"Remission" for oligometastatic prostate cancer

I personally don’t believe that you are “cured” from prostate cancer. I DO believe that cancer goes into “remission “ , as was the case for me for 7 years. Then it started all over again. 😞

I agree with firespooks. Cure and remission seem to be used too easily sometimes. My take is that I will be monitoring my psa number in my blood test for the rest of my life with no guarantees just like I monitor other blood test results. Blood tests, imaging and radiation technology are improving rapidly. Whatever treatment you end up taking, regardless of the term used to describe it, there is something better to help you if you get a biological re-occurrence later on.

Thank you both, and fully agree. I know that I'll be monitoring my bloodwork every 3 months (I'm in the Ironman study) and taking a fistful of meds for the rest of my life — at stage 4, I'm happy just to be here and not needing chemo (yet).

I was just curious about how many others with oligometastatic PCa have heard the word "remission" from their onco teams, even if you take it with a large grain of salt.

There is indeed a lot of confusion over this. At one time, cure means you have RP and the cancer is never recurs. Except that is not true. That is why you have recurrence treatment. All other treatment, including hormone is supposed be remission only because sooner or later the disease mutates. Except when it doesnt.
One common fallacy in comparing with other disease mutation is that each subsequent generation gets weaker until it becomes harmless. Influenza for example. Covid 19 is more recent.
The more scientific or cautious statement I have heard is that when you PSA < 0.1 it can be scientifically determined that 99% of the malignant cell is dead. May be more, but that cannot be scientifically determined at this time. However, if there is any, the volume is so small, and the cells are so idle that it would not do any harm for many years. So for all intents and purpose, some doctors will call that a cure.

Dont mind me. I am just another layman trying to make some sense of the whole thing.

Thank you. My PSA is currently undetectable, but I don't know if it would flare up again if I stopped the Firmagon and Erleada (and have no intention of experimenting to find out).

The best advise is your medical team.

For the longest time it seems the generally held belief in the medical community was that de novo cancer, could be cured. Surgery was viewed as curative if imaging did not show spread outside the prostate.

Such was the case in 21014 when I was diagnosed, CT and MRI showed no spread outside the prostate, pathology report was excellent, surgeon told me in our first consult after surgery that given his surgery it's and my pathology report, I would not have any future problems...

Meanwhile I'm look at the T2CNoMx and thinking "I don't like that Mx" as it means they cannot say with any degree of assurance!"

15 months later after nothing but undetectable PSA, < .1, that same surgeon hesitates before he turns to face me after looking at his computer screen and seeing my PSA.

In January 17 we did triple therapy treatment, no cure but 4-1/2 years off treatment.

In April this year when it came back my oncologist initially talked about SBRT combined with 24 months of Orgovyx and Xtandi as being potentially curative.

I looked him in the eye and said, " given my clinical history, do you really think so, if you are, I'm on board with your recommendation!"

I said given my clinical history, three failed and elusive attempts at the gold ring, a cure, I see this as a chronic disease we actively treat as needed over time until as my radiologist says, you die of something else...!"

He looked at me and said, yeah, let's do a treatment that balances quality and quantity of life based on your clinical data and disease history."

So, SBRT, 6-12 months of Orgovyx, stop if PSA stays undetectable, then actively monitor with labs and consult every three months.

I do have friends who 10+ years after their surgeries are "cancer free" and see their urologist once a year for labs and consult.

Their cancer is not mine, particularly their Gleason Scores.

So is PCa curable, yes and no. I'm in the camp that says advanced PCa is not, but it is manageable and with the exception of the 27k or so who die each year of it, may be managed as a chronic disease, treated as necessary. I would liken it to AIDS, once a guaranteed death sentence, today, not so much.

So, follow the clinical data, if it's aggressive, GS, PSADT, time to BCR.....treat aggressively but maybe not continuously?

Kevin

I agree the term “cured” is used too often with PC. I had a RP in 2017 and told I was likely cured. Three months later my PSA started up. I had 18 months of ADT and 36 treatments of SBRT. PSA was undetectable for 7 months after treatment ended. After PSMA PET scan, I had two more tumors treated with radiation and my PSA remained stable for 18 months. It is now going up fairly rapidly so I will likely begin ADT again soon.

I've heard there's some research in the pipeline for detecting dormant cancer cells (which don't show up in any current screening). Perhaps I'll be around long enough to see that roll out, so that they can test my spine and say "yes, you still have dormant prostate-cancer cells there" or "no, you don't, so you can stop ADT." But as of today, that's just dreaming.

Those days is what they call in the medical profession, if all you have is a hammer, everything is a nail syndrome. Now we have what some doctors like Dr. Scholz calls revolution. PSMA PET can find cancer cells down to 2 mm with 90% confidence. You can treat it earlier and for have better results. Like one of our members here says it would be wonderful if they can detect even smaller tumors than 2 mm. May be 1 mm, or less than 1mm even? Who is to say the scientists are not working on that already?

Dont mind me. I am just another layman trying to make some sense of the whole thing.