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Posted 3/12/2021 3:28 PM (GMT 0)
So my MO says I will be on ADT the rest of my life... Even though my PSA and T is negative. So once you have metastasized you never can be cured?
Posted 3/12/2021 4:39 PM (GMT 0)
There are a handful of men that it appears have been cured after metastasis, but that is the exception to the rule.

https://consultqd.clevelandclinic.org/metacure-trial-can-we-cure-more-oligometastatic-prostate-cancer/
Posted 3/12/2021 5:03 PM (GMT 0)
Your medical oncologist gave you the general consensus, but, as Duck already wrote, there are exceptions to almost any medical situation.

PS: Your PSA and T are not 'negative'
Posted 3/12/2021 5:05 PM (GMT 0)
I don't know the stats but I do know good people like you who post hope for others!
Posted 3/12/2021 5:18 PM (GMT 0)
There is much current interest in oligometasatic PCa (generally defined as 1 to 5 mets) in general, including therapy with curative intent. Here are some recent studies:

Metacure Trial: Can We Cure More Oligometastatic Prostate Cancer? (2020, Article cited by Duck2 above)

Curative-intent Metastasis-directed Therapies for Molecularly-defined Oligorecurrent Prostate Cancer: A Prospective Phase II Trial Testing the Oligometastasis Hypothesis (2021, Full Text)

Newly Diagnosed Oligometastatic Prostate Cancer: Current Controversies and Future Developments (2020, Full Text)

Management and treatment options for patients with de novo and recurrent hormone-sensitive oligometastatic prostate cancer
(2021, Full Text)

Multidisciplinary total eradication therapy (TET) in men with newly diagnosed oligometastatic prostate cancer (2020, Full Text)
Posted 3/12/2021 8:12 PM (GMT 0)
Hate to say it, but you are incurable like myself.

"PetScan found nodules in both lungs Biopsy stage 4 PSA 1.03"

All stage 4 are considered incurable
Posted 3/12/2021 8:25 PM (GMT 0)

alephnull said...
Hate to say it, but you are incurable like myself.

"PetScan found nodules in both lungs Biopsy stage 4 PSA 1.03"

All stage 4 are considered incurable

The last CT scan I had showed the nodules shrinking...My MO says I don't need another scan right now because my PSA and T are where they need to be, so he says the ADT is working....
Posted 3/12/2021 9:03 PM (GMT 0)
Probably not a hope for cure but my MO was hoping to target anything they could see on Axumin PET scans and at least delay returning to ADT after being on break for almost two years. After two negative scans a third scan when my PSA reached about 5.0 was able to identify enlarged lilac lymph nodes and also nodes in the prostate bed. But the radiation oncologist ruled out spot radiation for now. He said he could safely target the iliac nodes but not the ones in the former prostate bed, which would risk collateral damage. What I see going forward for most of us who reach this state is ongoing ADT - intermittent if possible--and possibly spot radiation of oligomets.

Dana-Farber is installing some new external beam radiation equipment, which may make spot radiation possible for me later on. The accuracy and ability to fine-tune this equipment has increased a lot over the last few years.
Jim
Posted 3/12/2021 9:13 PM (GMT 0)

alephnull said...
Hate to say it, but you are incurable like myself.

"PetScan found nodules in both lungs Biopsy stage 4 PSA 1.03"

All stage 4 are considered incurable

Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options

This paper was published in 2014.

Djin
Posted 3/12/2021 10:06 PM (GMT 0)
I just finished ~50Gy salvage radiation to my pelvic lymph nodes and spot radiation to 3 metastatic pelvic lymph nodes. The prostate bed was clear on scans and I got about 70Gy to that area 8 years ago after surgery. I am on Eligard + Xtandi until Jan 1, 2022 then I am off those and getting regular blood tests to see what happens. If nothing else I have kicked the can further down the road. My RO says he always has at least 1 guy in my situation in for treatment and indicates 'significant' success in stopping the PCa progression.

If it didn't work, then I am up for whack-a-mole as the mets show up. The question appears to be whether my immune system can be arsed to produce more CD8+ 'killer' T cells when presented with blood-borne pieces of dead cancer cell proteins.

As always, thanks for the links, Djin. smile
Posted 3/13/2021 1:44 PM (GMT 0)

DjinTonic said...

alephnull said...
Hate to say it, but you are incurable like myself.

"PetScan found nodules in both lungs Biopsy stage 4 PSA 1.03"

All stage 4 are considered incurable

Oligometastases in prostate cancer: restaging stage IV cancers and new radiotherapy options

This paper was published in 2014.

Thank you for the link. Can you explain what you are reading in LAYMEN terms for us unlearned folks...

Djin

Posted 3/13/2021 3:16 PM (GMT 0)
As to a doctor predicting what might happen 5, 10 or 15 years in the future, I would disregard the statement. How does he know what will or what won’t be developed that might take you off ADT? For now, that is your treatment. Have you discussed Provenge? Many men have benefited from it making subsequent treatments more effective. It is great that you are in remission and controlling the disease. Based on your situation, make sure the MO you have is the very best for you. Do not be afraid or reluctant to seek assessments from other MO’s. Information gathering is very important.

And yes, for most cancers, including PCa, metastatic cancer is generally not curable with few exceptions. But there will always be exceptions and variation within both life expectancies and actual outcomes. What metastatic situations are looking for is a longer remission, life extension and improved quality of life. Many incurable metastatic men live a long time with the disease. Same is true with many other incurable cancers.
Posted 3/13/2021 4:01 PM (GMT 0)
What JNF just posted is a true as you are gonna get...believing is seeing...its all about biology...be really different and "don't mess with mr in between'"...'nevah...nevah quit]...Commit....

An aside...dang it is still raining here...cats and dogs living together...Biblical proportions....I always tell folks never come to Hawaii in March and when and if you do visit remember it is not Disneyland...it is a group of islands that can kill you in minutes if not seconds...
Posted 3/13/2021 4:02 PM (GMT 0)
steve0. I was pointing out that there is rethinking about some advanced-stage cancers. The term oligometastatic simply means "with a few metastases". Definitions vary a bit, but, as I mentioned, this is usually defined as 1 to 5 mets, and the mets do not have to be local (e.g. pelvic). Many are looking at oligometastatic PCa as its own disease stage that may, in some case, even be curable but, perhaps more importantly, probably warrants a different approach to detection and treatment than full-blown stage IV disease.

Djin

Post Edited (DjinTonic) : 3/13/2021 9:05:00 AM (GMT-7)

Posted 3/14/2021 4:11 AM (GMT 0)
Hi ... incurable/curable isn't really a useful construct. As JNF and Djin kindly have pointed out there are always specifics to each of our circumstances and paths to choose.

As you are just beginning this journey, I'd encourage you to ask more pertinent questions. Look for combinations of treatments, follow the NCCN guidelines and how they change, find other sources of information beyond one MO, and seek to get involved in new treatments as soon as possible. It's about how to live with this disease until there is a cure or you die of something else.

In your case, you might want to look into doing ADT with Abiraterone which is recommended for high risk cases and you can look at when to do an early round of chemotherapy -- recommended in the CHARRTED trial. Then when you start to be resistant to ADT and can get insurance approvals be ready for immunotherapy and genetic testing so that you can target the disease. There's a small chance that you'll end up with a long term remission, but you'll be alive and ready when better treatments come along.

That's the question ...
Posted 3/14/2021 8:55 PM (GMT 0)
I know I am not being cured(absent a great new discovery). I just want a long enough remission so that I can die of a heart attack( or something other that PCA) in 15-20 years. Hoping I have some of my Dad's good genes. He's 101.
Posted 3/14/2021 9:15 PM (GMT 0)
Sounds about right to me, Gobucks.
Posted 3/14/2021 9:31 PM (GMT 0)
"So once you have metastasized you never can be cured?" Your statement is correct, steveO, IF you remove your '?'

But you, like the rest of us, can heal to the point of extended remission.
Posted 3/14/2021 9:55 PM (GMT 0)
I am not sure if my brothers cancer compares to your type in anyway but it may be helpful to tell his story.
While on vacation in Ocean city Maryland , a walk in clinic detected a mass that turned out to be no-Hodgekens lymphoma. The tumor was attached to every organ in his abdomen. Two days later it was removed in a several hour surgery. He went on to radiation treatment and chemo.
He was cured for 12 plus years.
He did however developed lung cancer and bravely beat it for 4 plus years but then lost the battle.
Those 12 plus then 4 plus years mean a lot to us all.
That was 5 year's since and drugs have been developed that may have added more time and quality to his life.
In any case always hope and stay as positive as you can

Glen
Posted 3/14/2021 11:14 PM (GMT 0)
In reference to Swan's great post...and you must think in a multi dimensional way. to get this..if you choose to think binarily...Logicaly or in a box with a box within a box thats what YOU choose.....this revelation which oc cured just seconds ago to me is...if the fates...the gods...the universe can...in the twinkling of an eye take and cross you thru the veil...and we all know it can,,,why shouldn't the reverse be true as well....Boink
Posted 3/16/2021 12:42 AM (GMT 0)
Logos,- Indeed !!!, nice way to put it. I think you nailed it for me. I shall start thinking in a multidimensional way. I think most Doctors think only one dimensionally. Like the one that said I would only survive 3 years(back in 2012). They often refuse to even mention remission, in case they are wrong. And to mention a cure..their attitude is.. forgit bout it.. My new Oncologists never have and never will prognosticate. That's actually good , because for all their learnedness, they do not actually know. I understand that. I understand my diagnosis, but I hate the term "palliative" care. And I choose to reject that term. I am getting "amazingly effective" treatment.

Dijin Tonic, -Thanks for those links, that's just what I need these days.

Keep the faith!
Wings over My whammie in extremley windy Ridgecrest, Cali. Logos did you send that our way?? lol brutha
Posted 3/16/2021 3:34 AM (GMT 0)
Wings I wish I could hone it tighter...but I can not...ive tried...and dead ends....no exits...paths close and reveal even more...to vex...yet in that mix...I am comforted...very strange...wonderfully so...ahh the winds...the rains..."the troubles",,,seem to mimic me... yet in doing so...bow to their own turmoil and submit to their own power
Posted 3/16/2021 4:08 AM (GMT 0)
Forgive me for still trying to concise the "idea"... when stymied...I revert to reverse which ironically got me into this situation lol...ok the Lord taketh and Lord give-ith away...is it me in the Lord or is it the Lord in me... and does it really matter.
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