Stage 4

Hi. I am new here.I just found out last month that I am stage 4 with distant spread. 1 spot in ribs. 1in chest and 1 in spine. Also 8 areas in pelvic region. Psa was 64 and gleason of 8. 12 core samples show 9 cores of 8. Doctor gave me 2 weeks ago my first 3 month injection of lupron. I am to start erleada soon.The radiation doctor says no radiation now because of the size of the prostate and also no chemo either. My question is does this sound like the correct treatment for what I have and they told me my prognosis was 5 to 6 years at best.Any input would helpful. 



  • Old Salt
    Old Salt Member Posts: 899 Member

    Sorry to read about your stage 4 diagnosis. Are you seeing a medical oncologist? If not, you should; preferably one at a well recognized medical center.

    More in general, I doubt that anyone can predict your demise from this disease. In fact, I find it inappropriate.

    I am not an MD and I haven't seen any patients with your diagnosis, but I have read of several men who have lived much beyond the 5-6 years predicted for you.

    Keep the faith!

  • Georges Calvez
    Georges Calvez Member Posts: 545 Member
    edited April 2021 #3

    Hi there,

    He could be right, and on the other hand he could be wrong.
    The course of prostate cancer is notoriously difficult to predict. It is possible to make generalisations about groups of men with similar types of prostate cancer with some degree of certainty but individual cases are a lot harder to impossible.
    Some men with stage 4 disease can remain on ADT for years, sometimes taking breaks, while others find that the cancer is less amenable to treatment and it progresses relatively rapidly.
    Statistics, and these are embodied in the nomograms which obsess some doctors and men with prostate cancer, say very little about the individual, they deal with groups of individuals.
    Never forget that for better or worse you are a sample size of one with a unique cancer and physiology that will respond to treatment in their own ways.

    Best wishes,


  • GeorgeG
    GeorgeG Member Posts: 152
    edited April 2021 #4
    I agree with the opinions

    I agree with the opinions given above. You were given generalized projections which at least notify you of the seriousness of the situation but do not predict your particular outcome. The best thing that you can do is spend your energy and channel any anxiety into finding the best possible doctors and center that you have access to so that you will get the very best outcome possible.  As stated, with emphasis on a medical oncologist for overall management of your situation.




  • Josephg
    Josephg Member Posts: 317 Member

    Welcome to the club that nobody wants to join.  We are here for you.

    If you are willing, please tell us you age, and please post the details of your biopsy and the final clinical staging of your prostate cancer (PCa), which is a short series of letters and numbers, which should be part of your biopsy results, probably close to the end of the report.  Also, if you are willing, please post the results of any scans (CT, MRI, PET) that you have received.  We are not medical professionals here, and we cannot directly offer you any medical advice.  However, we are all very experienced PCa patients, and most of us have done extensive research on PCa, which you will be starting to do, as well, if you have not already started.  If we can view the above asked for information, we can give you our layperson opinions on your situation from the patient's experience.

    In my layperson opinion, your medical professionals are taking the usual steps, when treating metatastic PCa, which has spread to distant locations.  You are now on Lupron, and it appears that you will also be going onto apalutamide (brand name Erleada).  Folks here in the forum, such as VascodaGama and others, who are extremely familiar with most of these drugs, will they chime in and give you more technical details on exactly what these drugs are doing as treatments for your PCa, as well as known side effects.  For me, I am currently on Elgard (same as Lupron) and Zytiga (probably similar to Erleada).

    In the long run, we PCa patients try very hard to maintain the best quality of life possible in our own situations, and I suggest to you that you take time to determine which elements of your life are the most important from a quality of life perspective.  That will be very important, as you assess the potential treatments that are, and will be, recommended by your medical professionals, as all treatments have side effects, and will have potential impacts on your quality of life for you and your family. 

    I wish you the best of outcomes on your PCa journey, and I repeat that we are here for you. 

  • VascodaGama
    VascodaGama Member Posts: 3,491 Member
    edited April 2021 #6
    If in doubt get a second opinion from another physician

    Hi Driver, 

    Welcome to the board. I wonder your age. Surely the diagnosis described above of your advanced case is worrisome but I would like to know the details that served as the basis to classify you in stage 4. Did they confirm the bone metastases via a biopsy or was it just based on a bone scintigraphy scan? Did they report lymph nodes involvement?

    The typical treatment for stage 4 patients is chemotherapy which may be paired with hormonal treatment or given alone, but any other health issues/status of the patient may alter the options in therapies. Radiation in advanced cases is usually reserved to treat pain  caused by the  bone mets.

    Apalutamide is an antiandrogen approved by the FDA for  none metastatic prostate cancer which seems not to be your case. This newer drug is more refined than the traditional bicalutamide but it interacts with many more other medications (356 drugs) as it uses the typical pathway CYP2C8 for metabolism requiring vigilance on its side effects. I wonder why did your doctor recommended this drug. Have you been included into a running clinical trial for the drug Erleada (apalutamide) for metastatic cancer?

    Gleason score 8 cases have typically bad prognosis but neither this type of Gleason nor stage 4 classifications are valid diagnosis to predict a period in life span. I really hate those ducks in white gowns urologists that state the time that a person can live.  In your shoes I would get a second opinion from another physician, even if you have started already the hormonal treatment (ADT). You can always do spot radiation of identified bone metastases if these are located at appropriated/possible places/areas.

    Best wishes and luck in your journey. 


  • Clevelandguy
    Clevelandguy Member Posts: 750 Member
    edited April 2021 #7


    Stage four and no chemo or radiation and just ADT drugs?  Boy if it was me I would find another doctor who wants to help you fight the beast.  In my opinion and I am no doctor if they found the cancer they can kill it so now is the time to act not months from now.   The longer you wait the more the exisiting cancer can grow or spread to other areas. As one of my buddies once told me gravity is holding you down but what's holding you back.  Remember great doctors with great facilities = great results.  Good luck and beat those doctor predictions.

    Dave 3+4