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Gleason 8 recurrence with bone met - is there still hope? Is it oligometastatic at this point?

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Posted 3/6/2017 9:06 PM (GMT 0)
Hi all,

we went to the radiation onc today and got *some* encouraging news (he doesn't believe my dad has neuroendocrine or small cell prostate cancer, though we are getting a pathology review done anyway. he says it would've jumped out at the pathologist if it was the case) BUT he also said something which has completely devastated me (he said this just to me as i went and asked him questions seperately from my parents)

he said if my dad wants to take any big trips, it should be sooner rather than later and definitely in the next 1 or 2 years. This has completely crushed me. From the way he was speaking, my dad won't have long left. I mean, I realise his Gleason is 8 and he has aggressive disease. But one or two years?!

He also said my dad's cancer isn't oligometastic. When I asked why he said because it's aggressive. Is that true?! I was holding on to the fact that it may still be curable at this stage because only one bone met has shown up.

Does anyone have treatment options etc they'd like to share, or what has worked for them? I want a long term, durable remission. Am I just dreaming?

The radiation onc seemed resigned to the fact that it's not long now til the end and isn't taking a curative approach. I get why, I know...stage 4 cancer and all that. But I have hope still that we can stave this thing off for a few more years. Others have...haven't they?

Thinking of going to see Dr.Kwon at the Mayo clinic for a second opinion and a consultation. I just refuse to believe he's gonna be gone that soon. I just can't.

Post Edited (snowcake) : 3/6/2017 3:34:59 PM (GMT-7)

Posted 3/6/2017 9:32 PM (GMT 0)
No, once it has metastasized to bone it is not curable. However, it can be managed for a long time. If he has a good response to hormone therapy, that is a good sign that he will survive it longer. He is right that small cell would have been obvious, so at least, it's not that. I'm sure that second pathology report will provide some good info. It sounds like he has some good doctors.
Posted 3/6/2017 10:13 PM (GMT 0)
thanks, TA. i asked about cure because i watched a presentation by eugene kwon where he said you can still have a curative approach even when there are bone mets.

i guess we should've gone to see him before the bone met happened and while my dad's PSA was zero and he was considered "cancer fee" and in remission. but hopefully it's not too late now.
Posted 3/6/2017 11:51 PM (GMT 0)
I have no idea why Kwon would say that. The available data do not support that. I know he is running a clinical trial to find out if localized treatment of mets for oligometasatic disease has any value. As he just started that trial, he would not have any data yet on which to draw any conclusions. So far, the data on localized treatment of metastases is very disappointing. Once the thousands of cancer cells have spread systemically, the only known way of delaying progression is via systemic treatment.
Posted 3/7/2017 12:28 AM (GMT 0)
it's in this video at around 20 minutes, i didn't understand it to mean localised treatment only, i thought he meant systemic...unless i've misunderstood him (which is possible considering the state i've been in the past few weeks)

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

i just want to believe that a few more years are possible
Posted 3/7/2017 2:35 PM (GMT 0)
Systemic treatments are administered throughout the body and include drugs we ingest or receive through injection and infusion. ADT and chemotherapy are good examples. Localized means it is to a specific area. Radiation and surgery are localized to a specific area and don't have any effect on the disease outside of that area.

It had been surmised that if a person had fewer than five known mets that they could be locally treated and could be curable. To TA's point, however, if there are five known mets there could be hundreds of unknown mets that would not be treated locally and would grow to cause problems at a future date. Kwon's study should better clarify that, but not anytime soon.

So the localized treatment of mets is more to alleviate adverse symptoms like pain, joint compressions, etc. These improve quality of life and do some de-bulking and thus may have a positive effect on longevity, but in no way will be curative. By the time a PCa tumor shows up on a scan there are millions of cells in that spot.

Regarding estimates of longevity, that gets very difficult until it is physically apparent that the body is irreversibly overwhelmed by the cancer. I read into your ro's comments that your father is in the best shape currently that he may expect to be in and he should take advantage of the time to pursue activities that will become more physically taxing. That doesn't mean death is imminent. Age by itself is a factor. Add the disease and treatment side effects and it naturally gets tougher to do certain things. So, no time like the present to travel, play golf, swim, skydive, etc.

I agree with TA that your doctors appear to be doing the things we would expect to see. However, I personally am fine with additional opinions for confirmation and potentially different approaches. If it helps you, by all means reach out to Dr. Kwon for a consultation and assessment. He is well known and has treated many other men on this forum.
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