Is PCa "incurable" if it recurs again after RP and SRT?

The answer to that question, generally, is "yes" but it's important to remember the difference between an "incurable" disease and a "terminal" disease. Once they get fifty or sixty birthdays under their belts most people start to accumulate "incurable" diseases. I have several (and, no I am not counting PCa). And, if you do find yourself in that situation, don't forget to ask you doctors that question again every chance you get because there are a number of very promising treatments in the pipeline and today's "yes" may be tomorrows "maybe" and next week's "no".

Sanctuary,

I've had surgery and radiation as primary treatment.  As time went on bone mets appeared.  I then spot radiated those and went on intermittant hormone therapy. 

Can I ever be cured of prostate cancer?  Probably not.  Do I ever use the terms incurable or terminal to describe it, never.  My ongoing goal in this journey is to utilize anything and everything I can to treat this as a chronic condition.

Jerry

As a constant reader of HW and an occasional poster, I would like to thank everyone(past and present)for their willingness to pass on the information that most all of us desire in order to make informed decisions regarding our treatments and quality of life issues.

JerryL.

I do agree that that this probably IS a chronic disease. I only use uncurable because I believe that most lay people generally use this term.

Thanks again for your responses.

I would come down firmly on the side of maybe, maybe not.

Sometimes the disease goes into a phase called oligometastatic cancer. This means that there are 5 or fewer metastases (LN and bone) that can potentially be wiped out by SBRT. It is not at all clear how often this oligometastatic phase occurs.

Finding them is challenging. The C11 PETs are being used to locate them, as well as some other experimental PET and USPIO MRIs. There is always an open question of whether there are micromets that are invisible to those imaging scans. Another emerging possibility involves whole-pelvis radiation to destroy even the micromets in the LNs. ADT, chemo and/or immune therapy may augment the effect of the radiation.

- Allen

Tall Allen mentioned oligometastatic cancer.  Here is some information on it:

http://www.dattoli.com/publication/PCRI%20INSIGHTS%20Oligometastatic.pdf

(might have to cut and paste into your browser)

"Most surgeons, radiation oncologists and particularly medical oncologists regard prostate cancer as either confined to the prostate gland and curable, or widely metastatic and incurable.

However, we now know that there is an intermediate stage where the cancer has spread outside the prostate gland but is not widespread. This intermediate stage is called oligometastic (the oligo-prefix comes from the Greek word for "few")."

I failed SRT 2 years ago.

I expect to live quite awhile!

Mel

My Surgery / Adjuvant RT finished in July 2010. In September 2010 my psa started going up. We battered it back down with 6 months of HT, and now it is going up like a rocket.

My docs agreed that 3 years was a reasonable survival expectation. I am past that, and not yet deceased.

It is, in my mind, not curable, but to some limit controllable. In the sense that I know I am going to land this flight in a less than desired manner, but it would be worse if I did nothing.

It will only be terminal if I fail to die of something else first.

From what I've read HT and chemo are the final barriers once SRT had failed. They are not curative but they slow or stop the progression. That's why HT is recommended as early as possible before PCa has spread too far and become essentially terminal. Guys still die of PCa butany have long lives before succumbing to it. That's all anyone can hope for since none of us are getting out of here alive! It's all about the trade off of life at all costs vs quality of life.
Bob