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Thread: New diagnosis - Gleason 9, psa 20

  1. #51
    Quote Originally Posted by Garden View Post
    ...

    We were told surgery and radiation were not options at this point. Then, we got a call from a research team we forgot about signing up for. It is a study of men with advanced cancer who “debunk” with surgery or radiation. I understand previous studies have shown mixed results. His doctor says it is up to us. We can do it or not. I thought they were concerned about making it worse. Trying to decide what to do. Thinking maybe radiation as opposed to surgery.
    Has anyone here “debunked” by radiation or surgery after it has spread? Has it been effective? Were there side effects that make it difficult? Whatever experience you have would be so appreciated.

    Thank you!
    Hi Garden. Cytoreduction, which is the medical term for tumor debulking, has had mixed results in prostate cancer, also depending on the location of the metastases. Here is the Abstract of a recent review paper from the Subforum, Topic (P). The Subforum link is near the top of the main Forum page and has other papers on the topic of RP for metastatic disease.

    Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense? [2018, Review]

    Abstract

    Purpose
    Surgical removal of the primary tumor in metastatic prostate cancer (mPCa) is becoming a hotly debated issue. The purpose of this review was to summarize the current knowledge on cytoreductive radical prostatectomy (cRP) in this setting.

    Materials and methods
    We performed a non-systematic Medline/PubMed literature search of articles published in the field between January 2000 and April 2015.

    Results
    Cytoreductive surgery has demonstrated its benefit in various malignancies with a solid biological rationale to justify its assessment in mPCa. cRP appears as a safe and feasible procedure in expert hands and well-selected patients. A growing body of evidence suggests a survival benefit for patients undergoing cRP as a part of a multimodal approach compared to those treated with systemic treatment alone. Nevertheless, little is known about the best clinical and tumor characteristics for the selection of patients most likely to benefit from cRP. The current literature is based on retrospective studies with small cohorts and limited follow-up or large uncontrolled population-based studies.

    Conclusions
    Data from various other malignancies together with the biological rationale and preliminary results in PCa suggest that cytoreductive surgery may be an option in some mPCa patients. The lack of randomized controlled trials and the low level of evidence in the current literature preclude any firms conclusion on the benefit of cRP in mPCa. Ongoing phase II and future phase III studies are mandatory to define the exact role of cRP in mPCa and to identify the patients who are most likely to benefit from cRP.
    There is only a buy option for the Full Text of this paper (no rental option). Perhaps your local library has access, or someone you know may have access to online medical journals at work.

    I sent you a PM. To view it, click on Notifications/Inbox at the top right of the forum page.

    Djin
    Last edited by DjinTonic; 06-12-2019 at 01:28 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: negative

    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 cm 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%, 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018
    09-26-18 (13 m) 0.013 checking rise
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

 

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