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Posted 5/26/2020 1:45 PM (GMT 0)
Concerning Mets.
Is it a matter of If or when you get them....?
Posted 5/26/2020 1:55 PM (GMT 0)
looks like your on the right path... My path was different. because my PSA was so low I kept putting off taking the next step. Well when my PSA got to .0569 my doctor said we need to do another blood test and get a Pet Scan. The blood test came back at 1.06 and the pet scan showed some nodules in my lungs.... now stage four and just started ADT. I keep wondering if I would of started ADT sooner maybe no METS
Posted 5/26/2020 3:26 PM (GMT 0)
If a patient's "curative" treatments have failed, they move to palliative treatments. When palliative treatments fail, and the PSA continues to increase, mets undoubtedly will develop.
Posted 5/26/2020 3:37 PM (GMT 0)
PS, There are some semantics involved. Systemic Mets might be thought of as "the cancer is somewhere," but can't be directly detected. Then there are mets that can be pinpointed, such as on a scan.
Posted 5/26/2020 4:04 PM (GMT 0)
Also with prostate cancer "metastatic" is usually reserved to mean distant mets. Spread to local lymph nodes near the prostate bed is in fact metastatic, but is usually considered less severe than distant mets.
Posted 5/26/2020 9:57 PM (GMT 0)
It all depends on the specifics of the cancer.

G3 has never shown to metastasize. Most PCa is G3. So, actually most PCa does not metastasize. G4 and G5 can adapt to living away from the prostate and can and will metastasize and mutate into forms like small cell. But again not all G4 or G5 are alike and act the same. Several years ago I read that from the time the PCa is first detectable it is 5-7 years to Mets and then 3-5 years to death. These are median estimates and assumes no treatments whatsoever. The article did not distinguish between G grades and tumor volume and the like. So it was very much a generalization and not a predictor of what any one individual could expect.

When PCa becomes incurable, it’s natural progression will be to further mutate, metastasize to other areas and cause a lot of problems and eventually for some, will be the direct cause of death. Thankfully we have a lot of great treatments that for many can manage and slow the progression of the disease for many years and even decades even in a metastatic situation. Unfortunately we have also lost men within a matter of months or a few years when the PCa was advanced and untreatable, despite all the available treatments.

So it just all depends as each person is different and each person’s cancer is different than anyone else.
Posted 5/27/2020 12:49 AM (GMT 0)
I'd like to clarify the (correct) statement that G6 (3+3) PCa doesn't metastasize. This is comforting for men newly diagnosed. However, it should be tempered with other facts:

1. A positive G6 biopsy is no guarantee that a lesion with the highest grade was sampled. In fact, perhaps a third of G6 men who opt for surgery (and therefore can have their entire prostate sampled and examined) have their Gleason score upgraded. That means that they G6 status was an inaccurate diagnosis.

2. Even if you currently have no lesions higher than G6, you can develop new higher-grade lesions. This is why men on AS, active surveillance, are strictly monitored for a worsening of their status for which they are counseled they should seek treatment. about 10% of prostate-confined (and RP-confirmed ) G6 (and 16% of non-confined G6) are actually at high genomic risk for developing mets within 5 years. We now know that propensity to develop mets cuts across all G scores.

3. Although G6 itself cannot metastasize, it can grow locally out from the prostate -- e.g. extraprostatic extension or bladder neck invasion -- another reason it needs to be carefully monitored.

(Whether a lesion >G6 can develop as a clone from a G6 cell is an open question. However, whether progression can occur this way or ex novo from tumor precursor cells in healthy tissue is academic, since G6 men do progress)

The point of emphasizing the above is that the goal is to prevent mPCa from occurring whenever possible. A diagnosis of G6 comes with a degree of uncertainty.

Djin
Posted 5/27/2020 2:21 AM (GMT 0)
Many doctors use the term “in remission” to describe the situation after successful cancer treatment since no one knows for sure that a cure has been achieved given the way a cancer can reappear after a long time periods. For some reason, we do not use that term very often around here but I think it applies here as well. There is no way to know that you have been “cured” after having grade 4 or 5 cancer so while you hope you are cured, you are really hoping for a long remission period that exceeds your remaining life span in my current thinking. Love to hear an argument that cancer can be cured currently and the warranty that come with it.
Posted 5/27/2020 7:07 PM (GMT 0)

Mumbo said...
Many doctors use the term “in remission” to describe the situation after successful cancer treatment since no one knows for sure that a cure has been achieved given the way a cancer can reappear after a long time periods. For some reason, we do not use that term very often around here but I think it applies here as well. There is no way to know that you have been “cured” after having grade 4 or 5 cancer so while you hope you are cured, you are really hoping for a long remission period that exceeds your remaining life span in my current thinking. Love to hear an argument that cancer can be cured currently and the warranty that come with it.

Amen to that, Mumbo. Well stated!

Doctors should use the term, in-remission, rather than the self congratulatory and false hope term, cured.

Unfortunately there is no true cure for prostate cancer. There are, however, a myriad of good treatment choices.

Sorry, I only stopped by here, thinking this thread was about the hapless NY Mets.baseball team.

Post Edited (garyi) : 5/27/2020 1:10:21 PM (GMT-6)

Posted 5/28/2020 3:31 AM (GMT 0)
Mumbo,
That's pretty much what I tell people when they ask how I am doing. I tell them right now I am undetectable and that's the best I can hope for! When and if it changes then i will have to deal with it then. Not really much else we can do.

Larry
Posted 5/28/2020 10:19 AM (GMT 0)
I associate remission with metastasis. Totally unscientific, I have no idea whether doctors use the term that way, but if someone tells me their cancer is in remission, I assume it's already metastasized and is hibernating. I agree that "cure" isn'tt the right word if, say, you had RP, pathology showed G7 with EPE+ and several years later your PSA has managed to stay undetectable. At year 7, 8 or 9 you could suddenly lose your <. Still, I don't think remission is the right term. We need something between "cure" and remission."
Posted 5/28/2020 11:28 AM (GMT 0)
The cancer definition of remission is when there is a decrease in the signs of the cancer and/or that it has become undetectable. A complete remission is where the disease is not detected and treatment has stopped. A common statement at that time is cancer free. Less often will a doctor use the term cure, unless one has been in complete remission for a number of years. Even then, the term cure is conditional because there is no way to say a person is completely cancer free and absolutely free of any potential recurrence.

So in PCa if one has observable Mets and the treatment reduces the Mets then remission is an appropriate statement. If, additionally, the PSA becomes undetectable and treatment is stopped, it would be a state of complete remission while that status continues.

I never had observable Mets, I underwent treatment, the treatment has stopped and my disease is undetectable based on PSA testing. Thus, I am in a state of complete remission, according to the medical definition. My doctor uses this term, but does not use the term cured. He knows that there is a possibility of recurrence and that I still need to be monitored. I completely understand that and am comfortable with it. When asked, I say my PSA continues to be undetectable and I am not receiving any treatment and that is what we want. If someone asks further then we discuss as I have just explained. Most just say good and we go on to other topics.
Posted 5/29/2020 12:30 AM (GMT 0)
JNF - I think you will appreciate this, my wife was released from doctor’s care at 10 years after successful BCa treatment. At 16 years (Dec), a recurrence was noted in a CT chest scan for something different. The doctor’s assume that the cells were dormant for a long time and finally decided to wake up, no other explanation since she had all the records for those 10 years that could be reviewed by them. It is a single rib met behind where the breast was removed and the doctors are amazed because they rarely see that with metastatic cancer so the prognosis is good so far.

Therefore, like Sky and you, I choose my words very carefully when talking to others about PCa. Most think you beat it and are back to normal. The problem is you can not “unsee” cancer and the risk is always there. Just have to learn to live with it and move on.
Posted 5/29/2020 12:56 AM (GMT 0)
Mumbo, I wish your wife well. Hopefully her docs can be very effective.

My wife had her first BCa bout in 1996. Then in 2010 another bout in the same breast that had been radiated and chemo-ed. A recurrence? No, a different cancer. But, again, a whole lot of treatment. Today she is still clear according to the blood markers and yearly scans.

For both PCa and BCa it is known that the cancer can go dormant for 10 years or more and then awaken and cause problems. One of my clients had a low risk PCa at age 55 and chose surgery. Sixteen years of undetectable PSA and all the sudden it started rising. Put on ADT and still rose, then chemo. Nothing worked and last year he passed due to lung Mets.

So you never know.
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