The Age Old Question, what do you mean when you say ...cured!?

Posted by kujhawk1978 @kujhawk1978, 4 days ago

Thought this was interesting.

I see a lot of posts about whether or not a treatment will "cure" one's PCa.

There is generally no issue when truly confined to the prostate and surgery as to a "cure." I have two friends who now 12 years later see their urologist once a year and go on their merry way.

The debate comes in when PCa is outside the prostate, particularly in the Oligometastatic disease (OMD) state.

With newer agents, combination therapies, can we cure or manage advanced PCa? I'm in the latter camp.

Many clinical trials seem to use progression free, radiographic free survival vice overall survival since they are easier (time and money) to measure.

I am 11+ years into my journey. I think I am here because of the advances in managing advanced PCa though if a curative treatment were in the realm of the possibility, I'm in!

Meanwhile, as many on this forum know, I suck it up, do the treatment for defined periods, enjoy my time off treatment and have lived a lot in these 11+ years, a far cry from that infamous day, 23 January 2014 when my urologist called me about the results of my biopsy...you have PCa and it's pretty aggressive, ouch!
https://journals.lww.com/oncology-times/fulltext/2025/06000/finding_a_single_definition_for__cure_.8.aspx

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

Good topic.

I once heard an interview with a cancer researcher who had been invited by the Vatican to serve as devil's advocate during a beatification process. People who prayed to the candidate saint claim to have been cured of cancer, but the researcher pointed out that as long as they were still alive, it was impossible to say that the cancer wouldn't recur, so strictly speaking, they weren't "cured."

In the end, the Vatican compromised by referring to them as "miraculously-prolonged remissions," and created a new saint.

"Prolonged remission" is the best any of us gets with cancer, at least until they find a way to test for individual dormant cancer cells. They'll use the word "cured" looselt if there's a statistically small chance of recurrence for people in your situation, and they can treat you with "curative intent" (vs "palliative intent"), but there's no test that can actually verify you're cured of cancer, the way a blood test might for other diseases.

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Hi Kevin, I am intrigued by your comment where you write “have lived a lot in these 11+ years, a far cry from that infamous day”.
Personally, I was diagnosed in March and my mental health is not good. How long did it take you to be in a better mental state after being diagnosed? I realize there will probably not be a day that goes by for the rest of my life when I dont think about prostate cancer, but there has to be room for improvement. Thanks!! 🙂

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My RO said that the word "cured" is basically a misnomer. You are cured for that day.

It has been 2+ years for me but I find that every 3 months, I get a little stressed out waiting for my PSA results but other than that, Prostate cancer is not on my mind. I will do a 30 second elevator pitch, at times, to people I meet on the golf course, about the importance of testing. I also consider myself in a far better position medically, than many others including others on Mayo connect and of some family and friends.

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@bens1

My RO said that the word "cured" is basically a misnomer. You are cured for that day.

It has been 2+ years for me but I find that every 3 months, I get a little stressed out waiting for my PSA results but other than that, Prostate cancer is not on my mind. I will do a 30 second elevator pitch, at times, to people I meet on the golf course, about the importance of testing. I also consider myself in a far better position medically, than many others including others on Mayo connect and of some family and friends.

Jump to this post

Well put. Once you've had any significant cancer, "cured" just means your remission lasts long enough for you to die of something else first. 🤷

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@johndavis60

Hi Kevin, I am intrigued by your comment where you write “have lived a lot in these 11+ years, a far cry from that infamous day”.
Personally, I was diagnosed in March and my mental health is not good. How long did it take you to be in a better mental state after being diagnosed? I realize there will probably not be a day that goes by for the rest of my life when I dont think about prostate cancer, but there has to be room for improvement. Thanks!! 🙂

Jump to this post

That's a good question...

At the time, the call from my urologist floored me, literally. I was 57, both daughters in high school. When we met for a consult about treatment, he didn't help when as we walked to the scheduling desk for surgery, he said "Kevin, that's a pretty aggressive cancer,,!" To the nurse, he said "this is Kevin, he's NDC..." I learned that was "newly diagnosed cancer!"

I began to settle down, albeit still unsettled after the PET/CT came back negative for any activity outside the prostate, I met with the surgeon who explained he would endeavor to spare the nerves. I said if you have to take them because you find cancer there, just do it, life was my priority.

After the surgery, when reviewing the pathology report and his notes, my surgeon said in not so many words, I was cured, though he did not use the word. I'm thinking T2CNoMX, looking at the Mx and thinking "they don't know if it's spread outside the prostate...!

Now comes the labs and consults every three months and the "prostate specific anxiety test! For the first five, no issues, < .1. The 6th, he looks at his screen, hesitates, then turns and leads with "this doesn't mean your PCa is back, it's .2. So now, we're back to 23 Jan 2014 and the phone call, floors me!

Now I begin to inform myself, reading literature (aka, research). I learn about SRT, discover the nomograms at MSKCC, discover that data from Mayo and clinical trials indicate with my clinical data, often BCR has spread to the PLNs and a treatment decision should consider including the PLNs and short-term systemic therapy.

I am beginning to feel that I am in charge, I am attacking my PCa, going for the gold ring (from my childhood, the merry go round where a gold ring meant a free ride), the cure. My medical team dashes that, dismissing the idea, saying there is not long-term data to support it. I acquiesce. I do the SRT to the prostate bed, 90 days after, my radiologist hesitates, I know that hesitation , then turns and says "Kevin, the SRT did not work, your PSA has more than doubled, it's .7!"

That is my "aha" moment. Never again, I will decide my treatment in concert with my medical team, the shared decision making model, their expertise, training, education, experience count in my decision making but I make the best decision and they support it.

Still, it was not easy going in and getting the Lupron shot, it was not easy going into the infusion center, for whatever reason, going in for radiation treatments never bothered me. I hesitated when taking the loading dose of Orgovyx...

Not sure I'm answering your question so let me see if I can wrap this up...

I have given one reason, the transition to shared decision making where I make the decision.
Another may be attitude, I have always been a glass half full person, looking on the bright side.
Another may be my experience over 22 years in the Army where the focus is on accomplishing the mission,., gathering facts, determining course of actions, choosing the "best" one and having alternative plans in case that doesn't work.
I have "mitigated" the side effects through diet, exercise and managing stress.
There are statistics about 5 and 10 year survival.
The older I get the more I understand there are less days in front of me than behind me, so get on with life.

I think you do get to a point the longer you are on this journey where you just deal with it. I can tell you that by and large, I don't think about my PCa in a fretting sort of way. I ski every year with friends, my wife and I have taken vacations, Ring Road in Iceland, Big 5 in Utah, New England coast, Oregon Coast, Colorado in the Fall, Sedona...today I am playing pickleball with a group of dads from our kids days, this weekend I rode the Garmin Unbound 50, a gravel bike ride in the Flint Hills of Kansas near Emporia with my sister and daughter's boyfriend. I've attended concerts to watch Chicago, Billy Joel, the Eagles, enjoyed the recent successes of some of my favorite sports teams, the Royals, Chiefs and Jayhawks, watched my daughters graduate from high school, college and become grown adults...

Ok, you get the idea, you too likely have a lot of living to do, as the Nike slogan says, "just do it!"

Kevin

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Thanks for sharing your journey Kevin. Your grit and determination to live life on your terms is commendable.

The Flint Hills are a most amazing place - largest tall grass prairie left in the world. And go Chiefs and Jayhawks!

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@johndavis60

Hi Kevin, I am intrigued by your comment where you write “have lived a lot in these 11+ years, a far cry from that infamous day”.
Personally, I was diagnosed in March and my mental health is not good. How long did it take you to be in a better mental state after being diagnosed? I realize there will probably not be a day that goes by for the rest of my life when I dont think about prostate cancer, but there has to be room for improvement. Thanks!! 🙂

Jump to this post

I was diagnosed in May of 2022, age 60. Surgery August of 2022. Naturally, I was concerned and confused. After the surgery I had a year of PSA tests every 3 months. Then a year of tests every 6 months. I asked for them every 4 months which the doctor agreed to. After 2 years I was given the ok for annual PSA testing but I opted for every 6 months. No BCR to date. PCa is in the back of my mind, but I am not focused on it like I was before treatment. After you receive your treatment I think you will think a lot less about it. What helps me is to try to control things that are in my control. Weight, exercise, and diet choices. I stopped all processed meats, no more snacking on cheese. Subbed nuts and fruit for that. But I still put cheese on pasta and such. You'll get through this just fine. Honestly, I feel healthy and not much different than before surgery.

REPLY
@kujhawk1978

That's a good question...

At the time, the call from my urologist floored me, literally. I was 57, both daughters in high school. When we met for a consult about treatment, he didn't help when as we walked to the scheduling desk for surgery, he said "Kevin, that's a pretty aggressive cancer,,!" To the nurse, he said "this is Kevin, he's NDC..." I learned that was "newly diagnosed cancer!"

I began to settle down, albeit still unsettled after the PET/CT came back negative for any activity outside the prostate, I met with the surgeon who explained he would endeavor to spare the nerves. I said if you have to take them because you find cancer there, just do it, life was my priority.

After the surgery, when reviewing the pathology report and his notes, my surgeon said in not so many words, I was cured, though he did not use the word. I'm thinking T2CNoMX, looking at the Mx and thinking "they don't know if it's spread outside the prostate...!

Now comes the labs and consults every three months and the "prostate specific anxiety test! For the first five, no issues, < .1. The 6th, he looks at his screen, hesitates, then turns and leads with "this doesn't mean your PCa is back, it's .2. So now, we're back to 23 Jan 2014 and the phone call, floors me!

Now I begin to inform myself, reading literature (aka, research). I learn about SRT, discover the nomograms at MSKCC, discover that data from Mayo and clinical trials indicate with my clinical data, often BCR has spread to the PLNs and a treatment decision should consider including the PLNs and short-term systemic therapy.

I am beginning to feel that I am in charge, I am attacking my PCa, going for the gold ring (from my childhood, the merry go round where a gold ring meant a free ride), the cure. My medical team dashes that, dismissing the idea, saying there is not long-term data to support it. I acquiesce. I do the SRT to the prostate bed, 90 days after, my radiologist hesitates, I know that hesitation , then turns and says "Kevin, the SRT did not work, your PSA has more than doubled, it's .7!"

That is my "aha" moment. Never again, I will decide my treatment in concert with my medical team, the shared decision making model, their expertise, training, education, experience count in my decision making but I make the best decision and they support it.

Still, it was not easy going in and getting the Lupron shot, it was not easy going into the infusion center, for whatever reason, going in for radiation treatments never bothered me. I hesitated when taking the loading dose of Orgovyx...

Not sure I'm answering your question so let me see if I can wrap this up...

I have given one reason, the transition to shared decision making where I make the decision.
Another may be attitude, I have always been a glass half full person, looking on the bright side.
Another may be my experience over 22 years in the Army where the focus is on accomplishing the mission,., gathering facts, determining course of actions, choosing the "best" one and having alternative plans in case that doesn't work.
I have "mitigated" the side effects through diet, exercise and managing stress.
There are statistics about 5 and 10 year survival.
The older I get the more I understand there are less days in front of me than behind me, so get on with life.

I think you do get to a point the longer you are on this journey where you just deal with it. I can tell you that by and large, I don't think about my PCa in a fretting sort of way. I ski every year with friends, my wife and I have taken vacations, Ring Road in Iceland, Big 5 in Utah, New England coast, Oregon Coast, Colorado in the Fall, Sedona...today I am playing pickleball with a group of dads from our kids days, this weekend I rode the Garmin Unbound 50, a gravel bike ride in the Flint Hills of Kansas near Emporia with my sister and daughter's boyfriend. I've attended concerts to watch Chicago, Billy Joel, the Eagles, enjoyed the recent successes of some of my favorite sports teams, the Royals, Chiefs and Jayhawks, watched my daughters graduate from high school, college and become grown adults...

Ok, you get the idea, you too likely have a lot of living to do, as the Nike slogan says, "just do it!"

Kevin

Jump to this post

Thanks Kevin, this is very helpful! I just feel sort of overwhelmed by all that has happened in the few months. Just had robot assisted prostatectomy and recovering after 2 weeks and it looks like I will be undergoing adjuvant radiation later this year. I am thinking they will have me on ADT drugs which I am more afraid of than radiation. It’s like a crazy rollercoaster of emotions.
Thanks again!

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...a speaker on a PCRI.org You Tube video made a good point. if there is a rise in the PSA sometime a PSMA PET CT scan will be performed. One pelvic lymph node is the usual culprit maybe two. However both are amenable to spot radiation. Then its back to square one in the safe zone. Even JRB's one bony lesion is amenable to spot radiotherapy with medical treatment thereafter. His 30-40% five year prostate cancer survival (PCS) mentioned by one pundit appears to be overly pessimistic. The worst possible scenario for you is pretty sanguine.

REPLY
@kujhawk1978

That's a good question...

At the time, the call from my urologist floored me, literally. I was 57, both daughters in high school. When we met for a consult about treatment, he didn't help when as we walked to the scheduling desk for surgery, he said "Kevin, that's a pretty aggressive cancer,,!" To the nurse, he said "this is Kevin, he's NDC..." I learned that was "newly diagnosed cancer!"

I began to settle down, albeit still unsettled after the PET/CT came back negative for any activity outside the prostate, I met with the surgeon who explained he would endeavor to spare the nerves. I said if you have to take them because you find cancer there, just do it, life was my priority.

After the surgery, when reviewing the pathology report and his notes, my surgeon said in not so many words, I was cured, though he did not use the word. I'm thinking T2CNoMX, looking at the Mx and thinking "they don't know if it's spread outside the prostate...!

Now comes the labs and consults every three months and the "prostate specific anxiety test! For the first five, no issues, < .1. The 6th, he looks at his screen, hesitates, then turns and leads with "this doesn't mean your PCa is back, it's .2. So now, we're back to 23 Jan 2014 and the phone call, floors me!

Now I begin to inform myself, reading literature (aka, research). I learn about SRT, discover the nomograms at MSKCC, discover that data from Mayo and clinical trials indicate with my clinical data, often BCR has spread to the PLNs and a treatment decision should consider including the PLNs and short-term systemic therapy.

I am beginning to feel that I am in charge, I am attacking my PCa, going for the gold ring (from my childhood, the merry go round where a gold ring meant a free ride), the cure. My medical team dashes that, dismissing the idea, saying there is not long-term data to support it. I acquiesce. I do the SRT to the prostate bed, 90 days after, my radiologist hesitates, I know that hesitation , then turns and says "Kevin, the SRT did not work, your PSA has more than doubled, it's .7!"

That is my "aha" moment. Never again, I will decide my treatment in concert with my medical team, the shared decision making model, their expertise, training, education, experience count in my decision making but I make the best decision and they support it.

Still, it was not easy going in and getting the Lupron shot, it was not easy going into the infusion center, for whatever reason, going in for radiation treatments never bothered me. I hesitated when taking the loading dose of Orgovyx...

Not sure I'm answering your question so let me see if I can wrap this up...

I have given one reason, the transition to shared decision making where I make the decision.
Another may be attitude, I have always been a glass half full person, looking on the bright side.
Another may be my experience over 22 years in the Army where the focus is on accomplishing the mission,., gathering facts, determining course of actions, choosing the "best" one and having alternative plans in case that doesn't work.
I have "mitigated" the side effects through diet, exercise and managing stress.
There are statistics about 5 and 10 year survival.
The older I get the more I understand there are less days in front of me than behind me, so get on with life.

I think you do get to a point the longer you are on this journey where you just deal with it. I can tell you that by and large, I don't think about my PCa in a fretting sort of way. I ski every year with friends, my wife and I have taken vacations, Ring Road in Iceland, Big 5 in Utah, New England coast, Oregon Coast, Colorado in the Fall, Sedona...today I am playing pickleball with a group of dads from our kids days, this weekend I rode the Garmin Unbound 50, a gravel bike ride in the Flint Hills of Kansas near Emporia with my sister and daughter's boyfriend. I've attended concerts to watch Chicago, Billy Joel, the Eagles, enjoyed the recent successes of some of my favorite sports teams, the Royals, Chiefs and Jayhawks, watched my daughters graduate from high school, college and become grown adults...

Ok, you get the idea, you too likely have a lot of living to do, as the Nike slogan says, "just do it!"

Kevin

Jump to this post

❝ There are statistics about 5 and 10 year survival.
❝ The older I get the more I understand there are less days in front of me than behind me, so get on with life.

All very true and wise. I'll just add that 5- and 10-year survival stats are trailing indicators (significantly so). When you see a 5- or 10-year survival stat, what it usually means is "If you'd been first diagnosed in 2005 or 2010, your odds of surviving 5 and 10 years would have been X." It takes that long to get from initial selection of participants to study execution to study results to the secondary lit reviews and research papers most specialists cite, even if their papers have very recent dates.

Does that mean our odds are always going to be improving? Of course not. But over all, cancer treatments have changed so much over the past 5–10 years that you need to take most existing survival stats with a whole shaker full of salt. In 10 years or so, we'll know what our survival odds were (and I wouldn't bet against our being there to see them).

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