Not stopping to find the studies right now, but there are some studies out there that seem to indicate that surgery might well be helpful if the horse has already left the barn. Probably not any of that old proof stuff, but some things that sure make me wonder.
First one that comes to mind is the very large study that came to light a couple of years ago, something like 30,000 high risk guys whose primary treatment was surgery only. All G8-10s, many with various other high risk nasties such as pretty hgh PSAs and such, but can't really say exactly, going by memory. Only 13% had even had salvage RT. The vast majority had not been killed by PC at even 20 or 25 years. Actually, I found the link:
www.renalandurologynews.com/prostate-cancer/study-supports-surgery-for-high-risk-prostate-cancer/article/338483/Also, for the abstract:
/www.ncbi.nlm.nih.gov/pubmed/24510158So "overall survival rates at 5, 10, 15, 20, and 25 years were 92.8%, 78.6%, 59.5%, 38.6%, and 20.0%, respectively. Cancer-specific survival rates were 96.4%, 89.5%, 82.0%, 72.9%, and 68.8%, respectively,".
So, with the OP question being: "My question is,are there any studies showing if the RP is a positive or negative factor for the further treatment that will be needed. I guess what I am asking is does the PCa mover slower after the prostate is gone or does it make any difference?", I would ask: Out of 30,379 men (mean age 62.5 years) who underwent RP for Gleason 8-10 non-metastatic PCa, would you expect that a certain percentage of these cancer cells have escaped from home? In fact "73% had node-negative disease" which I suppose means 27% had lymph node invasion, IOW at least 27% have sho nuff left the barn? And I am thinking that most likely quite a few others- like me- had positive margins and seminal vesicle invasion. IOW, not contained.
Now someone just posted a thread here showing that only roughly 50% of untreated high risk guys made it 8 years before PC took them out. Now if out of those 30,379 high risk men, which would include the 27% with positive nodes, 89% were still alive(Edit: i.e., PC specific survival- "only" 11% had died from PC) at 10 years and 82% at 15, that sounds like a very stout difference. (And remember, only 13% even had additional RT).
Since the mean age at treatment was 62, and 69% had not died of PC even at 25 years( 31% had died of PC by 25 years?), that means that mean age of 87, 69% were still not dead from PC! Not many of us are going to make it to 87 escaping other causes of death to be able to see if a metastasized PC is going to finally kill us.
So what can account for such improved out look of surgery only vs no treatment when some of the horses have quite likely already left the barn? I think the theory is the the primary(master?) tumor communicates with it's children that have left home, telling them how much to reproduce, or not. Cutting Mama or Papa tumor out interferes with growing the family. Is there any RCT style proof of that theory? I doubt it. OTOH, guys who seem quite likely to NOT be contained- even with at least 27% who clearly were NOT contained- seem to do one heck of a lot better mostly just from cutting out the primary tumor. So, do you draw any conclusion from that? I do.
One more, but no link. In the old days, they would
open you up, sample the lymph nodes, and if positive for PC, close you back up. Then I think they would offer you ADT. Then they did a study or 2 where instead of closing you back up, they went ahead and debulked by taking the prostate and lymph nodes. These people had a much better survival than the ones who were not debulked. But I can't remember the specifics. Sounds close enough to proof for me. But again, what is the explanation for this, getting much better results by removing the prostate even though the cancer has obviously escaped the prostate? It seems highly likely that a significant # of those LN+ cases had also already spread not simply beyond the prostate, but beyond the lymph nodes. But they still did a lot better with RP + LN dissection. Don't know why, other than possibly the theory mentioned above.
Post Edited (BillyBob@388) : 10/6/2017 7:15:05 AM (GMT-6)