than others.
And worth noting, there are no Professional Docs on this site, which I think is per the forum rules. A lot of Docs know a thing or two, but like others remind us, depends a lot on their field of expertise or specialty. Get second opinions, always.

Thanks Ron for sharing your decision pathway discussions with us.
Wings

Thanks for all the info George I reall appreciate lt. it also helps with the decision making.
I have decided to have the surgery and it is scheduled for April 11.
After much reading and discussing with family, friends and my 2 daughters who are both RN's and discussed it with the Dr.'s they work with. We all feel that is what is best for me.
Ron