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"Remission" for oligometastatic prostate cancer

Posted by northoftheborder @northoftheborder, Oct 21, 2023

As I mentioned in another post, I have prostate cancer with a single metastasis to T3, treated initially with debulking surgery to the spinal lesion, then with SBRT to the metastasis site and the prostate itself, and Degarelix (Firmagon) and Apalutamide (Erleada) medication since diagnosis 2 years ago.

At my last visit in July, the head of my oncology team told me I was in "full remission." Another, younger oncology resident had told me earlier that the term "remission" does not apply when the cancer is being controlled with medication.

For others with oligometastatic PC (< 4–5 metastases), have your ocologists used words like "remission" or even "cure"? I understand that it's an active debate within the discipline.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

wellness100 | @wellness100 | Nov 12, 2024
In reply to @kujhawk1978 "When going over the pathology report from my surgery in 2014, my urologist did not use..." + (show)
@kujhawk1978

When going over the pathology report from my surgery in 2014, my urologist did not use the word "cure." He did however say "he didn't "see" any "problems" in the future given my pathology report and what he saw during the surgery.

Meanwhile, I'm looking at the pathology report and the final staging T2CNoMx thinking, they don't know if it has metastasized...! Which, given the state of imaging at the time, was a fair staging.

I was right, it had, as evidenced by the BCR 18 months later. The rest as they say is "history," as in my clinical history (attached).

My medical team - radiologist and oncologist (I'm beyond a urologist) generally believe that we are managing my PCa as a chronic disease with specific criteria about when to go on treatment, with what, for how long, when to come off treatment. We have never discussed treatment in terms of a cure once it became advanced.

It's worked for my PCa, one that is high risk - GS 8, GG4, time to BCR, PSADT and PSAV. I am fortunate, no resistance yet, no involvement of bones or organs. The day may come when that changes.

I do have friends who were diagnosed around the same time as I was, had surgery by the same urologist as I did and 11 years later, they see their urologist once a year for a PSA test and go on their merry way. I also have a friend who is terminal with his PCa.

My take is there is a possibility of cure with De Novo diagnosis, once it is advanced, we can control it as I and my medical team have done for10-1/2 years, but a cure, not there yet.

Medical research since 2014 has changed greatly (for the better) the imaging and treatment landscape for PCa, particularly advanced both castrate sensitive and castrate resistant. Sadly, for the 30k or so who die each year because of PCa, it has not changed enough.

Kevin

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Some doctors are more reserved than others. Also we might know more now than 10 years ago, have better scans, treatments, experience etc to back up.
Dont mind me. I am just another layman trying make some sense of the whole thing.

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crperle | @crperle | 6 days ago

I am oligo, with one spot that showed on a PSMA 16 months post RALP. PSA 0.2.

Mayo rad onc said it is possible that oligo can be "cured" or at least that it isn't known to be incurable like polymetastatic bone cancer.

So, that's what I'm aiming for. The word "remission" did not come up.

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northoftheborder | @northoftheborder | 5 days ago
In reply to @crperle "I am oligo, with one spot that showed on a PSMA 16 months post RALP. PSA..." + (show)
@crperle

I am oligo, with one spot that showed on a PSMA 16 months post RALP. PSA 0.2.

Mayo rad onc said it is possible that oligo can be "cured" or at least that it isn't known to be incurable like polymetastatic bone cancer.

So, that's what I'm aiming for. The word "remission" did not come up.

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That's what I'm hoping for, too.

While it might be possible that oligometastatic prostate cancer can be cured sometimes, the medical field has no way to test that yet (they can't detect individual dormant cancer cells hiding in the bone marrow, waiting to wake up some day). That's probably why while some oncologists say that it might be curable, they're reluctant to pronounce that it's actually be "cured", and talk about patients with 10+ years "remission" instead.

I'd love it if there were a way to see if there's still any cancer in me. We attacked it *very* aggressively at the start: debulking surgery to the spine, post-surgery radiation to the metastasis site, a huge "curative" dose of radiation to the prostate itself, and almost 3½ years on ADT and Apalutamide. So it's theoretically possible that I'm cancer-free, but the risk right now is that if I stop my hormone treatment, some dormant cancer cells could wake up and start to divide, and even worse, evolve castrate resistance to that they don't respond to the hormone treatments any more.

I dream that in 5 years or so I'll be in an appointment and my oncologist will say "There's a new test you can try ..." But until then (or until my PSA becomes detectable again), it's basically a case of Schrodinger's Cancer.

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crperle | @crperle | 2 days ago

Schrödinger's cancer is a turn of phrase for sure. I start ADT as soon as the paperwork is dry and my PSA just nudged down...(probably due to LabCorp rounding up the last one, but still)...

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kam23 | @kam23 | 1 day ago

I was PC stage 4 and am 2 years clear…and 11 months post Lupron. I had to discontinue Lupron due to muscle deterioration. Stopped at my request. We will have to see anything comes back. My Gleeson score was 10. I wish I could comment more on cure versus remission.

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rick137 | @rick137 | 1 day ago

My med onc told me remission means PSA< 0.1 ng/mL. I suspect that criterion was before PSMA PET/CT scans. My own criteria are PSA< 0.1 ng/mL and a clear PSMA PET/CT scan. The med onc defined cured as again having a PSA< 0.1 ng/mL after stopping hormone therapy. More accurately I would say "cured" as long as PSA< 0.1ng/mL.

What if your course of treatment was initial 1st and 2nd generation hormone therapy combined with radiation therapy. Your prostate is still there after end of therapy. One cell went rogue in the past. What is probability another cell won't do the same in the future?

All a matter of probability. Think of a graph with Probability of PSA< 0.1 ng/ml on the y axis and time after end of therapy on the x. Curve starts Probability = 1.00 at time equals = 0. How long does it remain 1.00? How fast does the Probability fall?

My treatment as gone well so med onc said that being 84 I would not die from prostate cancer. The expected lifetime from the SSA actual tables for a male 84 is 6.22 years. So statistically I only have to be "cured" for that length of time. And the rest don't count.

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northoftheborder | @northoftheborder | 1 day ago
In reply to @kam23 "I was PC stage 4 and am 2 years clear…and 11 months post Lupron. I had..." + (show)
@kam23

I was PC stage 4 and am 2 years clear…and 11 months post Lupron. I had to discontinue Lupron due to muscle deterioration. Stopped at my request. We will have to see anything comes back. My Gleeson score was 10. I wish I could comment more on cure versus remission.

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Thanks for sharing that! I'm sorry that you had to stop ADT, but I'm very happy to hear that you're still in remission 11 months later. That sounds promising.

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kam23 | @kam23 | 21 hours ago

I should state that I had ADT, Docetaxel chemotherapy and radiation therapy. Chemotherapy was not offered by my university oncologist, so my wife found a doctor at Mayo Rochester….Dr.Kwon that did incorporate it into my plan. The chemo was administered by Minnesota Oncology.
Thanks.Best of luck.

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