You have been diagnosed with advanced or metastatic prostate cancer. It is a shock, you have cancer and your cancer has already spread outside of the prostate gland.
Your doctor might have already told you that at this stage it is no longer curable, and technically it can be called terminal! That is a lot of stuff that has been just pushed on to your plate.
Theoretically, this is correct, but for many of us, despite having this diagnosis, we will not die from the prostate cancer! Treatment today allows us to delay the cancer long enough that we will live our life fully to die from some other, unrelated cause.
The treatment goal for men with advanced, metastatic prostate cancer is not to cure the disease, but to make it into a chronic illness so that we can deal with it as needed, but live our life in a full and happy manner. In order to do this, we need to educate ourselves about our treatment options so that we can work hand-in-hand with our doctors in making the best possible treatment choices.
Often, this means questioning our doctors about their recommendations, introducing additional treatment possibilities that they have not thought about and offering research findings to them 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 the possibility of debulking the cancer. 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.
However, there has been an accumulation of data that shows that the removing the gland and the primary tumor(s) does slow down cancer progression and more importantly extend survival.
In a retrospective study by Culp and associates published in European Urology addressed this question. Culp and associates used the Surveillance, Epidemiology, and End Results (SEER) database to study almost 8000 men who either received no local therapy or received local therapy with a radical prostatectomy or brachytherapy, despite being diagnosis with advanced metastatic disease. Their analysis revealed a statistically significantly improved overall survival and cancer-specific survival for the groups of men who received the two local treatments, whether it was surgery or brachytherapy, with surgery being associated with the best overall results.
There have been many other studies drawing the same conclusion like the one performed by Heidenreich et al. which has been published in by the NIH in PubMed. The Heidenreich study demonstrated 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 a RP with lymphadenectomy might give a survival benefit in men who were found intra-operatively to be node-positive.
However, not al the studies have come to the same conclusion and so there remain many physicians who are skeptical about the value of tumor debulking.