Your doctor has just told you that you have advanced, progressive or metastatic prostate cancer. The doctor also has just told you that this type of prostate cancer is terminal; there are no cures currently available.
You find that you are in shock! You have cancer, your cancer has already spread outside the prostate gland and it is not curable. It doesn’t matter who you are, you are going to feel overwhelmed.
Theoretically, what the doctor told you about our current ability to cure your cancer and about it being terminal is correct. Despite these truths, the fact is that for many of us, we will not die from the prostate cancer, we will die with prostate cancer!
Treatment today often delays cancer long enough so that we will live our life and then die from some other unrelated cause. For men with advanced, progressive metastatic prostate cancer the goal is to make the prostate cancer into a chronic illness. Our treatments can put you into a long-term remission so that you can live your life in a full and happy manner.
As we have said in many of the posts on this webpage, in order to do this, we need to educate ourselves about our cancer, and our treatment options so that we can work hand-in-hand with our doctors in making the best possible treatment choices.
To do this might mean that you will need to question your doctors about their recommendations, offer them additional treatment options that they have not thought about and offer them research findings that could change their thinking and the course of your treatments.
One very common area of conversation for a man who has been diagnosed with advanced prostate cancer is about the possible merits of debulking the cancer. Debulking cancer, lightening the tumor burden, involves removing the prostate gland and possibly other nearby tumors. Traditionally, a newly diagnosed man with distant metastasis is not offered the opportunity to have the prostate gland removed since the cancer is ultimately terminal and the treatment itself will cause significant side effects.
If your doctor automatically makes this decision it should become a point of contention that you raise with your doctor. If they tell you that having surgery for prostate cancer that has left the gland will not provide you with any positive result, you should question this assumption.
There is now mounting data that shows that the removing the gland (thus the primary tumors) does slow down the prostate cancer’s progression and more importantly it can extend your survival.
In a retrospective study by Culp and associates published in the journal, European Urology, addressed this question. Using the Surveillance, Epidemiology, and End Results (SEER) database they evaluated almost 8000 men who either received no local therapy or received local therapy with a radical prostatectomy or brachytherapy, despite being diagnosed with advanced metastatic prostate cancer.
Their analysis revealed a statistically significant improved overall survival (OS) and cancer-specific survival for the groups of men who received the local treatments, whether it was surgery or brachytherapy, with surgery being associated with the best overall results.
An additional search of the literature finds that there are many other studies that come to the same conclusion.
Heidenreich et al., published in by the NIH in PubMed concluded that a radical prostatectomy (RP) achieved excellent survival rates in men with high-risk prostate cancer, even in men with very high PSA levels. They found that the completion of an RP with lymphadenectomy might give a survival benefit in men who were found intra-operatively to be node-positive (a spread of their cancer into neighboring lymph nodes).
Making this type of decision more difficult is that fact that not all other studies have come to the same conclusion. Therefore, many physicians remain skeptical about the value of tumor debulking.