Palliative vs. Curative

Dr. Eugene Kwon's talk at the 2014 PCRI conference is available here:

https://www.youtube.com/watch?v=NkqizmvqJPo

To summarize, in his opinion the approach to our disease has been "palliative", which means to slow the progression of the disease so that we can live to die from another cause. He now thinks that medicine's goal should be "curative", which means to eliminate the disease completely, forever.

Every PSA nadir, is an opportunity for a cure. With the new imaging available, it is possible to see where the cancer returned (this will happen to 50% of us) and treat either with radiation or surgery. Sometimes this takes several iterations. Image then cut then later, image then radiate etc. new spots until finally zero cancer.

This may not always work, but usually does. The imagery is expensive. Plus, for some, there sometimes but rarely, is prostate cancer without generating PSA; meaning that imagery may be useful even though you think you are in remission because PSA is zero.

In any event, take a look at the video.

Age 63
PSA 2.9 12/02, age 51
BX/DX, 9/03, G6, 4 of 12 cores
Brachytherapy 9/03
PSA nadir 1.1 5/08
PSA 1.8, 12/08
BX/DX, 2/09, G8, 1 of 12 cores
Hyperthermic, Hormone (one Lupron), IMRT (10) spring 2009
PSA nadir < 0.1 10/09 through 01/12
PSA 0.2 4/12
PSA 2.9 5/14
C11 Acetate PT/CT, found 2.0 cm lymph node 5/14
Lupron/Casodex 5/14
Nadir <0.01
2/15 SBRT to node
3/15 PSA 0.02,T=0
6/15 PSA<0.015,T=105

Generally, it appears to me that the bulk of cancer care is, by definition, palliative. Even the definition of "cure" is a hedge: if you remain cancer free for 5 years after treatment then you are considered cured. I'll have to watch this video carefully, because I'd like to really understand what the terms mean.

Has ANYONE ever been "cured" after bone mets have been detected??

I looked at a couple of Dr. Kwon's videos a few years ago and this is builds upon and is consistent with what I saw before. Now that I have been through the traditionally "curative" treatments -- RP and SRT and am now once again seeing a rising PSA -- I'm once again thinking about what comes next. What I see here is encouraging. The question I still ask is how representative are the patients discussed here. Are these outliers -- a few cases among thousands? (He says his clinic sees 40 patients per day) or are they the tip of an much larger iceberg if we were all only hip to the potential of high resolution scans and targeted treatment? I don't pretend to know the answer, but I hope Dr. Kwon is on the trail of something that could actually benefit many of us.

I will probably have choices to make in the months or next couple of years ahead. One of those may be a trip to Rochester or some place similar. In this video Dr. Kwon shows identifiable hot spots that reveal themselves at a PSA of less than 0.9 (if I am remembering correctly). My next test (in late July) will tell me if I am still above or below 0.1. Both my uro and my RO are suggesting putting me on Casodex when I hit 0.5 (my uro's statement is he'd rather go after it "before it gets to the bone"). Do I want to go there? Would I rather see if this warrants a trip to Mayo or someplace similar first? I would also want to consult with a medical oncologist before making any decision.

And then, to be crass, there are the financial considerations. Will my Medicare Advantage plan cover a trip to Mayo or equivalent? When, or at what point, should I ask the VA to acknowledge that my remission is over (I'm an Agent Orange Vietnam veteran) and boost my disability rating? Too many unknowns right now. But so far 3 out of 3 of my doctors (primary care, uro, and RO) are not happy with my last three test results and say remission is over.

I still wonder if the zapping of identifiable hot spots really extends life. Is there still an underlying micrometastic pathology that will still be producing new hot spots? Does zapping hot spots actually extend life or just add medical procedures to the same lifespan?

I still wonder if the zapping of identifiable hot spots really extends life. Is there still an underlying micrometastic pathology that will still be producing new hot spots? Does zapping hot spots actually extend life or just add medical procedures to the same lifespan?

NOT A MEDICAL PROFESSIONAL: The way I see it, you are like me, 13 years down the road, with a 6 month doubling time. I found an oncologist, free of methodology to advise from there. My onc tells me that they won't do anything until PSA around 0.5. The scans are not effective at 0.1. You have some time. Plus consider statins, metformin and aspirin, removing animal protein from diet partially, and a supplement such as Pomi-T (proven in a study), see link below. Slow down the train, weaken this sucker.

http://www.pomi-t.com/asco-pomi-t-study-summary/

Age 63
PSA 2.9 12/02, age 51
BX/DX, 9/03, G6, 4 of 12 cores
Brachytherapy 9/03
PSA nadir 1.1 5/08
PSA 1.8, 12/08
BX/DX, 2/09, G8, 1 of 12 cores
Hyperthermic, Hormone (one Lupron), IMRT (10) spring 2009
PSA nadir < 0.1 10/09 through 01/12
PSA 0.2 4/12
PSA 2.9 5/14
C11 Acetate PT/CT, found 2.0 cm lymph node 5/14
Lupron/Casodex 5/14
Nadir <0.01
2/15 SBRT to node
3/15 PSA 0.02,T=0
6/15 PSA<0.015,T=1

Purg,

I fight saying it, but you are one of the prime cases in point. I wonder if treatment really makes a difference. Are we all just going wherever we go anyway?

Jim